A new study from the University of Minnesota School of Public Health finds pregnant women who are assigned a health care provider for their pregnancy – as opposed to selecting a care provider themselves – have a higher chance of receiving prenatal care from a midwife. Moreover, women who have a midwife as their prenatal health care provider report having fewer communication problems than women who receive care from different types of clinicians. This suggests that the assignment of a default midwifery care option for low-risk pregnancy care may result in better patient-clinician communication during pregnancy and childbirth.

The results of the study were published today in Maternal and Child Health Journal. The study uses data from the Listening to Mothers III survey, a national sample of 2,400 women who gave birth in U.S. hospitals in 2011 and 2012.

“Good communication and informed decision-making are cornerstones of high-quality, patient-centered care,” said Katy Kozhimannil, Ph.D., M.P.A., lead author and assistant professor in the School of Public Health. “In this study, we found that women who saw a midwife for pregnancy reported that they were more likely to ask questions during their visits, had a better understanding of the medical words being used, and more often felt that their care provider spent enough time with them.”

The study reports that women whose maternity care provider was assigned to them had a 63 percent greater chance of having a midwife rather than a physician. Also, pregnant women with a strong preference for a female clinician were more than twice as likely to have a midwife. While many women reported communication problems, such problems were only about half as likely to be reported by women who had midwives, compared with women who saw physicians.

Specific findings:

• 24.1 percent of women who saw physicians held back questions because they didn’t want to be difficult, compared to 14 percent of women who saw midwives.
• 30.1 percent of women who saw physicians held back questions because they felt rushed, compared to 24.3 percent of women who saw midwives.
• 53.6 percent of women who saw physicians said their provider used medical terminology they didn’t understand, compared to 40.3 percent of women who saw midwives.
• 47.7 percent of women who saw physicians said their health care provider did not encourage them to talk about all questions and concerns, compared to 36.7 percent of women who saw midwives.

The findings are relevant to current policy discussions about improving the quality of maternity care in the United States. In December 2014, Britain’s National Institute for Health and Care Excellence (NICE) recommended that all healthy women with uncomplicated pregnancies give birth under the supervision of midwives rather than physicians. In the wake of the NICE recommendation, a New York Times editorial called for greater access to midwifery care in the U.S. While these recent recommendations were based primarily on clinical evidence, the results of this study indicate that pregnant women cared for by midwives may also experience benefits beyond health – including better communication with their providers.

With nearly 4 million American women giving birth each year, improvements in patient-provider communication could have a big effect across the country.

“Moving forward, one possibility suggested by these findings is greater use of a default midwifery option for pregnancy care for low-risk women, coupled with strong consultation and referral networks to ensure that women receive specialized care when complications arise,” said Kozhimannil. “Taken together with evidence on midwifery care’s quality and safety track record, our research implies that this kind of systems-level reform has potential to enhance communication and improve women’s birth experiences.”

~ Post by Matt DePoint, Academic Health Center