Midwives decrease C-section rate in New Jersey

March 28, 2005 -- Today the Courier News (New Jersey) ran a generally very good piece by Stefanie Matteson about the midwifery program credited with helping the Muhlenberg Regional Medical Center achieve the state's second lowest rate of Caesarian sections, despite serving a low-income urban patient population that is more likely to have high-risk pregnancies. The article highlights the midwives' care model, presents key data and includes good comments from relevant persons, though it could have focused a bit more on the midwives' clinical skill, as opposed to the admirable "cultural climate" they create.

The piece starts with the bottom line: while New Jersey's overall 2004 C-section rate was 33.1%, the nation's highest, Muhlenberg's rate was just 22%, the second lowest in the state. That helped the hospital garner a high ranking in obstetrical care from a leading national health care quality assessment firm. The piece rightly notes that this is even more impressive because Muhlenberg serves a low-income population that is less likely to get good prenatal care, and more likely to experience the high-risk pregnancies that often lead to C-sections. About 66% of the hospital's 2004 deliveries were performed by nurse midwives. Muhlenberg chief operating officer Nancy Fiamingo attributes the low C-section rate directly to the "cultural climate" created by the midwifery program at the Plainfield Health Center, which refers maternity patients to the hospital. The piece reports that the health center was founded in 1969 under the Model Cities Neighborhood Program "in part because of extremely high infant mortality rates." It then observes--in a remarkable sentence that would have been a good subhead--that the "health center's largely low-income patients may now be receiving better obstetrical care than patients at hospitals in affluent communities, where Caesarian rates are much higher." And (we note) this has occurred despite the midwives probably having on average fewer years of formal education than the obstetricians who typically provide more of the care in such affluent communities. It's enough to make us wonder if the number of years of formal education is not the only factor in clinical ability, and if the practice model and type of education and experience could also matter. In any case, these results are consistent with the many studies showing that the care of advanced practice nurses is at least as good as that of physicians.

The piece then provides some helpful background about midwifery. The Health Center's spokeswoman Andrea C. West notes that mothers receiving "collaborative midwifery" spend less time in the hospital, in addition to having fewer C-sections. Shirley White-Walker, chief of midwifery at the Health Center, reportedly notes that the midwives--"along with a team of experienced nurses, obstetricians and pediatricians that provides full-time back-up support"--have the "patience" to pursue the "natural birthing process." She is quoted as saying that the midwifery model of care is "basically noninterventionist," and that because of the experience of the midwives and nurses, patients are more comfortable and need less medication. The piece briefly describes the experience of a Flemington mother who recently delivered vaginally, reporting that she soon got over her initial apprehension because of the "calming" influence of the nurses who stayed with her during the five hour process: "They explained what was going to happen before it happened and as I was going through it. I never felt that I was being rushed. I felt that they were there for me and only me. It was very comforting."

The piece might have done more to bring out that this is more than just a nice "culture," but the result of a powerful clinical practice model involving science-based patient support, monitoring and communication. It is not something that just any supportive person could do. Nurse midwives also have advanced clinical diagnostic and interventional skills, in addition to their psycho-social skills. Despite the article's excellent focus on outcomes, some readers might still come away with the idea that this achievement was the result of the midwives being great hand-holders, which does not do credit to the depth and range of their skills.

On the whole, we commend Ms. Matteson and the Courier News for a generally strong and helpful piece about the value of nurse midwives.

See the article by Stefanie Matteson "Plainfield site credits midwives as part of low Caesarean rate" in the March 28, 2005 edition of the Courier News. You can email Ms. Matteson at smatteson@c-n.com and please carbon copy us if you do at letters@nursingadvocacy.org so we can follow your comments.