How Midwives Can Help the U.S. Attain the SDGs

Black and white image of the moment a newborn is delivered, with mother, midwife and baby.
Black and white image of the moment a newborn is delivered, with mother, midwife and baby.

Every October, midwives celebrate National Midwifery Week to spread the word about their unique style of woman-centered, evidence-based care. This year, National Midwifery Week fell on the heels of the United Nations endorsing the 2015 - 2030 Sustainable Development Goals (SDGs). What better time to acknowledge the many ways midwives can help us achieve these goals right here at home in the U.S.?

Our nation's more than 11,000 certified nurse-midwives (CNMs) and certified midwives (CMs) are key players in achieving 2 SDGs in particular: Ensure healthy lives and promote well-being for all at all ages (SDG 3) and Achieve gender equality and empower all women and girls (SDG 5).

Midwives are best known for attending births. Prenatal care has an impact on incidence of low-birth weight and premature births, which can have life-long repercussions and costs associated with them. Less well known is CNMs' and CMs' valuable contribution to women's health through primary care services, including annual exams, writing prescriptions, basic nutrition counseling, parenting education, and reproductive health visits.

Typically, in the developed world, there are approximately 2.5 midwives per OBGYN. Here in the U.S., that ratio is flipped: there are approximately 3 OBGYNs per midwife. Even though midwives attended a record number of births in 2013, which is the most recent year that final statistics are available from the CDC, we can do so much better!

Right now midwives attend just over 8% of all U.S. births. If more women had access to CNMs/CMs in the U.S., midwives could attend a larger proportion of healthy births and provide more well-woman services, freeing OBGYNs to use their specialized skills to assist women with more significant complications--a win-win for all.

Midwives specialize in fostering low-risk birth based on a woman's natural physiology, which most women are able to experience. Decades of research point to the safety and efficacy of midwifery care. Two Cochrane reviews, a U.S. systematic review of the literature, and The Lancet examined outcomes data associated with midwifery care, and all endorse the use of midwifery care as a core part of maternal care systems.

It may come as a surprise that the U.S. does not currently have the best maternity care system in the world. The total amount spent on health care in the United States is greater than in any other country in the world, but this high expenditure has not translated into quality care. According to the most recent State of the World's Mothers Report, even though the U.S. spends more per capita on childbirth care, it ranks only 33rd in maternal deaths among 179 countries. In fact, tragically, US women are more likely to die during childbirth than women in any other developed country. We must do better for our women and girls.

The American College of Nurse-Midwives Healthy Birth Initiative® aims to maximize women's opportunity to have a healthy birth using their own natural physiology, while avoiding unnecessary procedures that may interfere with that process, and pose physical and emotional burdens to women. As we celebrate midwives this October, please take the opportunity to spread the word about midwives using ACNM's many resources. We believe everyone has the right to know how much midwives make a difference to women and families!