The culture war between doctors and midwives, explained

The culture war between doctors and midwives, explained


It’s one thing to lose our patients to doctors
but to those charlatans? It makes me sick. That’s an episode of the Mindy Project,
in which a fight brews between Mindy Lahiri – a doctor – and a midwifery practice. Midwives! Who the hell do you think you are? Let’s say I have a heart attack. How would you handle that? Would you, uh, rub eucalyptus leaves all around
my chest, huh? This is an exaggerated sitcom plot, but the
idea points to a long-standing culture war between doctors and midwives – that’s rooted
in race and class in America. Alright, ladies. Let’s go downstairs, let’s set up appointments with some real doctors. Midwifery is an incredibly common practice
in a lot of countries. In the UK, midwives deliver about half of
all babies, including Kate Middleton’s. In Sweden, Denmark and France, midwives oversee
around three quarters of births. But here in the US, they participate in
less than 10 percent of births. In these countries – the ones that tend to
rely on midwives more frequently – maternal mortality rates are a fraction of America’s. In fact, maternal mortality has risen in the
U.S. as it has declined elsewhere. So if midwives are popular and effective in
many other industrialized countries, why is the U.S. medical system still wary of them? The answer is complicated. For most of human history, babies were delivered
by midwives. Midwifery can be found in the Old Testament. They were respected for bringing their knowledge
and training to childbirth. In America, midwives were integral to both
indigenous and immigrant groups. And in the South, they known as “granny
midwives.” Midwives have always existed. It’s just that we have changed over time. That’s Patricia Loftman, a midwife of 37
years and a member of the board of directors for the American College of Nurse-Midwives. When you look at midwifery, say in the time
of enslavement, the midwife was actually the person who made certain that women were able
to produce healthy babies. Now, after slavery ended she was no longer valuable because she
was not making certain that there was a continued slave labor. I want you to
meet Mrs. Mary Coley. A midwife who lives in Albany, Georgia. Generally in the South, most of these women
were black women taking care of women, both black and poor white, because during the days
of segregation you could not access hospitals. In the mid-to-late 1800s, the professionalization
of medicine became a major trend, and male doctors began taking control of childbirth
away from female midwives. It was determined that in order to get women
into the hospital, you had to get rid of these midwives who were taking care of all of these
women in the home. All of these women who had been attending
births all of these years, they were blamed for maternal deaths, infant deaths. Two days ago a
baby, delivered by a midwife, died, when it ought to have lived. My examination showed that its cord got infected. And you all know what that means. Something wasn’t clean. Joseph DeLee of Chicago, the most influential
OB-GYN of his day, called midwives, “relics of barbarism” and “a drag upon the science and
the art of obstetrics.” In the South especially, much of the attack
on midwifery was rooted in race. One Alabama doctor dismissed black midwives
as having “fingers full of dirt and brains full of arrogance and superstition.” Some states outlawed home-birth midwives,
while most others created new regulations that made it harder to enter the profession. By the 1950s, a vast majority of women gave
birth in hospitals, attended by doctors. But something changed in the 70s: Middle-class
white women wanted more of a voice in their maternity care and that led to a rise in midwifery. Except this time, most midwives were white women. The US currently has around 15,000 certified
midwives. It’s a growing profession, but still overwhelmingly
white. Just about 5 percent of the nation’s midwives
are women of color. In addition to being from the community and
understanding not only linguistically and culturally what women need, midwives of color
protect women in a system that is hostile to them. With black mothers three to four times more
likely to die from causes related to pregnancy or childbirth, there’s evidence that empowering
midwives might change outcomes for moms and babies. Researchers found that some states have clearly
done more to integrate midwives than others. And while there are many factors that can influence maternal and infant health, many states with the least integration also had some of the highest rates on key indicators including premature births, neonatal mortality, and C-sections. In recent years, groups like the American
Congress of Obstetricians and Gynecologists have become much more welcoming to licensed
midwives. We’re all in this together. But that hasn’t resolved the culture war
between doctors and midwives just yet. There is a role for a midwifery and physician
collaborative relationship. We’re not enemies. We are colleagues who need each other. Thanks for watching! ProPublica has been reporting on the disparities
in maternal mortality in the US, and how it’s the most dangerous industrialized country
in which to give birth. There’s a lot more to the story of midwives
in America that we couldn’t fit, including the current barriers to entry that a lot of
midwives – especially midwives of color – face in certain states. For more on that and ProPublica’s latest reporting
on maternal health, click on the link below.

