1 DOES THE UNITED STATES NEED MORE MIDWIIVES? Does the United States need more Midwives? Madison Courtney Georgetown College Author Note This paper was prepared for English 125, taught by Professor Burch Abstract Does the United States need more midwives? This is the question this paper will explore by looking at the fact that the US has a very high newborn mortality rate and that we use more OB-GYNs for deliveries than any other country. I find that there is a correlation between OB-GYNs and the high infant mortality rate due to the fact that OB-GYNs are surgeons and they use surgery (cesarean sections) that is a lot more risky than a vaginal birth. Midwives only use surgery when necessary and their less risky tactics lead to lower newborn death rates or labor complications. Therefore, I concluded that the United States does need more midwives. Does the United States need more Midwives? The United States newborn death rate is the second highest in the world, this is a fact that many people are unaware of today. With the amount of money the US spends on healthcare, we should not have a rate this high. Because OB-GYNs are used more in the US than any other country, you have to wonder if there was a correlation between the two. After research, I have found a correlation between OB-GYNs and newborn death rate because of labor interventions that lead to cesarean sections. Midwives don’t have the same outcome as OB-GYNs. Midwives aren’t as quick to use interventions and their cesarean section rate is a lot lower than OB-GYNs leading to lower risk labors and therefore a lower newborn death rate. Therefore, the US needs more midwives. Literature Review In a documentary by Lake it is said that among 33 industrialized nations, the United States is tied with Hungary, Malta, Poland and Slovakia with a death rate of nearly 5 per 1,000 babies, according to a report from Save the Children (April 2006). This is the second worst newborn death rate in the developed world. The five countries with the lowest infant mortality rates (Japan, Singapore, Sweden, Finland and Norway) midwives were used as their main source of care for 70 percent of the birthing mothers (2008). Cesarean sections have many more risks than vaginal births. C-sections are more likely to occur because of the interventions during labor. Pitocin is a common intervention that puts the baby in stress during labor, which leads to a cesarean section. OB-GYNs are a lot more likely to use these interventions than midwives. Lewis Mehl-Madrona, MD, PhD, coordinator of Integrative Psychiatry and Systems Medicine at the University of Arizona College of Medicine Program in Integrative Medicine, comparing 1,046 home births to 1,046 hospital births found negative outcomes consistently higher in hospital births. These included a fetal distress rate six times higher in hospitals, a respiratory distress rate 17 times higher in hospitals, babies requiring resuscitatio.

1. 1
DOES THE UNITED STATES NEED MORE MIDWIIVES?
Does the United States need more Midwives?
Madison Courtney
Georgetown College
Author Note
This paper was prepared for English 125, taught by Professor

2. Burch
Abstract
Does the United States need more midwives? This is the
question this paper will explore by looking at the fact that the
US has a very high newborn mortality rate and that we use more
OB-GYNs for deliveries than any other country. I find that there
is a correlation between OB-GYNs and the high infant mortality
rate due to the fact that OB-GYNs are surgeons and they use
surgery (cesarean sections) that is a lot more risky than a
vaginal birth. Midwives only use surgery when necessary and
their less risky tactics lead to lower newborn death rates or
labor complications. Therefore, I concluded that the United
States does need more midwives.
Does the United States need more Midwives?
The United States newborn death rate is the second highest
in the world, this is a fact that many people are unaware of
today. With the amount of money the US spends on healthcare,
we should not have a rate this high. Because OB-GYNs are used
more in the US than any other country, you have to wonder if
there was a correlation between the two. After research, I have
found a correlation between OB-GYNs and newborn death rate
because of labor interventions that lead to cesarean sections.

3. Midwives don’t have the same outcome as OB-GYNs. Midwives
aren’t as quick to use interventions and their cesarean section
rate is a lot lower than OB-GYNs leading to lower risk labors
and therefore a lower newborn death rate. Therefore, the US
needs more midwives.
Literature Review
In a documentary by Lake it is said that among 33
industrialized nations, the United States is tied with Hungary,
Malta, Poland and Slovakia with a death rate of nearly 5 per
1,000 babies, according to a report from Save the Children
(April 2006). This is the second worst newborn death rate in the
developed world. The five countries with the lowest infant
mortality rates (Japan, Singapore, Sweden, Finland and Norway)
midwives were used as their main source of care for 70 percent
of the birthing mothers (2008).
Cesarean sections have many more risks than vaginal births. C-
sections are more likely to occur because of the interventions
during labor. Pitocin is a common intervention that puts the
baby in stress during labor, which leads to a cesarean section.
OB-GYNs are a lot more likely to use these interventions than
midwives. Lewis Mehl-Madrona, MD, PhD, coordinator of
Integrative Psychiatry and Systems Medicine at the University
of Arizona College of Medicine Program in Integrative
Medicine, comparing 1,046 home births to 1,046 hospital births
found negative outcomes consistently higher in hospital births.
These included a fetal distress rate six times higher in hospitals,
a respiratory distress rate 17 times higher in hospitals, babies
requiring resuscitation 3.7 times higher in hospitals, maternal
postpartum hemorrhage three times higher in hospitals and 30
birth injuries in the hospital compared with none occurring
during the homebirths (2008).
In America, midwives attend less than 8% of all births and less
than 1% of those occur outside a hospital. “In 1900, 95% of all
births took place in the home. In 1938, half the births took place
at home, and in 1955, 1% of births took place at home (Lake,
2008).”

