The culture war between doctors and midwives, explained 

In the UK, midwives deliver half of all babies. Compare that to the US where midwives attend only around 10% of births, and maternal and infant mortality rates are much higher. Could a larger role for midwives improve health outcomes? Read more: bit.ly/2IYSvVw

While I enjoyed this video, I feel that the comparison between maternal mortality rates in America, and countries like Sweden and Denmark was misleading. This video seemed to insinuate that the reason America has a higher maternal mortality rate is because of their lack of midwives. Correlation does not equal causation. There are a lot of other factors, and reasons why countries like Sweden and Denmark may have lower maternal mortality rates, the most obvious being their free and widely accessible healthcare, compared to the USA, where many women do not have health insurance or sufficient health care.

*I think you need to look at our terrible healthcare system for the maternal mortality rate, not the rate of midwifes.*

What happens when a hospital runs out of labor and delivery nurses? They have a mid-wife crisis

Why didn't they mention the lack of insurance coverage for midwives?! That's the main reason people can't get a midwife, because it isn't covered by insurance so it's super expensive.

Fun fact about midwives in the 1800’s: A lot of children died because the male doctors didn’t wash their hands but the midwives did, so a lot of midwives actually saved infants, but where being blamed by the doctors because apparently the midwives where dirty.

In Germany doctors are not permitted to do births without the assistance of a midwife. Also a doctor is prohibited from giving orders to a midwife regarding birth. That said, if course both usually work in a team for the best result possible.

This was really interesting to watch - I didn’t even know this was an issue, it’s just so common to have a midwife when having a baby in the UK.

I’m a birth worker. I work in the labor and delivery world. I have seen births both by doctors and midwives. And hands down.... Midwifery care is much more sensitive, thorough, and gentle than care provided by doctors. I attended a birth at John Hopkins and was horrified by the treatment of the family... especially the mother. The doctor was nowhere to be found when she needed him. The security guard told me it was common for her to see a baby born in the waiting room because of all the protocols and rules and regulations that slow down the admission of families in labor. Doctors tend to stick to what is text book. Which is amazing during a medical emergency, illness, or disease. But labor isn’t always textbook. No two pregnancies and labors are the same even within the same woman. And doctors tend to look only at what averages and statistics tell them. Take Due dates for example. Your due date is your ESTIMATED due date. It’s merely your 40 week marking point. But in reality your due date could be off by as many as TEN DAYS. Babies can be born any time between the 37th week of pregnancy and the 42nd week. Yet I’ve seen some doctors do inductions of women who are only 3 days past their due date. Their bodies end up not being ready for labor. They react poorly to the pitocin. And then ultimately end up in the OR for a cesarean because their labor didn’t progress at a pace the doctor seemed reasonable. But her body wasn’t ready for labor to begin with. It was just recently discovered that BABY triggers labor by sending out a hormone to the mother’s body pretty much saying “hey mom. My lungs are done forming. I’m ready to see you now.” Now with Midwifery care. Midwives tend to look at the bigger picture when it comes to pregnancy and labor. They know what the textbook says but they also recognize that the textbook wasn’t written about... say... Mrs. Smith who lives down the street. Midwives will not only make sure Mrs. Smith is physically healthy for pregnancy and labor but they will also make sure she is mentally healthy, that her home environment is secure, that she has the extra support she needs, and the resources she needs as well. Midwives will be in the room or very nearby form the moment you’re admitted into their care until up to 4 hours after baby is born. (This is all my experience). Bottom line from my first hand experience is this: midwives treat pregnancy and labor as an important and beautiful life event and doctors treat pregnancy and labor as a medical emergency.

When I first heard about midwives, I had to google it. Living in America, I rarely hear or talk to people with that occupation.

Weird. We just think midwives are highly trained nurses that take care of pregnant women and births (in Finland). Other than giving birth by yourself in the woods in some sort of new age ritual, I didn't think you had births without midwives, except in case of C-section.

Attributing the US's higher maternal mortality rate to the use of doctors instead of midwives is very misleading. It ignores the vastly different healthcare systems, overall, between the US, UK, France, Sweden, and Denmark. There is no information in this video that supports or refutes the argument that either doctors or midwives improve infant or maternal health. Talking about the history of midwives in the US and its intersection of race and gender is interesting from a historical perspective but does not support any argument made in the video in favor of modern midwives or against modern doctors. If you want to show the benefits of midwives, you cannot show it using a graph or map. Use some form of rigorous data analysis like linear regression to isolate the effect of midwifery on healthcare outcomes. Vox, you have at best added nothing to the conversation and at worst misinformed people. Do your research and present it. I came to the video wanting to learn and instead you told a story with no substance.