100 thoughts on “The culture war between doctors and midwives, explained

  1. 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: http://bit.ly/2IYSvVw

  2. 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?

  3. Nurses advocate more for patients than doctors, on any floor.

    And it simply because we spend more time with patients.

    We, nurses can make the dr take a blood gasses using doppler( To increase chances to find the artery) instead of blindly poking and hurting patients.

  4. Ok back up for a bit
    When theres a shortage of midwives as a whole dont bring race into it
    Theres 15000 of them it doesnt matter if they are white or black atlesst theyre there

  5. Idk man…if my wife was having a baby…I would much rather take her to the hospital with professionals, adequate equipment and instruments and emergency protocols than to invite some old woman over at home..who's qualification is based on what she has practiced by observing others of her kind and not extensive scientific research

  6. How does everyone involved with this channel not realize that "people of colour" is just a fancy way of saying "coloured people"?

  7. I've lived in the US my entire life and everyone is always shocked to find out I was delivered by a midwife and not at a hospital. I never realized that it was so common in other industrialized countries, I just thought my family was weird

  8. Wait but… I thought midwives were only responsible for births. Why does Mindy talk about heart attacks then in the beginning, then?

  9. 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.

  10. I'm actually going to take this video as a blatant attack on science, logic, reasoning, and true dialogue/debate. Awful video vox. Next time come with an actual report and argumemt.

  11. Midwifery is a qualification you can get in most countries- what is going in USA?
    Edit: no way would I want a male doctor- just too embarrassing

  12. well sum reasons for us having a higher mortality rate and it going up in our nation is because we have a higher population, less ppl educated about sex and pregnancy, more ppl who dont believe in medicine and vaccines, etc

  13. I always thought midwives were a normal thing and there still midwives in hospital working with the doctors at least in Denmark

  14. I’m a little confused at the progression of your video… first you compared midwives to doctors. Then by the end you were comparing white midwives to black midwives. And there was a lot of history in the video, but the facts didn’t really run full-circle to tie everything together. It seems a lot of your audience is confused what your conclusion is, and that’s no good.

    Also, why not compare to Canada, a country which likely uses the same amount of midwives as America, but also has universal healthcare, and see what the difference is there? And, there being far less racial history in Canada, what effect that has had in comparison to the US? Considering the childbirth cultures between Canada and US are very similar, perhaps comparing those two would provide much more relevant and useful information. All said and done, it seems much of your audience is concluding the mortality rate is connected to the healthcare system, rather than institutionalized racism.

  15. This is a terrible and biased video. You make it sound like the lack of midwives are the only reason why maternal fatality is higher in the US. It is much more complex. How about the different health Care coverage? Health insurance? Social programs that are much more available in many European countries? Never mind that the education and training for midwives is drastically different in North America than in Europe.

  16. 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.

  17. In South Africa, midwifery is one of the qualifications a person needs to become a senior registered nurse. Said another way, you can only become a midwife if you're a nurse first, which I think works well

  18. There are actually many midwives who are well trained nurses with bachelor's degrees. I dated a girl in college who was becoming one and told me all about it. The pay is crazy, suburban white woman are willing to pay out the nose for midwifery services.

  19. I lived the first 30 years of my life in the US and thought midwives were an irrelevant relic of the past. I now live in the ME and see that it’s really just a US perspective. Midwives are extremely common on the other side of the world. There is a place for doctors ofcourse, but midwifery has been modernized and is very safe and even at times better then a doctor. But of course it should be the expectant mother’s choice.

  20. 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.

  21. 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.

  22. . Midwives in America do not undergo the same training as other countries standards vary state to state. It is more dangerous to go with a midwive in the USA because of this. You are showing one half of a very big picture.

  23. The thing is, in America, you have to be trained to be called a midwife. Mortality rates among mothers is higher when you end up with on of these midwives.

    It can be done safely, but you need to make sure that your midwife has credentials.

  24. This video is informative because as a French, I didn't even know it was possible to give birth at a hospital without the help of a midwife. That's such common practice here, never thought it could be otherwise.