4. In the 30s doctors routinely took x-rays of the pelvis, resulting
in babies with cancer. In the 70s, use of the drug thalidomide,
used for morning sickness, caused birth defects, while in the
90s, the drug Cytec was used to stimulate contractions in
mothers who had undergone previous Cesarean section. This
was later found to cause ruptured uteruses and high infant
mortality (Lake, 2008).
“Hospitals were offered as this gleaming, wonderful place
where you could go and have a baby that would be cleaner and
safer. The reality of course was that giving birth with an
obstetrician at that time was much more dangerous than giving
birth with a midwife because as doctors were graduating from
medical school, many had not witnessed a live birth before they
went out to practice (Lake, 2008).”
They were actually given the drug scopolamine in the 40s, 50s
and 60s that put mothers into a kind of “twilight sleep” that
didn’t stop pain, but merely eliminated the memory of pain by
attacking the brain functions responsible for self-awareness and
self-control, resulting in a kind of psychosis, followed by post-
traumatic stress-like memories in thousands of new mothers
They were strapped to the bed using sheep’s’ wool so it
wouldn’t leave marks (Lake, 2008).
Labor is a business. If a midwife is getting a lot of births at a
hospital they will be fired because they don’t bring in as much
money. Midwives are also less accepted people are uneducated
about what a midwife does. Midwives are normally very well
educated in the birthing process. Midwives are far better trained
to do natural and vaginal deliveries than an OB-GYN. upon
leaving medical school; most OB-GYNs have never witnessed a
live birth. OB-GYNs are trained to do surgery rather than just
letting a woman’s body deliver the child on its own, so they are
only really necessary for high-risk patients. However, as
medical anthropologist Robbie Davis-Floyd points out, the
medical- industrial complex – the relationship between
hospitals, the powerful lobby group the American Medical
Association, and the insurance companies – has a history of

5. discouraging home births, and discouraging midwives who
practice in a hospital setting (Lake, 2008).
Once men were involved in the labor process, rather than
trusting their bodies to deliver a child, they relied on medical
processes. “Childbirth, until modern times, was a natural event
in the life cycle and treated as such. Over time, men became
involved inadvertently when they were called upon to assist in
extremely complicated childbirths. The shaman, priest,
physician, or barber-surgeon of the middle ages came to the aid
of the distressed midwife. He had tools to extract the baby,
perhaps in pieces (Brodsky, 2006).”
“Modernism overtly and covertly conveys an illusion of right
answers, of one way to give birth. Truth be told there id no
right way to give birth. As childbirth educators we must
continue to encourage expectant parents to ask questions, to
investigate the literature, and to recognize the politics behind
decisions that are made (Savage, 2002).” Gould Suggests that
doctors do not cause cesarean sections but by patients making
the decision because they believe it is safer. While there is no
evidence that supports the fact the cesarean sections are safer,
popular culture makes them seem easy and attractive. There is
even such thing as ‘designer births’ where a woman will get a
C-section and then a tummy tuck immediately after.
Discussion
There is an apparent problem in the United States when it comes
to labor. We would like to think the large amounts of money
that we are spending on healthcare makes our healthcare is
superior, however because of our surprisingly high newborn
death rate it is apparent that we are not superior. The rate of
newborn death is higher because of high rates of cesarean
sections and labor interventions. Labor interventions such as a
labor-inducing drug called Pitocin, put the baby in distress,
once the baby is in distress they need to perform a cesarean
section in order to save the baby. Cesarean sections are major
surgery, recovery time is a lot longer for the mother and the
child may be at risk.

6. These interventions are very common when it comes to OB-
GYNs in order to speed up the labor process. In hospitals,
where OB-GYNs are the primary care source, the fetal distress
rate was six times higher in comparison to home births, a
respiratory distress rate 17 times higher, babies requiring
resuscitation 3.7 times higher, maternal postpartum hemorrhage
(bleeding from ruptured blood vessel) three times higher and 30
birth injuries in the hospital compared with none occurring
during the homebirths (Mehl-Madrona, 2008). While this data
compares home births and hospital births rather than OB-GYNs
and midwives, it is safe to assume that the home births were
midwife assisted and the hospital births OB-GYN assisted.
Because in America, midwives attend less than 8% of all births
and less than 1% of those occur outside a hospital (Lake, 2008).
Even in hospitals, midwives rates of complications continue to
be significantly lower than OB-GYNs simply because they are
less likely to use interventions.
Drugs are not carefully tested when used on pregnant
women or during labor. In the 30s doctors routinely took x-rays
of the pelvis, resulting in babies with cancer. In the 70s, use of
the drug thalidomide, used for morning sickness, caused birth
defects, while in the 90s, the drug Cytec was used to stimulate
contractions in mothers who had undergone previous Cesarean
section. This was later found to cause ruptured uteruses and
high infant mortality (Lake, 2008). These methods and drugs
seemed safe at the time and they were only questioned after
they caused problems. If these issues were older it would be
easier to overlook, arguing that today we are more cautious. But
there was something used under 20 years ago that was killing
mothers and newborns. It seems much safer to go the natural
route. (I’m pretty sure there was something they used recently
that they thought was causing issues, need more research)
It is very obvious which route of birth is safer, so why do we
continue to favor more medical/surgical processes. The reason
we have this mindset was because during the feminist movement
during the 30s women had the understanding that the reason