Having lived in the UK all my life, it actually surprises me that the percentage here is only 50%. I couldn't imagine giving birth without a midwife - in fact, if you give birth in an NHS hospital, I don't even know if it's possible for a midwife to not somehow be involved in the birth?

My grandma was a midwife to almost everyone in our family😌☺️

Isn’t it a bit inappropriate to correlate a lack of midwifery to premature births, neonatal mortality and c sections? Whilst there is probably a benefit to having midwifes involved in pregnancy, there’s a multitude of other lifestyle, genetic and environmental factors that contribute more to those three medical occurrences. Vox should have mention the other factors because otherwise you could just assume from that info that midwifery reduces those things, a statement that may be well correlated but with no legitimate causal link...

Your maternal mortality statistics are a textbook example of confusing correlation with causation.

In Sri Lanka where we have maternal mortality rates comparable to the west midwives play a major role. I’m happy to say that there’s a nice rapport between doctors and midwives here. It’s the nurses and midwives that. Have a small rift developing. This is what I’ve seen in my 4 years as a med student. No sexism, no class issues. It’s team work here.

living in britain i just thought that midwives where every where, but i guess not

My grandma was part of the movement in the 70’s. She later became a doctor helping immigrants, but before that she started a midwifery college. She made so many contributions to the midwifery health industry, and almost everyone in our family has been a home birth. So cool to see a video on this 😊

I was born in the US and my mother used a midwife. She faced a lot of stigma and prejudice for her choice. She was very happy with the help she provided during the pregnancy and though I had to be delivered through C-section at a hospital, she was always happy with her choice. Like the woman said at the end, both doctors and midwives have their place in modern medicine.

Will never forget the value and of the midwives that were there every step of the way through my difficult labour. It's really sad that profession that also cares about the person giving birth, not just the child, is devalued the way it is.

I am a U.K. doctor. I support U.K. midwives. They are mad, but marvellous. They have skills and communication I could never hope to have. Obstetricians have life saving skills for obstetric emergencies. I am not an obstetrician and it would take many more years in the NHS system to become one. Obstetricians and Midwives work in harmony in the U.K. Sharing knowledge and experience. They both work on an evidence base here. And thankfully in the U.K. it has not and never will be a race or social class issue.

I live in Canada. I had a midwife and a OBGYN. My midwife was wonderful, in addition to the babies health. She also made sure I was well physically and mentally well. I gained alot of insight on the delivery process from her. She consulted with my doctor and was there supporting me every step of the way. Wonderful experience.

Midwifery was not just a racial issue. Historically, there’s an interesting relationship between midwives and abortion. For centuries, midwives were also the people who performed abortions, something no dignified man would even discuss at the time of the founding of the USA. The subject was considered unfit for men. However, another group did want abortion discussed, and they wanted it outlawed. Since the founding of the country and for many years after, Christian anti-abortionists sought to outlaw abortion. Each time, their efforts failed. Look into the attempts in the early 1800’s, and you will see many failures. In the late 19th century, a different tactic was employed. Anti-abortionists started to rally doctors against midwives, because they claimed midwives were practicing medicine. Doctors were gaining provenance, as medical science had considerable improved. Doctors bought into the arguments and pushed to restrict midwives’ ability to perform abortion. With the nascent power of doctors, many states began to severely restrict abortion. Those restrictions stayed in place until Roe vs. Wade, during which time the moral arguments used against abortion seeped into the zeitgeist of the culture. Abortion had become something performed in secret, hidden from view, shunned, and not discussed.

