Dear Producers of The Today Show,
A real opportunity to educate women about safe and high-quality maternity care in the United States has been lost. The American College of Nurse-Midwives (ACNM) is extremely disappointed with the imbalanced reporting done by The Today Show’s September 11 segment “The Perils of Midwifery.” The segment (later renamed “The Perils of Home Births” online) highlighted a single tragic story of a family’s loss of their baby during childbirth at home with a midwife. Our hearts go out to the McKenzie family. We hope that they are receiving the support they need in this extremely difficult time. It would be inappropriate for ACNM to comment on the specifics of this situation. What we can say is that adverse outcomes can happen in any birth setting. Sometimes they are preventable, and sometimes they are not. Health care providers in every setting—home, birth center, or hospital—know the tragedy of loss.
In telling this story, The Today Show failed to do the research needed to provide insight on either homebirth or midwifery, relying instead on a series of sweeping, misinformed statements. Women choosing midwifery care were described as simply following a fashionable “trend” made popular by celebrities, rather than as women making thoughtful, well-considered decisions. Childbirth “without drugs or doctors” was labeled “extreme birth,” decades of published research on perinatal outcomes were ignored, and the midwifery profession overall was badly misrepresented.
Certified nurse-midwives (CNMs) and certified midwives (CMs) are well-educated, licensed, and certified health professionals who are experts in normal birth and women’s health. They provide comprehensive care during pregnancy, labor, and childbirth. They practice as independent providers within a health care system that provides for consultation, collaborative management, or referral as needed, with physicians and other health professionals. Their skillful, attentive care maximizes the likelihood of a healthy baby, a healthy mother, and a satisfying birth experience. In 2006, CNMs and CMs attended more than 317,000 births in the United States—nearly 11% of all vaginal births—in hospitals, birth centers, and at home. Overall, midwife-attended births have increased by about 33% in the past ten years.
This rising popularity of midwife-attended births has been supported by a growing body of research demonstrating that the best outcomes for low-risk women occur with midwifery-led care, continuous support, and low-technology strategies during labor. Unfortunately, women in US hospitals are not routinely provided with these options. Most Americans would be surprised to learn that, in spite of a vast array of technologies and medical interventions, the US has nearly the worst maternal and perinatal death rates in the developed world. This fact is a major reason why women are seeking alternatives in childbirth.
A review of the published research on childbirth reveals that midwives are leading providers of maternity care in most developed countries, and that midwifery care is an excellent option in the US. Here are just a few research–based publications from the past year alone:

* Evidence-based Maternity Care: What It Is and What It Can Achieve cites several systematic reviews showing improved outcomes associated with midwifery-led care.

* A recent Cochrane Review concluded that midwifery-led care is the best option for women with low-risk pregnancies.

* An April 2009 British Journal of Obstetrics and Gynaecology study concluded that planned homebirth is as safe as a planned hospital birth for women with low-risk pregnancies.

* Authors of two recently published studies from two different Canadian provinces (September 2009 Canadian Medical Association Journal and September 2009 BIRTH) concluded that women who planned homebirths attended by a registered midwife had outcomes that were at least as good as women who planned hospital births.

Lastly, also missing from this story was the voice of ACNM, the professional association representing most midwives in the United States, as well as the voices of those who have dedicated their lives to improving the health and well-being of women and infants by promoting evidence-based maternity care. If we had been consulted, The Today Show would have been in a better position to deliver useful information to women and families about their childbirth choices.
ACNM urges The Today Show to produce a different story—a well-balanced account of midwifery and what current research tells us about the risks and benefits of childbirth in homes, birth centers, and hospitals. We welcome the opportunity to participate in such a story. In the meantime, we urge families to focus on educating themselves to make the healthiest and safest decisions for themselves and their babies. The research clearly shows that a midwife is an excellent choice.
American College of Nurse-Midwives
Enclosure: Evidence for Midwifery-Led Care and Planned Homebirth

Evidence for Midwifery-Led Care and Planned Homebirth
Resources for Additional Reading from the American College of Nurse-Midwives

* ACNM Online Media Kit contains essential facts about midwives, birth statistics, state-by-state trends, evidence-based research, and more.

* Homebirth: Resources for Payers and Policymakers outlines the research on homebirth.

* ACNM Position Statement on Homebirth outlines ACNM’s official stance on homebirth.

* ACNM Homebirth QuickInfo answers a variety of questions related to homebirth, including finding a homebirth practice, insurance reimbursement, and legal guidelines.

* ACNM Clinical Bulletin on Homebirth gives guidelines for health care professionals providing homebirth services.

* Choosing Your Care Provider outlines questions women and families should ask when choosing a midwife or other birth care provider.

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