The blog of the Urban Institute
May 9, 2013

Prenatal Care from Midwives May Lead to Healthier Babies, Healthier Moms

May 9, 2013

An uncomplicated birth experience resulting in a healthy baby was all I wanted when I became pregnant. I decided that the best way to achieve this was to seek prenatal care from a midwife, understanding anecdotally that midwives advocate for minimal intervention and a natural, well-supported birth experience.

In late March, I achieved my goal—giving birth naturally to a healthy baby boy. I fit the typical profile of women cared for by midwives: white, highly educated, and relatively affluent. I have no medical, emotional, and social history that would put me at greater risk of complications; plus, I have already given birth naturally to two healthy children. 

Research on the impacts of midwife care on moms and babies have typically studied women like me, since women like me are more likely to be seen by a midwife.  Many argue that this has confounded findings that midwifery care results in improved birth outcomes.  However, African American women and low-income women, who are disproportionately more likely to experience maternal and infant complications during birth, might actually benefit the most from approaches endorsed by midwives. 

A study of the Family Health and Birth Center (FHBC) in Washington, D.C. offered us the opportunity to test this hypothesis. The FHBC is a freestanding birth center designed to provide comprehensive midwife-directed care to low-income, mainly African American women who live in the District’s Wards 7 and 8. Care delivered here is designed to meet the varied needs of women at risk of having poor birth outcomes because of stress, inadequate social and emotional support, poor education, and poverty.

Our recent research, which compares outcomes for women cared for at the birth center with similar women who gave birth in D.C., finds that women who received prenatal care at the FHBC were more likely to carry their babies to term, less likely to have a C-section, and, on average, had babies that weighed more than the babies of similar women in the District who were not cared for at the birth center.

These findings suggest that, by reducing C-sections, increasing average birth weight, and prolonging gestational age, the care delivered at the FHBC results in improved or as good maternal and infant outcomes. Given rising health care costs and a continued trend of increasing C-sections nationwide, these results suggest that alternative models of maternity care can be safe and effective in promoting non-interventionist approaches, can improve maternal and infant outcomes, and perhaps address the seemingly intractable problem of low-birth weight and preterm babies in the United States. Using this model more often among women with low medical-risk pregnancies, including those with increased social risk factors, could contribute to better outcomes for mothers and their babies.

Baby image from Shutterstock.


As an organization, the Urban Institute does not take positions on issues. Experts are independent and empowered to share their evidence-based views and recommendations shaped by research.


As former General Director of the Familiy Health and Birth Center, I am most grateful to Sarah Benetar and the team at the Urban Institute for this well-designed study. Along with the recently published National Birth Center Study II, it shows that using midwife-led care in birth centers cannot only reduce disparities, it can actually reverse them. Folks, we know how to improved maternity care; the model has been proven to work. Let's find ways to train more midwives and build more birth centers!
The place of birth is not as important as making midwifery care available to all childbearing women. Presently the birth center shows that given the freedom to practice midwifery (often not possible under acute care hospital rules) good outcomes are achieved. We need to be educating 5 midwives to every 1 surgical obstetric specialist. It is not rocket science that the cesarean rate would sky rocket when that is what we have supported (with our tax dollars for residency programs) for the past 60 years. Every country with better outcomes have a ratio of 4-5 midwives to 1 surgical/ obstetrical and they probably also have a higher percentage of women who age with their uterus intact. It will take at least a generation for us to catch up but we never will if we don't support teaching Midwifery 101 at the primary level in all medical and nursing schools so graduates will understand normal, physiological birth and be prepared to make an informed career choice for their specialty in obstetrics and midwifery. Lastly, if we want change we need to invest at least as much at the beginning of life as we do in the end of life. Why are we not supporting the mother in the first 6-12 months of her baby's life as they do in other countries? What kind of men are running our government? Where is the Hospice type care for childbearing women and families? Investment at the terminal end of life is marvelous but there is no return on the investment. Such care at the beginning of life I'm confident would have an enormous return to mothers, babies, families and society as a whole for we would be recognizing the mother as the first level primary care giver and teaching her how to navigate the system efficiently and effectively for her family. We don't even have a proper system for doing this let alone the willingness to invest our resources in it. Start by setting the goal for educating 100,000 new midwives and reverse the ration of 1 midwife to 4-5 surgical/obstetrical specialist in control of birth care t- 4-5 midwives to one surgical/obstetrical specialist who collaborates and consults with the midwives for a team approach to care.