I noticed an obvious trend in my midwifery practice, and to confirm my findings I reviewed my client stats over the last four years with my summer intern, Alyssa Prince, who is studying Biology and Society at Cornell University. Upwards of 66% of my clients transferred into my practice after starting prenatal care with OB’s or other midwives, and this means that approximately 2 out of every 3 women I have cared for were dissatisfied with their previous provider. In 2018, 70.59% of my total client list transferred in; in 2017, 63.6%; in 2016, 73.3%; in 2015, 53.8%.
My transfer rate correlates with the increasing nationwide rise in midwife attended births, as reported by the CDC and ACNM (American College of Nurse Midwives). More women are now working with midwives to give birth, which correlates with my increasing transfer rates. In 1990, 3.9% of all births in the U.S. were attended by midwives, and in 2014, the rate was 8.3%. That is a 4.4% increase in midwife attended births, almost doubling the number of midwife attended births in 24 years.
Women are transferring into my practice between 12 and 34 weeks and here are some of their reasons:
-“I realized my provider was not philosophically aligned with my birth preferences.”
-“I started with my GYN since my first period, and then was discouraged when I heard about his birth statistics and c section rates.”
-“I was not heard or listened to, and my questions were not taken seriously.”
-“There was a lack of communication and I felt rushed with short visits.”
-“My OB/GYN was encouraging me at every visit to plan a c section and I had no high risk problems”.
-“My provider never put their hands on my belly, and relied exclusively on ultrasounds.”
-“A friend/relative/doula recommended you, I loved your website, and here we are.”
-“When I met you, you did everything different! You talked to my unborn baby, and asked permission to even touch my belly.”
-“Since talking to you on the phone, you have been my safety net.”
When I ask women "why are you transferring so late?” I often hear, “I was so busy at work,” or “I thought it would get better.” But this mindset is not optimal for several reasons. Thirty four weeks of being in a stressful physician - client relationship is thirty four weeks of stress which impacts your life, nutrition, hydration, baby’s well being, and birth outcome. Additionally, most midwifery practices could be full and would be unable to accept you as a new patient in your third trimester. This possibility could lead to further stress from running around looking for a new provider. Doulas are often hired as a solution for a less than ideal and impersonal relationship. Doulas are wonderful but are not medically trained, so it’s best to hire one who will work alongside your unified birth team.
If more healthy, low risk women started their prenatal care with a midwife rather than transferring in their late second or third trimesters, they would feel well taken care of right from their first visit. If women do their research early on, they can establish a relationship of trust and confidence with a qualified midwife or group of midwives and get holistic care with focus on prevention and natural approaches to pregnancy wellness.
When a woman has an extremely high risk medical condition, she needs obstetrical care and a surgeon who is qualified to care for her medical condition, and not a midwife. There are many excellent, highly skilled obstetricians nationwide. If a woman has a preexisting high risk medical condition, or one develops during the course of the pregnancy, depending on what it is, she can be co managed with an obstetrician, maternal fetal medicine specialist, or other specialty providers while still having a midwife as her primary care provider. This an option that many women are not necessarily aware of. When I worked and collaborated for 15 years with the late Dr. Andrew Garber, he would fondly recall his days working on the labor floors in Ireland. He said, "the midwives ran the labor floor and they would call in the OB’s only if they needed a c section. It was a positive midwife/physician collaboration.”
In my solo, small, New York City midwifery practice, I strive to get to know my clients well, and this creates a strong bond where women feel safe, nurtured, and well guided. Trust develops and she will take direction from me as her midwife as though I were her dear friend or wise auntie. I limit my number of deliveries per month to ensure women get what they were missing from their prior provider - personalized, one on one, individualized care. If I have room in my birth schedule, I will accept late transfers as I truly have compassion for them as they realized their strained provider/client relationship. As they say, ‘better late than never’, however transferring in at 34 weeks means 34 weeks of catch up.
The midwifery model of care is a path to less interventions and c sections, whether the birth be in a hospital, birth center, or at home. Midwives see birth as a natural highlight in a woman’s life. They do not see pregnancy and birth as an illness that needs to be treated or fixed, as the medical model of care does. If you have been thinking about switching to a Midwife, you are a part of a noteworthy rising pregnancy trend and will become a positive statistic.
I hope you found this useful.
Do you know anyone who is a part of this trend?