I am a senior student midwife in Canada, near Toronto, so I can share a bit about how it works here. I actually don't think it's useful to compare OBGYNs and midwives or to say they are the same because it is very clear that we are not. (not what the video suggested, but a few of the comments). Midwifery is a Bachelors of Health Science in Midwifery and it is a 4.5 year degree. 1.5 years of studying medicine- anatomy and physiology, pharamcology, reproductive physiology, etc. We have access to a cadaver lab that we share with the medical students. We also do simulated learning in this time. The classes emphasize evidence based medicine. We study the SOGC guidelines, etc. Then for the next 3 years we are doing hands on learning in the field. We shadow OBGYNs and assist in c-sections, follow pediatricians, nicu resuscitation teams, etc. We also do placements within midwifery clinics. I am in the beginning of my fourth year, and I have delivered approx 50 babies and been at over 100 births, just for some perspective. So no, we are not the same thing. If I have a woman that has a baby in a transverse position or with placenta previa, and I consulting an OB to do a c-section, I am very thankful that they exist. But if my patient is having a straightforward vaginal birth in the hosptial and does not need any intervention, she is thankful to have someone that looked after her throughout her whole pregnancy and will look after her for 6 weeks postpartum. 3 of those visits are home visits, to prevent women having to leave the house in the first week which we can all agree is preferable. I hope that helps clarify a few things! Feel free to ask any questions.

I think if the US was to really fix our maternal death rate, we would need to have some sort of accessible universal health care, better postpartum care for mothers, AND start recognizing mid-wives as specialty trained RNs. It's perfectly normal and expected that nurses pick a specialty or two to focus their careers on... why would being a mid-wife be any different? It's a win-win for everyone.

Lol wat? I'm pretty sure not using midwives is not the main reason for higher mortality, just look at other european countries that dont use midwives. Beautiful example of misleading statistics. Also the "it's always been like this so it should stay like this" argument is a fallacy. Get your healthcare together and maybe then your child mortality will go down too.

In germany a doctor is only allowed to deliver a Baby without a midwive in some really rare cases of health problems for example...

I love the last line "we are collegues who need each other"... Not everything in this country needs to be a war but a recognition of partnership of combined practice and knowledge.

Midwifes are not a direct factor for maternal mortality in the US. One factor affecting the US maternal death rate is the variability in calculation of maternal deaths. The WHO deems maternal deaths to be those occurring within 42 days of the end of pregnancy, whereas the United States Pregnancy Mortality Surveillance System measures maternal deaths as those occurring within a year of the end of pregnancy. Some states allow multiple responses, such as whether death occurred during pregnancy, within 42 days after pregnancy, or within a year of pregnancy, but some states, such as California, ask simply whether death occurred within a year postpartum. Comparison of the US maternal death rate to the death rate in that of other countries is further complicated by the lack of standardization. Some counties do not have a standard method for reporting maternal deaths and some count in statistics death only as a direct result of pregnancy.

Misleading statistics. One graph shows that since 2000, USA infant mortality has gone up while it has gone down in some European countries, and this is paired with listing the current percent of births involving midwives. Very misleading. At a minimum you would need to show that in each case the change over time was correlated with a change in outcome. Even then, correlation would not prove causation. But the way it was presented doesn’t even show correlation. I’m in favor of midwives, but it is disingenuous to use misleading statistics. How much of the differences in infant mortality are more related to USA obesity rates and USA poor prenatal care, rather than having anything to do with midwives.

I was most fortunate to have the best midwife and doctor collaboration to help when I was in need. They were amazing and our family is forever grateful. I learned later how rare it is to have had this service. Thanks Vox for bringing it to light.

This comment section is going to be interesting

Did you know that women who give birth with a doctor attending are more likely to have a C section than mothers who have midwives running the birth? Hmm almost like doctors want to perform procedures more often than midwives.

As a Brit, I can't explain how weird it was to learn how unusual midwives are in the US. They're so normal here, regarded in many ways as the same as nurses, needing university degrees in the subject, and everyone went to school with at least one person who wanted to be a midwife.

Correlation is not causation. Showing that America has lower rates of midwife utilization and comparing that to higher infant mortality IS NOT EVIDENCE THAT MIDWIVES DECREASE INFANT MORTALITY. I would suggest that the premise of this video is extremely fallacious. Disappointing to see this content from such a well-established channel;.

In France we call mid-wife "sage-femme" literally translate to "wise-women" and they are really common and work pretty well with doctor. I didn't know the situation was so different in the US.

Very curious you didn't put canada on that initial chart.... It would have been more relevant because we also don't overly us midwives but have infant mortality more in line with Europe....

Wow, it never even occurred to me that other counties didn’t use midwives. I’m shocked at the material mortality rate of America... glad I live in Britain .

When I was young I thought a midwife was a person who took the baby from the dad and put it in the mother’s stomach

I had a midwives for my birth in canada and it was amazing, they laid everything out so much more clearly than any OB did. They made it so much more of a wonderful expierence.

