The Case for Midwifery Care: A Safer Choice for Birth & Prenatal Care

Midwifery is a safer option for medically uncomplicated pregnancies

I recently had a client get a Verification of Benefits (a document that one can get stating what is covered and what is not covered prior to getting the services in question). This client had the “platinum” level of insurance…the best of the best. So, you would think, “Great! All safe and reasonable choices will be covered and I’ll get to plan for the birth I want!” Only when we got the Verification of Benefits back, the insurance company let us know that, not only was home birth not covered, but MIDWIVES as an entire provider type were not covered either.

Those of you who know me know that I am not one to shy away from that proverbial soap box…so, excuse me while I take the mic. “Check, check. Can everyone hear me? *clears throat* Are you f*cking serious?!”

In the realm of childbirth, decision matters. From selecting the right prenatal care provider who feels right for you to deciding where to give birth, each choice can profoundly impact both the experience and the outcomes for the birthing person and their baby. Despite the growing body of evidence supporting midwifery care as a safer and more holistic approach for low-risk* pregnancies, a significant barrier remains: insurance coverage.

(*Side note about the term “low-risk”. This has become something of a political dog whistle in the birth world and has inappropriately combined medical risk with risks conferred by living in a society whose health care system is heavily impacted by racism, sexism, and homophobia. Pregnancies complicated by medical risk often times require the specialized care provided by OBGYNs and Maternal Fetal Medicine specialists. However, pregnancies complicated by the risks associated with a biased healthcare system benefit by culturally congruent, compassionate, relationship-based midwifery care. “Low-risk” is not a helpful term but is more commonly understood, so I’ll use it this once, with this footnote and use “pregnancies uncomplicated by medical issues” moving forward.)

Why Midwifery Care Matters

Midwives are trained healthcare professionals who specialize in providing prenatal care, assisting with childbirth, and offering postpartum support. Unlike obstetricians who primarily manage high-risk pregnancies and perform surgical interventions, midwives focus on promoting a natural and family-centered birthing experience.

Research consistently demonstrates the benefits of midwifery care for pregnancies uncomplicated by medical concerns. A landmark study published in the British Medical Journal found that midwife-led care was associated with reduced rates of interventions such as cesarean sections and episiotomies, as well as lower risks of preterm birth and newborn mortality compared to traditional obstetrician-led care.

Moreover, midwifery care emphasizes personalized attention, continuity of care, and informed decision-making. Midwives often spend more time with their clients, building trust and providing comprehensive education on prenatal nutrition, exercise, and childbirth preparation, and more! This approach fosters a sense of empowerment and confidence in the birthing process, leading to better birth outcomes and satisfaction. So, it’s no surprise that another study found that individuals receiving care from midwives felt a greater sense of autonomy and respect; and had a lower risk of being mistreated when compared to those who received OBGYN care.

And before we get too heated about this…yes, there are good OBGYNs who treat there clients well and yes, some of you reading this had great experiences with your physician-led care. AND the data does not lie.

The Insurance Dilemma

Despite the clear advantages of midwifery care, many individuals face a significant hurdle: insurance coverage. In the United States, the highest reimbursing health insurance plans, as I mentioned above, are starting to limit or exclude coverage for midwifery services, thereby eliminating a safer care option for individuals whose pregnancies are uncomplicated by medical issues.

This lack of coverage not only undermines individual choice but also contributes to disparities in access to safe and respectful pregnancy care. This gripe about lack of coverage at the top tiers of insurance seems newer to me. However, for marginalized communities, including people of color and those with less financial freedom, the inability to access midwifery care has been further exacerbating existing healthcare disparities and perpetuating inequities in health outcomes for birthing parents and their babies for a long time.

Why do I think this is? I think physician-advocating lobbying groups are negotiating better paying plans to exclude midwives, thereby forcing those reimbursement monies straight into physician-led practices. Yes, I said what I said. Can I prove it? Nope. Does it seem logical? Yes. Does someone have to prove me wrong with data before I’ll change my tune? Yes, and be prepared to come with truck loads of data, because that is the amount of data there is to demonstrate that midwifery is safer and more respectful for families whose pregnancies and births are uncomplicated by medical issues.

Advocating for Change

As advocates for health equity, it is imperative that we challenge the status quo and demand greater recognition and support for midwifery care. This includes advocating for legislative reforms to expand insurance coverage for midwifery services, increasing public awareness of the benefits of midwifery care, and promoting collaborative models of care that integrate midwives into mainstream healthcare systems.

Moreover, employers and policymakers must recognize the cost-effectiveness of midwifery care, which has been shown to reduce healthcare expenditures by minimizing unnecessary interventions and complications. By investing in midwifery-led models of care, we can improve health outcomes for birthing people and their infants, enhance the childbirth experience, and create a more equitable healthcare system for all.

Conclusion

Midwifery care represents a safer and more compassionate approach to prenatal care for birthing people. However, the lack of insurance coverage for midwifery services remains a significant barrier to access, perpetuating disparities in health outcomes. It is time for policymakers, insurers, and healthcare providers to prioritize health equity for birthing people and ensure that all individuals have access to the high-quality, evidence-based care they deserve. By supporting midwifery care, we can create healthier communities and empower birthing people to experience childbirth on their own terms.

If you’re local, please stop by. If you’re considering midwifery care, let’s talk about your options and get you the information you need to make the choices that are right for you and your family. If your insurance doesn’t cover the option you want, don’t be afraid to let them know it. If you have employer-sponsored insurance, let your HR rep know that this is unacceptable. If you pay for your insurance on the open market, consider using open enrollment as an opportunity to use your money to tell insurance companies that you’re only interested in options that protect your choices and your safety.

Remember, when it comes to birth & prenatal care, midwifery care matters!

Signature card for Kelly Wong McGrath
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