7. women have labor pains was because of Eve’s sins, they
believed it made them stronger women by not having the pains.
“Hospitals were offered as this gleaming, wonderful place
where you could go and have a baby that would be cleaner and
safer (Lake, 2008).” They were actually given the drug
scopolamine in the 40s, 50s and 60s that put mothers into a kind
of “twilight sleep” that didn’t stop pain, but merely eliminated
the memory of pain by attacking the brain functions responsible
for self-awareness and self-control, resulting in a kind of
psychosis, followed by post-traumatic stress-like memories in
thousands of new mothers They were strapped to the bed using
sheep’s’ wool so it wouldn’t leave marks (Lake, 2008).
Therefore, the mindset the US has is not a very solid one and it
should be changed for the safer route, rather than the more
popular one.
After this movement, once men were involved in the labor
process, rather than trusting their bodies to deliver a child, they
relied on medical processes. “Childbirth, until modern times,
was a natural event in the life cycle and treated as such. Over
time, men became involved inadvertently when they were called
upon to assist in extremely complicated childbirths. The
shaman, priest, physician, or barber-surgeon of the middle ages
came to the aid of the distressed midwife. He had tools to
extract the baby, perhaps in pieces (Brodsky, 2006).” Women
began to trust their bodies less and less and relied on doctors do
unnatural exhibit a natural process. This made labor unsafe.
The reason that this mindset continues to exist is because labor
is a business. If a midwife is getting a lot of births at a hospital
they will be fired because they don’t bring in as much money.
Even though midwives are far better trained to do natural and
vaginal deliveries than an OB-GYN. upon leaving medical
school; most OB-GYNs have never witnessed a live birth. OB-
GYNs are trained to do surgery rather than just letting a
woman’s body deliver the child on its own, so they are only
really necessary for high-risk patients. However, as medical
anthropologist Robbie Davis-Floyd points out, the medical-

8. industrial complex – the relationship between hospitals, the
powerful lobby group the American Medical Association, and
the insurance companies – has a history of discouraging home
births, and discouraging midwives who practice in a hospital
setting (2008).
There is also a lack of education. There is a rebirth of women
who are interested in improving labor conditions and pushing
the use of more midwives. Before this, however many women
had no clue what a midwife is. Many women picture a midwife
as uneducated woman showing up at the door holding a towel
and telling someone to boil water. In many states, midwifes
cannot get liability insurance in order to do homebirths meaning
that they deliver solely in hospitals. Midwifes are different in
the fact that they spend more time with the patient and respect
their wants and needs when it comes to childbirth. Many women
write up their own contract stating how they want the process to
go, such as not mentioning an epidural or saying the word
contraction. This allows the woman to be on charge of the
birthing process, rather than doing whatever the OB-GYN says
is necessary.
It could also be argued that the hospital is the issue, not the
provider. However most inductions occur at 4 and 10, implying
that OB-GYNs are quick to speed up the labor process when
they are ready to go home. It is the provider that makes these
decisions, not the hospitals. OB-GYNs are still surgeons and
they want to do the easiest route that they know best, surgery.
While this is widely accepted in the US, it is not the safest
route.
“Modernism overtly and covertly conveys an illusion of right
answers, of one way to give birth. Truth be told there id no
right way to give birth. As childbirth educators we must
continue to encourage expectant parents to ask questions, to
investigate the literature, and to recognize the politics behind
decisions that are made (Savage, 2002).” Gould Suggests that
doctors do not cause cesarean sections but by patients making
the decision because they believe it is safer. While there is no

9. evidence that supports the fact the cesarean sections are safer,
popular culture makes them seem easy and attractive. There is
even such thing as ‘designer births’ where a woman will get a
C-section and then a tummy tuck immediately after.
The US as a whole needs to change its mindset if we have any
hope of lowering our newborn death rate. Based on the evidence
collected, it is very apparent that in order to lower our newborn
fatality rate we need to change something and the best option is
more midwives.
Lake, R. (Producer), & Epstein, A. (Director) (2008). The
business of being born [Web]. Retrieved from
http://www.thebusinessofbeingborn.com Lake, R. (Producer),
& Epstein, A. (Director) (2008). The business of being born
[Web]. Retrieved from
http://www.thebusinessofbeingborn.com
Brodsky, P. L. (2006). Childbirth: A Journey Through Time.
International Journal Of Childbirth Education, 21(3), 10-15.
Savage, J. S. (2002). Postmodern Implications of Modern
Childbirth. International Journal Of Childbirth Education,
17(4), 8
Gould, D. (2007). Rising caesarean section rates: the power of
mass suggestion. British Journal Of Midwifery, 15(7), 398.