Living in Sweden, this video gave me a very surprising look into how midwifery is different around the globe. Most people here take it as a given that there are midwives all over the place. We even have them at schools, health centers and youth clinics. Interesting, thanks! I believe the USA health care system could benefit from midwives, as they don't cost as much as doctors to educate or pay. Doctors only attend births here if something goes really wrong, otherwise there are only midwives and nurses.

Amazing video, keep touching the topic!! OMS talks about natural birth and the importance of the midwives, and the non use surgeries

The statistic presented to support midwives are misleading. The real driver between the US and all those other countries is socialized medicine and not midwives. For example, Canada have a lower rate then the UK and France at 7.5 vs 9.2 and 7.8 despite mostly having babies delivered by doctor and not midwives. Determines if midwives have a positive or negative impact on death birthrate is fairly complex and the graphic presented is more a symptom of the US terrible health care system rather then anything else.

If there were no midwives in my country's hosiptals, the health system would collabse. They are an integral part of obstetrics here and only if there is a complication or a high risk of it during a birth that the obstetrician (docotr) is called to intervene.

Kind of a weak video. I mean, take the comparison with Europe. The US has higher infant death and maternal death, but lower midwifery compared to Europe. That seems like a weak correlation. Infant and maternal death rates have many, many factors. For example, the mother's health before pregnancy, medical care during the pregnancy, drug use, poverty, etc. I'm sure US mothers on average have worse pre-pregnancy health, less care during pregnancy, and do other things that disparately affect the mortality rates compared to Euro mothers simply because of the way public health and healthcare are dealt with in the US versus Europe. There is probably a correlation too between infant/maternal death rates and obesity when compared with Europe.

0:36 I know people who either would have died in childbirth or had their baby die during birth if not for midwives. Midwives have been around for as long as people have been giving birth. Their knowledge and handling of situations is invaluable.

Great video! Thanks so much for sharing!

I remember when my babies mom was pregnant she wanted to go to this hospital because the doctor there was on a television show. the whole pregnancy the doctor was the OB/GYN the date of birth the doctor was at his house they told us he was on his way but the midwife was there and delivered my daughter I didn’t see the doctor again until after we went home.

The acceptance of midwives in my country (Bangladesh) could go either way still. However, many families still prefer the care of midwives over doctors because of the cost of doctor fees.

I'm writing my thesis on this topic and would love to see your sources! Could you list some of them for me, or tell me where I can find them?

I'm a doctor and let me tell you midwives are good when it comes to normal deliveries but with unusual and complicated deliveries they know nothing and if the delivery exacerbate you need a doctor or you may need a surgery in a hospital today giving birth by midwives is really unwise decision

Aw now I kind of want a midwife to help me deliver my baby!

In our country having chosen midwife does not exclude doctors. You deliver with midwife in hospital and if something goes wrong or you strugle, then they call your delivery doctor.

My Grandma was a midwife and she has helped with so many mothers already. And the thing about my grandmother is, she would give birth to anyone in anytime of the day and she accepts any payment. I even witnessed one, but we weren't allowed to go inside obviously, and they were so many people outside and when the baby got out, the crowd was just full of joy.

My mother gave birth with a midwife in 86 and had no idea it was still a profession. She wanted to be one, but became an RN instead, for fear of having to ever hold a dead baby. Needless to say, this is interesting to me, and the video is appreciated.

Around the time that home doctor visits, having funeral visitation in your parlor, and burials outside of graveyards stopped, which is after WW1, midwifery was stomped out.

You assumed causation between the data of countries with higher midwife frequency and lower maternal mortality...even though it is only a correlation. There is a lot more that goes into obstetric care and outcomes than just the fact that midwives are present and we need to look at ALL data related to it to make an educated decision as to whether or not midwifery is a benefit to the U.S.'s practice of obstetrics. It is very likely that in fact it is the United States' practice of healthcare (being non-single payer) compared to countries like Sweden and the UK that could be leading to worse outcomes for these women and new-borns, not the lack of midwifery. Remember people, correlation does not mean causation.

Our first baby was born with a midwife. It was our best pregnancy/labor so far. The midwife listened to our concerns and helped us through the transitions with ease. With our second, we lived where it is illegal for midwives to operate and we were forced to have our baby in a hospital. No one cared and because of their rush to do things on their timetable, I literally nearly died and had to spend several days in ICU. Because of their mistakes, I can never have a regular pregnancy again. I will always be pro-midwife. There is more of a relationship and less forcing into a time schedule.