  25. … but the UK’s population is only a fifth of the US’s? The US has the 3rd largest population in the world, so more people obviously would lead to higher mortality rates. That much should be obvious.

  26. That statistic you pulled up about maternal mortality is 6 years old. I would like to see a more recent study.

  27. 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

  28. Can't we just agree that lack of insurance AND midwives are responsible for the infant/mother mortality rates. I mean I honestly wouldn't trust a male alone to deliver my child (if the doctor was male)

  29. 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.

  30. In Algeria , being a midwife is really really difficult , 5 years of studies , she would stay in hospital for several days it's a real hard job that most girls nowadays refuses to chose it , we have a huge lack of them which makes the actual midwives job more difficult. I'm a pharmacy student and I can see their struggle everyday

  31. … nothing about how for centuries, birth was something WOMEN dealt with amongst themselves? No analysis of how GENDER was a major factor in why midwives were viewed as simple and stupid while women were barred from practicing medicine, leaving men to think that (despite not helping with birth for the entirety of human history up to that point) they now had better knowledge than these "stupid simple women" and why on earth would they listen to midwives? I appreciated the racial analysis, as that was an important element of it I definitely didn't know about, but the gender factor, which seems like a HUGE factor in the history of midwifery vs doctors, is just completely ignored, which imo makes for an analysis with gaping holes.
    You also didn't mention Canada, where the stats on midwifery usage are more similar to the US (maybe it's a little more common) yet the maternal mortality rate is much better (HALF that of the us. HALF!). I see no reason to exclude Canada in this analysis; it's very similar to the US in a multitude of other ways.
    In my experience, midwives in the european countries you mentioned also have higher standards for their education for midwives… where I live, midwives receive 2 years of training straight out of high school, where a 52 in high school biology and other courses is good enough for them to get in. So I want to view midwifery as a positive, but when it comes to someone with 8 years of training vs someone who barely passed high school biology and got a 2 year diploma, I think I know who I'm going to choose for something as risky as birth. (it has been pointed out to me that midwives may fill gaps where I am, ie. women can see a midwife more easily than a doctor, they can help more after the baby is born, they may be able to provide other support women need that doctors can't give… i just don't believe that support, in my location, extends to the birth process itself).

  32. Very poor, lazy statistical conclusions. You show the US birth mortality rate, then say it has to do with the lack of midwives, then later show a graphic in the disparities between the mortality rates of black and white women that very clearly shows white women's birth mortality is very close to the other industrialized nations. Clearly a very large factor in our birth mortality rate is higher proportion of people of color combined with higher inequality. I'd venture to guess that a middle-class white woman in the US has a better birth mortality rate than a middle-class white woman anywhere else in the world, including midwife countries.

  33. I'm from the UK where doctors and midwives work hand-in-hand. It seems bizarre to me that America is almost against midwifery and sees it like some type of airy fairy nonsense

  34. What is wrong with having 5% of midwives black? isn't that the approximate proportion of black women in US population? Stop making things seem more racially motivated than they are… but then again it's vox.

  35. I'm an American, Australian, and New Zealand registered nurse (RN).
    In the US, licensed and certified midwives need to have training as a registered nurse before going to get a graduate degree education on midwifery. They're called certified nurse midwives (CNM). They have to go through nursing school for a bachelor level education, and then to a graduate program that trains in midwifery, so yes, they are a midwife and an RN altogether in the end.
    My understanding is that other countries have it where you don't need to go to nursing school to be a midwife. This can partly be an issue in the US where midwifery education requires a nursing education even if they have RNs who specializes in maternity/labor and delivery or even doulas besides not having universal health care.

  36. I’m a 20 yr old in the US and i had my daughter all natural with a midwife at a hospital. I would never pick an OB over my midwife. America has such a high rate of infant death it’s sad. Doctors don’t care, they push vaccines and medicine, they push induction, they push elective c sections in cases that midwifes and doctors alike could deliver babies as is etc breached doctors would opt to use surgery or forceps because it’s easy for them. We also have horrible maturity leave and no paternity leave

  37. I’m so tired of here that America has problems, trust me I know health care sucks I have lived their. I need news of Canada since I’m living here, the old news are going have to do.

