Midwives and birth centers are key to improving birth outcomes


Opinions expressed by contributors are their own and not those of SuperTalk Mississippi Media

Latifany McCaskill called me barely able to speak. She was about 38 weeks pregnant, had labor pains and was alone. She was examined at my clinic, Sisters in Birth, by a Certified Nurse Midwife (CNM) who primarily serves our Medicaid patients.

Latiffany represents a growing number of Mississippi women who seek midwifery care because they want better prenatal care and healthy childbirth. In the American healthcare system, they are at significant risk of undergoing unnecessary medical inductions, which often lead to caesarean (caesarean) deliveries and of dying from pregnancy-related disorders such as heart disease, hypertension and infections.

According to data from the Centers for Disease Control and Prevention, women in Mississippi have experienced the highest cesarean delivery rates since 2014, and black women have experienced the highest cesarean delivery rates nationwide since the 1990s. When a mother’s first child is delivered by caesarean section, she has an 89% chance that subsequent births will also be caesarean deliveries. The risk of a woman having an initial and repeat cesarean delivery is largely in the south-central region of the United States

Evidence consistently shows that midwifery care is associated with better prenatal care and better birth outcomes. A very large nationwide initiative by the U.S. Department of Health and Human Services (HHS) involving 45,000 pregnant Medicaid members of various races who primarily reside in the South found that patients who received midwifery care at centers autonomous births had significantly better prenatal care and birth outcomes. , including significantly lower rates of preterm birth, cesarean deliveries, low birth weight babies, and lower pediatric medical costs. Patients who delivered by caesarean section in their first delivery had a higher rate of vaginal deliveries after caesarean delivery (VBAC) and were more likely to breastfeed than patients whose babies were delivered by doctors in the hospital.

Another very large study comparing birth outcomes associated with CNMs and physicians in the U.S. military health system found that CNM births had lower odds of cesarean delivery, labor induction, birth complications , postpartum hemorrhage, endometritis and premature delivery. and a higher likelihood of vaginal birth, VBAC, and higher breastfeeding rates than women whose births were attended by physicians.

The 2014 Urban Institute—Health Policy Center study found that women who receive prenatal care at birthing centers are significantly less likely to have a caesarean and more likely to have a vaginal birth after caesarean section (VBAC). They concluded that birth centers could save Medicaid an average of $11.6 million per 10,000 births per year.

The Centers for Medicare and Medicaid suggests that Mississippi state leaders examine the accessibility of midwifery care and free-standing birthing centers to improve birth outcomes and achieve significant medical cost savings. In Mississippi, there are no birth centers and only 26 CNMs. Only three hospitals in the state allow CNMs to deliver; therefore, pregnant women must travel great distances within the state to experience a physiological birth.

In my quest to build a self-contained birthing center in Hinds County, I have sought funding from the City of Jackson, the Hinds County Board of Supervisors, the Kellogg Foundation, and the Legislature to no avail. State of Mississippi. Since 2019, I have asked Congressman Bennie Thompson and pleaded with Representatives Michael Guest, Michael Palazzo, and Trent Kelly to co-sponsor the BABIES Act, legislation designed to support birthing centers. Congressman Thompson was the only one to do so.

Congressman Thompson said, “This legislation would create a demonstration payment under Medicaid. The legislation provides guidance to develop a Prospective Payment System (PPS) that would reimburse stand-alone birth centers for antenatal, perinatal and postpartum care for mother and infant. By providing a cost-coverage model for stand-alone birthing centers, we can continue to use cost-effective and creative solutions to reduce maternal mortality and improve infant outcomes. »

I am so grateful for Congressman Thompson’s support of the BABIES ACT and my goal of developing a birthing center in Mississippi. Unlike his Republican counterparts, he has demonstrated true pro-life leadership, which is an understanding of the health issues that mothers and newborns continue to face, and the vital role that midwives and Freestanding birth centers can play in improving birth outcomes in Mississippi.

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