I am a paramedic in Canada and all of our emergency childbirth protocols and education was written by the College of Midwives. The stigma midwives have in the USA isn't present in Canada.

Who would've thought racism has had major effects and continue to do so.. weird

What...? I'm french and I've never heard of a french hospital that delivers babies and doesn't use midwives... O.o (apart from caesareans and other problems) It is well recognized here and considered "normal" if not obligatory I guess lol I had no idea some countries had hospitals that don't even have them wow xD

In the UK, Nursing and Midwifery are separate professions, although have the same professional regulator, it doesn't exclude you from being dual registered. Both usually require 3 year uni degrees and have a heavy focus on hundreds of hours of unpaid practice before you register. They have to register with the NMC so you're accountable to the public. Midwifery is much more autonomous across Europe compared to the US. Obs/junior doctors are available in the hospital setting, but midwifery is usually community-based for patients. Health Visitors (usually nurses that have done a Masters in public health nursing) also play a huge role in conjunction with midwives to ensure continuity of care postpartum.

In Poland we have midwives doing the entire delivery with surgeons being on standby in case of complications. Doctors are also checking the results from time to time, but are not interfering with the birth process unless they have to.

The extra presence of doctors doesn't seem to prevent deaths though.. Infant mortality rate is double as high in the US compared to where I live (Norway). Maternal mortality is even worse as it's *5 times higher.* Here the use of c-section is rare (even when delivering twins), and midwives are overseeing most births. And every check up and the birth itself is completely free. The only thing I ever paid for was parking the car outside the hospital..

Interesting video on the history of midwifery, but there is absolutely now way that the low use of midwives is the cause of high infant/magernal mortality in the US. OB/GYNs are trained to react in medical emergencies in ways that midwives can not. Our health care system needs a lot of improvement, but increasing the number and use of midwives is not one of them.

I’m an American mother of two healthy happy teens who were both delivered in a hospital by midwives. I had short labors (4 hrs & 6hrs), with natural births where I was allow to get out of bed, walk and even bathe if I chose to. I could never find a doctor who would allow me to do that. Midwives have faith in a healthy female body to do what it’s done for all of humanity. I still see my midwife for my annual checkups to this day, and the best thing about them is that they have time to actually talk to patients during visits. Doctors just can’t seem to spare the time.

Honestly there should be centers all over America that are government funded and focuses on midwives, birth is a natural process so doing it in a place that’s trying to treat aliments never seemed right and it’s justified when there’s a contraction of hospital born aliments. There of course needs to be trained professionals at the ready to deal with complications but the externes of a hospital environment isn’t necessary. Not to mention a midwife tends to care more about the comfort of the mother, they allow them to walk more, try different positions, instead of the highly dangerous standard of having their legs elevated so the doctor can see, America really needs to adopt these standards.

It's complicated.

The reason why European countries rely on midwifery while the US doesn't comes down to cost incentives: European medicine is socialized and manages costs by using midwives. The USs heavily regulated and tax subsidized "private" system encourages more expensive treatments whenever available, including using doctors for birthing. Your inclusion of race into this narrative has very little explanatory power in understanding differences in practice.

I am in the USA. There are some strict rules for midwives in specific states, but not all. I have had a hospital birth with an OB and a home birth with a midwife. I would NEVER go back to a hospital birth. I am due with my 3rd in February and have another home birth planned.

I had a midwife 2007, 2008 hospital doctor 2010. Midwifery is vital to the health care in this country.

My sister is training as a midwife in Canada; its a four year program, the same length as a family doctor. This isn't some vodoo stuff its real scientific medicine.

correlating percentage of midwifes present at birth and mortality rates has to be the best post hoc ergo propter hoc i've seen in weeks! thanks vox!

In Australia- population -24000000 number of midwives - 33000 infant mortality rate- 3.1 per 1000 ( Googled numbers) In recent years, Midwifery has become a more specialized profession with the national introduction of a 4 year bachelor degree at university.

Midwives are amazing. Both of my babies were delivered by midwives in Ontario, Canada. The same providers provided my prenatal, delivery and neonatal care. One of my deliveries was long and complicated requiring the help of a physician. I highly recommend midwifery care.

Correlation does not equal causation

Haha, if I were american I'd definetly get my wife out of country to let her give birth

As someone who has given birth with an MD and midwife. I can say the midwife group did make my birth easier and i felt well taken care of. i was more prepared with a midwife and they looked after my mental and physical help after giving birth. I had 2 very easy births, but my care was night and day between the two different providers.

