A new study has zeroed in on one possible reason the U.S. is far behind other countries in healthy births.

By Marisa Cohen
Updated February 26, 2018
Science Photo Library - IAN HOOTON/Getty Images

If you watch Call the Midwife, the series on PBS about a team of heroic nurse-midwifes who delivered babies in the poorest neighborhoods of London in the 1950s and 1960s, you know how crucial these highly trained health-care workers can be in helping a woman deliver her baby safely. But that’s not just ancient history—a new study has found out how important midwifes may be to assuring healthy outcomes for mothers and babies right here, right now, in the United States.

Despite spending more money on childbirth than any other country, the U.S. has a higher rate of infant mortality than most other comparably wealthy nations, including Japan, Sweden, Australia, the U.K., Germany, France, Switzerland, Netherlands, and Canada. One main difference between the U.S. and those countries? The presence of midwifes. In the U.S., only about 8 percent of births are attended by midwifes, whereas in countries like Great Britain, midwifes are present at more than half of all births (including births in hospitals, at birthing centers, and at home).

Researchers at Oregon State University decided to look into how the integration of midwifes in the health-care system affected birth outcomes in all 50 U.S. states, and the results, published last week in the journal Plos One, are eye-opening: In the states with laws and regulations that allowing midwifes to more easily participate in the health-care system (being allowed to prescribe medication and get reimbursed by Medicaid, for example), there were lower rates of C-sections, higher rates of breast-feeding, and even more importantly, fewer premature births and newborn deaths. (In the U.S., the majority of midwifes are CNMs, highly trained registered nurses who have a graduate degree in midwifery.)

How does your state compare? Well, if you live in Washington, you’re in luck: The Evergreen State had the highest midwife-integration score, followed by New Mexico, Oregon, New Jersey, and New York. The lowest score belonged to North Carolina, with Alabama, South Dakota, Ohio, and Mississippi rounding out the bottom five. (Click here for a full list.)

The researchers were careful to say that while their findings show a clear connection between midwife integration and birth outcome, there are most certainly other factors in play, such as economic status. But it certainly adds new and intriguing information to the great debate about the best—and healthiest—way to give birth.