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Nurse midwives deliver more babies in hospitals than homes in Washington State

When a certified nurse midwife delivers an infant, a prevailing assumption is that the birth occurs in the home of an older married, educated white woman who expects an uncomplicated event. After examining Washington State's live birth files from 1995 to 2004, researchers found that this presumption is not rooted in fact.

Carie G. Bussey, C.N.M., M.N., a midwife in Olympia, Washington, and colleagues looked at 590,943 vaginal, single births in the State over a 10-year period. They found that midwives delivered nearly 10 percent of Washington's babies, and 97 percent of those births happened in hospitals.

In addition, mothers who had midwife-attended births were likely to have characteristics associated with low socioeconomic status: young age, unmarried, low education level, minority, little prenatal care, and insurance from Medicaid. Because of these demographics, the women are considered to be at high risk for complications, dispelling the assumption that midwives tend only to low-risk births.

An increase in midwife-assisted births during the study period was attributed in part to Medicaid mandating reimbursement for midwife care beginning in 2004. Thirty-three States followed suit and required private insurers to reimburse for midwife care. The research team noted a small decline in the number of midwife-attended vaginal births from 2003 to 2004 (12.2 percent to 10.9 percent). They offer an upswing in cesarean births and fewer vaginal births after cesareans as a possible explanation. The authors recommend future studies of midwifery trends in other States and comparisons of outcomes of midwife-assisted births with physician-assisted births.

This study was funded in part by the Agency for Healthcare Research and Quality (HS013853).

See "Certified nurse midwife-attended births: Trends in Washington State, 1995-2004," by Ms. Bussey, Janice F. Bell, M.P.H., Ph.D., and Mona T. Lydon-Rochelle, C.N.M., M.P.H., Ph.D., in the September/October 2007 Journal of Midwifery & Womens Health 52(5), pp. 444-450.

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