According to the United Health Foundation, the United States infant mortality rate is higher than the majority of nations within the Organization for Economic Co-operation and Development (OECD). Of the 37 developed nations within the Organization, the U.S. ranks 33 for the number of infants kept alive beyond their first birthday. However, the work of midwives help to drastically improve these numbers.

Though midwives have been delivering babies for hundreds of years, and are a normal part of the birthing experience all over the world, they are still widely unknown and underutilized in the U.S. However, as the country grapples with its maternal health crisis, the importance of midwifery grows more pronounced, especially as this generation of parents demands more autonomy over their bodies.

The relationship between a midwife and patient is one of trust and collaboration, as the patient is an active participant in decisions regarding their health, instead of leaving these decisions solely up to their doctor. Additionally, people who have had negative birthing experiences are increasingly seeking midwives to assist with labor and delivery.

“Midwives have been around for a long time,” said Nurse Midwife Debbra Bersano in a recent podcast. Bersano has joined the Health Care Collaborative (HCC) of Rural Missouri and its Live Well Community Health Centers (Live Well). “Twenty years ago, midwives in the Midwest were just not heard of.”

Midwife certifications vary

Midwives are responsible for the health and safety of their patients, and can provide prenatal and gynecological care, even for people who aren’t pregnant and who aren’t planning to child bear. It’s not uncommon for a midwife to also be a registered nurse, but there are different types of midwives based on training and education.

A nurse midwife is an advanced practice nurse, Bersano said, with a master’s in nursing. They provide prenatal, delivery, and postpartum care, gynecological services and have prescription authority. Bersano said most midwives deliver in a hospital setting. There are also licensed midwives who don’t deliver in hospitals. Then, there are certified professional midwives who are not nurses, acquire on-the-job training, and complete testing prior to certification.

Although there are several levels of certified midwifery, they prove beneficial if medical problems arise, especially during a home birth. Midwives monitor both parent and baby and anticipate potential issues before they arise. However, because childbirth is inherently unpredictable, Bersano doesn’t advocate out-of-hospital births.

“I am going to be honest, I don’t recommend out-of-hospital births,” Bersano said. “Part of that has to do with I was a labor and delivery nurse for so many years, and I know how things can turn on a dime. Everything can go perfect and all of a sudden it is not.”

Bersano alluded to a study conducted in Washington state that compared perinatal deaths during at-home births versus in-hospital births. It concluded there was a higher perinatal mortality at home, but a higher C-section rate in the hospital.

“You can have a natural delivery in the hospital,” she said. “You can request no drugs, you can walk around, and we will monitor you some. I love for my patients to be up and walking, or up on the birthing ball. I want them moving, that is the best scenario for a pregnant woman in labor.”

Critical to the birthing experience

Midwives are crucial to the birthing experience because they allow pregnant people to be hands-on with their care. From the moment a pregnancy test comes back positive, midwives are there to help parents make the healthiest decisions throughout the gestational period.

Midwives aren’t there to force their medical opinions on patients, but they coach, inform, and answer questions. Midwives look out for and recommend treatment for dangerous pregnancy complications, such as preeclampsia, perform physical exams, Pap smears, and other prenatal care.

According to the National Institutes of Health (NIH), mothers who seek the care of a midwife are more likely to have a vaginal birth (less likely to have a C-section) and are more likely to be in labor for less amount of time. Additionally, mothers who go the midwife route are less likely to request an epidural, although the option for one always remains open.

Most importantly, the involvement of a midwife improves infant and maternal health outcomes, as reported by the NIH. Women who opt for a midwife are more likely to breastfeed. In a hospital setting, nurses are unable to remain with parents throughout the entire birthing experience, as they have other patients to care for. The presence of a midwife resolves that issue.

In rural communities, prenatal care can be difficult. As a result, Bersano said too often women delay care. “All the research shows if you have adequate prenatal care, you’ll decrease neonatal intensive care stays and decrease C-section rates,” she said. “One visit in the neonatal intensive care unit is going to pay for a lot of prenatal visits.”

When asked, Bersano said the best way to mitigate maternal and infant mortality rates is “education, education, education. I cannot stress that enough,” she said. “Unfortunately, in the U.S. we also have a high percentage of maternal obesity. Just having that patient understand what you eat is going to affect you and how the baby grows, or whether you develop gestational diabetes (elevated blood sugar levels during pregnancy) will also affect the baby.”

Besides labor and delivery, Bersano said her role also includes making certain patients know what’s available to them. This includes connecting patients with diabetic counseling, nutrition counseling, and smoking cessation support. “That’s a big one for me,” she said. “I like to keep my moms from smoking when they are pregnant. I’d like everyone to quit smoking, and especially when you are pregnant.”

Selecting a midwife

Before hiring a midwife, it’s important that parents know exactly what they’re looking for. Important qualities include someone who strongly advocates for their patients and the decisions they make.

Bersano talked about this during a recent HCC/Live Well podcast. “I tell my patients, ‘This is not my baby. This is not my body. You need to tell me what you want out of this delivery and out of this pregnancy.’ As long as it is medically safe, I have no problem.” Bersano urges parents to ask questions – will this midwife try to make a parent go against their birth plan, even if there’s no pressing medical need to do so? If the answer is yes, they might not be the best match.

Pregnancy and childbirth represent pockets of times when people are at their most vulnerable, and the type of care they receive could be a matter of life or death. Having a midwife in the room might seem antiquated or old-fashioned in the modern world, but the importance of their work is so great that it cannot be quantified.
Bersano is currently accepting patients for prenatal, postnatal, gynecological, perimenopause, and post-menopause appointments. Contact the Live Well Community Health Center – Lexington to schedule a visit, 660.251.6440. To learn more about HCC and its Live Well Centers, visit