HJNO Jan/Feb 2025

MIDWIVES 38 JAN / FEB 2025 I  HEALTHCARE JOURNAL OF NEW ORLEANS   pause — are normal. Midwives engage in shared, informed decision-making that honors the patient’s autonomy. While it is a misconception that midwives do not use technology, they do support engaging in the appropriate use of technology, mini- mizing intervention unless necessary, and honoring the process of physiologic birth. 15 MIDWIVES AND PHYSICIANS WORKING TOGETHER In a joint statement in 2011 and revised and reaffirmed in 2022, the ACOG and the ACNM stated that OB-GYNs, CNMs, and CMs are “educated, trained, and licensed independent clinicians who are experts in their respective fields of practice and work in mutual collaboration to optimize care for individuals they serve.” Further, the “[q]uality of care is enhanced by colle- gial relationships characterized by mutual respect and trust; professional respon- sibility and accountability; and national uniformity in full practice authority and licensure across all states.” 16 Therein lies the key — trust between physicians and midwives and collaboration when needed depending on the patient’s needs. In spite of what we may read in the media or see played out in TV shows, the majority of births are low risk with little to no inter- vention required. That said, in the setting of complications, midwives have been educated to recognize and manage diffi- culties as they arise, as well as when they need to call for a physician. Midwives are also more likely to serve populations that often have poor outcomes secondary to the effect of social determinants of health. For example, midwives attend births in one-third of rural hospitals in the U.S. 17 In Louisiana, while CNMs practice at some hospitals, the majority of hospitals do not have CNMs attending births in their obstetrical units. Ochsner Health is the largest employer of CNMs in the state, with sizable midwifery practices in both Baton Rouge and New Orleans. Ochsner Baptist in New Orleans houses an along- side midwifery unit called the Pekin Al- ternative Birthing Center. An alongside midwifery unit is defined as a birthing unit housed within a hospital that provides labor and childbirth services, located in close proximity to the labor and deliv- ery unit either in the same building or in a nearby building. Ochsner’s alongside unit is one of only four such units in the country. The majority of birth centers in the U.S. are free standing, meaning neither attached to a labor and delivery unit nor inside a hospital. Freestanding birth cen- ters that meet the rigorous accreditation standards of the American Association of Birth Centers (AABC) have excellent safety records and outcomes. The AABC website lists three Louisiana freestanding birth centers as having achieved accredi- tation — the Birth Center of Baton Rouge, Shreveport Birth Center, and the Natural BirthHouse in Lafayette — with two oth- ers in the process of achieving accredita- tion — Grace Midwifery Collective in Slidell and Saige Birth Center in New Orleans. Other hospitals in the state welcom- ing midwives include Baton Rouge Gen- eral, Touro, North Oaks Medical Center in Hammond, Terrebonne General in Houma, Our Lady of the Lourdes Re- gional Medical Center in Lafayette, and Beauregard Health System in DeRidder. Vedam, et al., developed a scoring sys- tem to measure the integration of mid- wifery in each state called the Midwifery Integration Scoring System (MISS) and subsequently assigned states a MISS score. 18 The system assessed two compo- nents in composing the score: the level of integration of midwives in the state as well as regional access to high quality mater- nity care. Each state was ranked on a 50- item scale, with no state achieving 100, the highest possible score. In the study, higher MISS scores were positively associated with significantly higher rates of physi- ologic birth, lower rates of obstetric inter- ventions, and fewer adverse neonatal out- comes. Scores ranged from 0 to 100, with a score of 100 indicating that a family in that state would have full access to high qual- ity maternity care in all settings without third-party payer — health insurance or Medicaid — restrictions. The highest score also indicated that all maternity care pro- viders in the state, including midwives, are regulated and have legislative authority to practice to their fullest scope in a variety of settings where births occur such as homes, hospitals, and birth centers. Additionally, providers in states with the highest scores had the highest rates of collaboration with other healthcare professionals. The state with the highest MISS score in the study was Washington with a score of 61, and the lowest ranking state was North Carolina with a score of 17. Louisiana’s MISS score was 28 of a possible 100 with a state rank- ing for integration of midwifery of 37. Some of the 50 items that states were ranked on included preterm and spontaneous birth rates, breastfeeding initiation, and neona- tal death. To highlight a few of the indica- tors used in the MISS rankings in context of recent statistics, currently only approxi- mately 3% of Louisiana’s births are attend- ed by midwives, compared to the national average of 12% (12% in the state of Wash- ington). The 2022 cesarean section rate in Louisiana was 35.5% compared to 32.1% nationally in the same year. In 2022, Loui- siana’s preterm birth rate was 13.3%, more than double the national average of 7.6%. In summary, midwives have been pro- viders of high-quality care around the globe for centuries, with a well-established track record of excellent outcomes. Mid- wifery is a standard of care in many coun- tries that have maternal child outcomes far superior to those of the U.S. They are a solution to the shortage of OB-GYN providers, particularly in rural and un- derserved areas. The women of Louisiana deserve the care that midwives can de- liver … pun intended. There are numerous