The midwife is the most important figure for women's healt, it's them who prepare you during the pregnancy, it's them that help you to deliver your baby safely and it's them who still help you if you need advice during breast feeding.

i thought midwife is your secret Affair to another woman 😕.

There is no arguments in this video, just exposing the history of midwives in the US. At best you have correlation, at worst fallacies. There also is no source. Using the angle a race is a nice idea, but there are too many wrongs.

In the UK we have midwives who follow the mother and baby from when she initially finds out she is pregnant until about 6 -8 weeks after birth, then passing them onto health visitors who take over until potentially the child is 19 years old (depending on the needs of the child, but very rarely in my experience). There are proven positive outcomes (increased immunisations, better dental outcomes and more access and help for families) when midwives and health visitors are empowered and employed. Nurse and Midwives pride themselves on Holistic care - meaning the whole person, whereas unfortunately Doctors often focus solely on the problem or diagnosis. Collaboration is key to get the best outcomes.

I've worked as a midwife in Sweden (during my studies), and am now a physician in Denmark. In Sweden and Finland, midwives are specialised nurses In Denmark, midwives are not nurses, but their own occuptation with nurse-related skills (and the admission rates to become a midwife in Denmark are similar or higher to that of getting into med school) Obstetrics and midwifery are areas of science, that are relatively new. Most techniques have been passed down, not because they were science based, but because they empirically worked. In the recent decades, science in these areas have grown, and so, some practices have been abandoned (i.e giving footling / breach birth if it can be prevented) - doctors are (usually) scientific (more than empirical) and midwives are (usually) more empirical than scientific (both sides have pro's and con's and need to be used in the right way). This is however part of where "the fight" between doctors and midwives occur sometimes. The "fight" between midwives and physicians, does exist in Scandinavia, however it is not much different from the "fight" between nurses and doctors. It can be resolved by role-distinction, teamwork, communication and respect for each others abilities and our own limitations. In practise (in Denmark and Sweden), from early pregnancy to birth a collaboration exist between midwives and doctors. When it's time to give birth, all births are being taken care of by midwives as a standard - if births are complicated / high risk, or complications occur, physicians (experts in disease and treatment) are called to aid the midwives (experts in the "normal" birth - with great experiance in complications related to births). In most cases this teamwork is effortless, and doctors are only physically involved with maybe 30% of births (but check the journals of all patients) Whether this is the best way of doing things in the US? Maybe - it would probably make less of a burden on obstetricians, if many of the tasks could be done by midwives. The notion that lack of midwives have a causally related to the mortality rates etc in the US is a plausible hypothesis (i.e overworked doctors tend to too many patients = more errors), but almost certaintly far from the only contributing factor (as many have already mentioned: access to pre-birth healthcare and healhcare in general, education about healthy pregnancy etc etc). That doesn't mean, that it wouldn't be a good thing to introduce in the US. I would NEVER be afraid to let a pregnancy be handled by experts (which is what the midwife with proper education is) in collaboration with a doctor on call All the best, and thanks for the videos! Peter

- shows the advantages of midwives - doesn't show the advantages of doctors - alludes to a correlation between doctors and infant fatality but goes on a 5min tangent about racism Officially done and unsubscribed with Vox. Was excited to learn about the topic, was disappointed.

It could be worse... In Brazil 55% of the births are through c-sections (caesarians).

After just giving birth in the UK, the compete process was midwife led, prenatal, home birth and postnatal care, I don't remember ever seeing a doctor! They are an incredible and undervalued resource in the UK and do an amazing job for mother and baby

Hey! im a registered midwife in the UK, its great to see people thinking about midwifery and people learning about what we do. Thanks Vox! If anyone has any questions regarding midwifery in the UK id happily answer them to the best of my ability.

