Catching Babies in New Mexico

By Allegra Huston
Issue 136 - May/June 2006

In January 2002, as I sat in a New York City taxi on my way into Manhattan from JFK airport, I was suddenly hit with waves of nausea. I clenched my stomach, determined to hold on until I reached my friend’s apartment. She was four months pregnant. By the time I’d pressed her doorbell, I was sure that I was pregnant too.

In my old life, before I moved to New Mexico, I’d have gone to the doctor’s office and sat with sick people, waiting for a cursory examination and a snatched 15 minutes of office time. Now, having lived in Taos for four years, I knew better. I was not sick, so I didn’t need a doctor. What I needed was an expert on pregnancy—in other words, a midwife.

There are two kinds of midwives in the US, the majority of them certified nurse-midwives (CNMs). Trained as nurses, CNMs operate within the medical model and under physician oversight. Direct-entry midwives, on the other hand, are independent practitioners who are not subject to the directives of a physician. Their model of care is based on the conviction that pregnancy and birth are normal life events that do not require medical intervention except in unusual circumstances. Taos, New Mexico, is the epicenter of nonmedical midwifery in the US; in 2003, nearly a quarter of all births in Taos County were attended by direct-entry midwives.¹

“The midwife’s goal is to empower women and their families by reminding them that they already have everything they need to master the challenges of pregnancy and birth,” says Julie Schochet—my Taos midwife and now a dear friend. In almost all industrialized nations, with the exception of Canada and the US, a pregnant woman’s primary caregiver is a midwife.² In the Netherlands, 70 percent of women choose midwives for their care, and 30 percent of births take place at home; many Dutch women never see a doctor during their pregnancies.³ In Scandinavia, after an initial visit with a family doctor, 75 percent of women are attended throughout pregnancy and birth by midwives alone.⁴ These countries have cesarean-section rates as much as two-thirds lower than that of the US, and their perinatal and maternal mortality rates are among the lowest in the world.⁵

Studies undertaken in California, Scotland, Canada, and for the US government all concur that midwife care is equal or superior to physician care for low-risk women.⁶ The World Health Organization (WHO) recommends that midwives should be the principal providers of care for pregnant women, followed by family doctors, with obstetricians involved only in cases of clinical necessity. (Significantly, the International Confederation of Midwives’ [ICM] International Definition of a Midwife, which WHO endorses, does not require that a midwife have nursing training or operate under the supervision of a doctor.⁷) Marsden Wagner, MD, a former WHO Regional Officer for Women’s and Children’s Health and now an author on the subject of midwifery, compares using an obstetrician for routine prenatal care and uncomplicated births to using a pediatric surgeon to babysit a healthy two-year-old. “Such a babysitter will come with a very high fee,” he writes, “and the costs will be even higher when the healthy baby gets tired and fussy and the surgeon turns to medication to calm things down.”⁸

Yet in the US, obstetricians have a virtual monopoly on childbirth, attending more than 90 percent of births.⁹ We pride ourselves on having the highest standard of medicine in the world, yet in the early years of the 21st century, these highly trained practi-tioners achieved a ranking of only 15th in the world for maternal mortality (a figure that has not improved for 20 years)—and, shockingly, 27th for infant mortality.¹⁰ In fact, a study for the US Centers for Disease Control showed that midwife-attended births had an infant mortality rate 19 percent lower than physician-attended births.¹¹ Clearly, specialized medical training and technology are not the decisive factors in successful childbirth. The midwifery model of care, which emphasizes individual counseling, hands-on assistance during labor and delivery, minimal technological intervention, and extensive prenatal and postpartum care, has proven again and again to result in healthier outcomes for both mother and baby.

For New Mexico, being the poorest state in the union has, in this respect, proved a blessing. As Roberta Moore, Maternal Health Program Manager for the New Mexico Department of Health, points out, “Because almost every county [in New Mexico] is federally designated as medically underserved, there is less competition than there is in many other states. Many areas cannot support enough obstetric providers, so midwives are welcome.” Yet midwives are not just a rural phenomenon. In the state’s largest city, Albuquerque, more than a third of births are attended by midwives; in Las Cruces (pop. 76,000), the figure is over half. Statewide, in 2003, midwives attended 30.5 percent of all births—by far the highest rate in the nation.¹² The cesarean rate was 20.3 percent,¹³ significantly lower than the national figure of 27.6 percent¹⁴—which, in 2003, rose for the seventh straight year.

“Midwives are a safe and cost-effective resource, and they provide options that are not otherwise available,” says Moore.