April 21, 2011

U.S. Trends in Midwife-Attended Births

A new article in the March/April 2011 issue of The Journal of Midwifery and Women’s Health (from the American College of Nurse-Midwives) describes trends in the percentage of U.S. births attended by midwives from 1989 to 2007.

Author Eugene Declercq looked at birth certificate records through the CDC’s VitalStats tool. Of course, it is possible (as the author notes) that there may be some misclassification, missing data, or other errors associated with birth certificate data. With that in mind, the findings were as follows:

  • The percentage of live births attended by certified nurse-midwives (CNMs) increased from 3.3% in 1989 to 7.7% in 2002, and decreased slightly to 7.5% by 2007.
  • The percentage of vaginal births attended by CNMs increased from 4.8% to a high of 10.8% in 2006, decreasing slightly to 10.6% in 2007.
  • The states with the highest proportion of CNM-attended births in 2007 were New Mexico (28.5% of all births), Vermont (18.3%), New Hampshire (15.4%), Oregon (15.3%), and Maine (15.1%).
  • The states with the smallest proportion of CNM-attended births were Arkansas (0.6%), Louisiana (1.4%), Alabama (1.9%), and Mississippi (2.0%).

The author does not attempt to fully explore possible explanations for any of the trends – the slight decreases of the most recent years, continuous increases over most of the examined time period, or geographic disparities – such as availability, awareness and attitudes, the cesarean section rate, or other factors. However, the data may be useful for those interested in women’s use of CNM services for birth or the history of CNM-attended births in the United States.


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