I love your new Netflix show btw vox. Also WTF America 😩

It takes more hours of training and apprenticeship in most states to become a barber than a midwife. Seriously, look it up for your particular state. Yes, the USA has higher infant mortality, but that infant mortality comes in part from groups like the Amish, who do not benefit from the innovations me in modern medicine, as well as extremely rural households who elect for home births and thus have the risky event of birth take place an hour or more away from a hospital. Infant mortality is highest in the state of New Mexico (which shows on your map as having midwives well-integrated with the medical system), and largely this comes from indigenous people and Latinos who live farther from population centers and who carry an active distrust of the mainstream evidence-based medical system. The UK doesn't have anyone who lives a half-hour up a dirt road and then another hour from the nearest hospital. The entire country is a bit bigger than Mississippi and has twice as many people as California. So they live closer together. The UK doesn't have an Amish/Mennonite community of over 2 million. The UK doesn't have a large cohort of undocumented immigrants who have home births rather than risk discovery by being admitted to a hospital. Infant mortality in the USA tends to be correlated with births outside of hospitals, not inside of them. Once you understand the issues more completely, it appears midwives are more of a solution in search of a problem. The role they play in hospitals seems to be as a medical advocate for women, which is important as there is a power distance between largely male physician and women who are in the vulnerable situation of childbearing. Women who request midwives are typically those strongly planning out their birthing process. They aren't the ones going to the ER when their water breaks, or when they start crowning. They're the ones who were taking pre-natals before they missed their first period. Those women tend to have fewer compilations, be higher-educated, have higher incomes, and live in large population centers. I have no opposition to midwifery, but I don't think the practice can make meaningful inroads in reducing infant mortality in the USA. That is a tough problem to solve.

Use case of one. When my wife gave birth to our son, 5 midwives helped with the birth (all women). The 2 doctors (man and woman) got involved for the snip/cut parts. This was a public hospital in Sydney, Australia and it was one of the doctors that was not impressive with a lack of care on one aspect of my wife’s condition. The midwives were caring, energetic and sweet. However they acted as a team and the doctors were able to focus on their role, think escalations, across more patients this way.

You make great content, go into depth on the stats, I really want to know what causes this?

hear ye! hear ye! this is how one sided arguments work. distorted facts taken on face value and projecting your own ideas upon the those distorted facts. could have at least interviewed an OBGYN. 2/5

"Midwifery"

My mom used to be a midwife. Didn't know it was THAT uncommon in the US.. It's kinda normal here in The Netherlands to have a midwife after delivery. There's usually one present during birth aswell, but doesn't actually control what's happening unless it's not in the hospital.

I'm an American mother who gave birth to my first child in a hospital with an obstetrician (a medical doctor), and to my second child in an out-of-hospital birthing center with a midwife. My midwife was also an N.D. (naturopathic doctor). My two pregnancies and births were both without any complications and both of my children were born quite healthy, with near-perfect APGAR scores. Comparing the two, I had a vastly superior experience with my midwife than with my obstetrician. She spent far more time with me on prenatal care, listening to all of my concerns and taking a holistic approach to my health, such as diet, sleep patterns, work & home stress levels, etc. My obstetrician always rushed me during prenatal visits and I had to advocate for myself to decline the pressure she put on me to perform unnecessary interventions which would "speed things along" during labor, presumably for her convenience but putting myself and my child at risk. For both births, I labored at home for as long as possible until active labor began and I went in to the hospital or birthing center. I barely saw the obstetrician until the pushing phase began, whereas the midwife stayed with me the entire time. She even showed my husband how to "catch" our daughter, since with her I had a water birth in a deep whirlpool tub. I wasn't discharged from the hospital until two full days after giving birth. With the birthing center, I was discharged 4 hours later, grateful to sleep in my own bed and recover in the comfort of my own home. My midwife even made two post-partum/neonatal house calls: one 48 hours after birth and another one week after. To top it all off, my birthing center experience cost substantially less than my hospital experience (although insurance paid for both), even though I used no anesthetic for either one and had zero complications, despite both babies weighing in around 10 pounds. With my second child, I felt much more empowered to trust my body to know what it's doing. I was allowed to have soothing classical piano concertos playing in the background and candles burning to relax me. I wish I could go back and redo my first birth with the midwife. I cannot sing the praises of a midwife-guided birth enough, and I'd highly recommend it to any mother with a healthy pregnancy. P.S. I used The Bradley Method for both births, which uses relaxation as a means of pain relief. It really works! And it works even better in a soothing environment, which a hospital *clearly isn't.*

Let's start off by splitting society into groups oh yeh great idea

Everything is about "race and class in US" for Vox

I love learning about things like this thank you

The biggest thing that jumps out at me is population density. European countries have quick access to a nearby hospital that could be 20-30 minutes away if something could go wrong during a delivery. In the US if you rely on a midwife at home you might not have the equipment and capabilities if something were to go wrong with the mother or child. To me, it is always safer for everyone to be in a hospital.