By: Isabel De Anda

Mothers-to-be have a variety of options available to personalize their birth plans to pain relief, delivery, and newborn care preferences. These options include using an obstetrics and gynecology doctor (OBGYN) to assist in prenatal appointments and labor, or a licensed midwife and doula to perform the same services. Mothers can opt away from the traditional hospital experience and choose alternative birthing methods such as birthing clinics or home and water births. However, the accessibility and lack of awareness of options inhibits many women from choosing alternative practices.

The medical definition of a midwife is a trained person who assists women during childbirth, provides prenatal care for pregnant women, birth education for women and their partners, and care for mothers and newborn babies after the birth. According to the World Health Organization, a specialized agency of the United Nations concerned with international health, 7.3 million nurses and midwives currently serve all maternal needs throughout Europe. However, in the United States midwifery makes up only 8.3% of all US births, and the practice itself is only legally regulated in 37 states according to the North American Registry of Midwives. Of these sates, Washington, Oregon, Idaho, Montana, and Alaska currently have the highest percentage of out-of-hospital births: between 3 and 6 percent in contrast to1 percent nationally.

Alternative prenatal practices have been criticized by OBGYN’s for safety concerns involving labor settings and delivery, as well as the need for emergency medicine. In addition, in certain states the practice of midwifery is allowed with only midwife certification, not licensing, and this creates another opposition to the alternative practice.

A 2015 New England Journal of Medicine study analyzed 8,000 births and found that although out-of-hospital births had a higher risk of neonatal seizures, it held the same risk as births that were planned in-hospital. Out-of-hospital births were found to involve less cesarean sections, fewer interventions to augment labor, and less scarring to the body. There were 15 deaths among the planned out-of-hospital births and 137 deaths among the planned hospital births, and these occurred within the 4 weeks following labor.

Furthermore, in another study by Health Affairs, a peer-reviewed healthcare journal, the average cost for an in-hospital birth was found to cost $10,000-13,700 depending on insurance and complications during labor. In contrast, hiring a midwife was found to cost $3,000-6,000 and include all prenatal visits, birth, and postpartum visits. Midwives spent 85% more time with the mothers during the labor process, as compared to OBGYN’s which spend only 20% of the process assisting. There is research to attest for both sides, but parental opinions and preferences ultimately influence the final decision.