  38. This went from science and medicine to the color of skin having something to do with birth come on vox

  39. As a Brit its CRAZY to me that midwifes are not a main part of the pregnancy and birth process. I would never trust a random doctor over a specialist midwife, and in British hospitals the maternity ward really is the realm of midwives, with doctors only being bought in for extreme cases or for surgery. America is bonkers

  40. “Rooted in race and class”

    Bullshit. That may have been the case in the past but today it is “medical degree vs tradition”. Tradition is bullshit. I want my science.

  41. Ummm, Singapore too has a lack of midwives but I don't recall having high infant mortality rates….the interpretation is quite off from the data presented

  42. why was America the only country used when comparing doctor delivery to midwife delivery. Isn't this just blatant cherrypicking? why werent other examples such as australia or new zealand used?

  43. Midwives would be a cheaper alternative for poorer people and would put less strain on doctors but what we really need is better sex Ed and healthcare

  44. I thought it was going to give evidence that midwives reduce infant mortality beyond just a correlation between infant mortality and midwives.

    It didn’t give us any specific reason that midwives would be better than doctors in making birth safer.

    I’m open to the idea, but this didn’t win me over.

  45. Wow. They missed a lot of key information that made this video really misleading. Like that midwives are also mostly unregulated and there's a HUGE difference between a nurse midwife and a midwife. Also, the riyals may have had a midwife present at their delivery, but don't think for a SECOND that they didn't also have a team of doctors there. Additionally midwives should never be the sole care provider for a pregnant women, and a plan should always be in place to seek medical help if needed during the delivery.

  46. Midwifery need to encouraged and boosted back into the birthing room. My dad’s life was saved because of a midwife. He nor the midwife were black and did not live in the south. Why on earth did this turn into a skin color thing? Why no information about maternal drug abuse and obesity? Midwives can make a difference but what a strange angle to go, Vox.

  47. HOLD IT. Midwives nowadays are pretty much specialized nurses, and even then they assist a doctor (and that's exactly what Ms. Loftman said at the end: they're not enemies, they are colleagues). Midwives back then were not medical professionals and they had to doctor to supervise them. So just because the name stayed the same, you shouldn't pretend that they are the same thing.

  48. This video is terrible. It implies that our high maternal mortality rate is due to a lack of midwifes but doesn't even bother to give a causal reason for that.

  49. This is so weird, in the UK midwives are regulated and trained in the same manner as nurses. Also, a doctor has 5 years of training which has to cover all aspects of health, but a midwife trains for 3 years in a specialised subject, they are experts in their fields.

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

  51. Midwives can only care for stable births and any time a complication occurs a doctor takes over. Simply put doctors are better and safer

  52. The mortally rate is recorded differently in the US then the rest of the world. If they use the same criteria our mortally rate for babies is lower.

  53. 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.

  54. I’m American and I used midwives through Planned Parenthood. Although, I think there are many reasons why maternal mortality is higher in America—obesity, drugs, lack of healthcare…

  55. I’m shocked since in the uk from the time a woman is pregnant to until she gives birth she’s in a midwife’s care, I could not thank those midwifes enough for taking such good care of my mum when she had my baby sister and me

  56. It's not like the midwives in Europe are taking over from doctors. They work together. I will be having one or two midwives plus a doctor when I give birth. They act as more personalized care and an advocate for the mother.

  57. Learning about bacteria and infection was revolutionary I understand why they didn’t like the midwife. Old school midwives had a lot of valuable knowledge but also hard clung on to superstitions that either didn’t help or could be detrimental. I really feel they over emphasize the racism as to why midwifery fell out of favor. The attitudes towards midwives have always been mixed. Midwives didn’t just deliver babies, they did fertility charms, abortion, mended maiden heads, and some basic gynecology. When it came to hunting and killing witches midwives were the most vulnerable to be attacked. They were kind of seen as a necessary evil. I would say the sexist attitudes towards midwives has a much longer history than racism.

  58. wait, midwives are not a common thing in the US? i live in germany and for us it’s such a common thing to let a midwives attend a birth. there are actually not enough midwives here because for german women it’s important to let a midwive attend their birth

  59. This video fails to note that in the same period when OB/Gyn took over the delivery process……life expectancy doubled and a large portion of this was the plummeting of maternal mortality….so while midwife delivery is an option for uncomplicated births…..this video makes it seem like ob/gyn's are inferior and there is no reason to believe this is true

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