Midwives could help prevent more deaths. Why don’t more hospitals have them?
Autumn Murdock is 36 weeks pregnant with her first baby, a boy, and she’s a little nervous. Tall and athletic, Murdock sinks into a circle of comfy chairs at a recent meeting for parents-to-be organized by her midwifery group.
She listens as SJ, a doula, talks about how she will guide Murdock immediately after she gives birth and through the first months of her baby’s life.
“You wanted to breastfeed, right? Some things you can request are immediate skin-to-skin with baby as long as the heart rate and breathing are doing OK.”
“Have you thought about how you’re going to feed yourself for those first couple of weeks?”
“Have you thought about visitors?”
In Illinois, a midwife is a nurse who has an advanced degree. They can manage a person’s entire pregnancy and deliver their baby. They’re trained that birth is a normal process, and not to intervene unless it’s medically necessary.
The focus of this midwife group is to try to stop so many pregnant Black people from dying before and after childbirth. They do that by building trust with these mothers, listening to and believing their concerns.
Yet despite research that shows midwives tend to have low C-section rates and better outcomes for both parent and child, WBEZ found many hospitals across the Chicago area are not investing in midwives — or, they’re cutting back. The latest example is Swedish Hospital on the North Side, which has been a training ground for other midwives and a destination for pregnant people who sought out the hands-on care the midwives were known for.
The midwifery void deepens depending on where you live, and even more if you want a midwife of color. Several hospitals declined to explain why they’re not investing more in this type of care.
It could in part be a staffing issue. Many hospitals facing financial problems are already cutting back on delivering babies altogether, while other hospitals are struggling to find OB-GYNS in the first place. Hiring midwives might not be a priority.
But midwives, health care advocates and other medical professionals told WBEZ it really comes down to this: Many hospitals don’t value midwifery. Births can take longer with midwives. Some say hospitals don’t pay them enough, and a lack of their presence is about money. And, they say a cascade of interventions can happen with OB-GYNs, ultimately leading to some unnecessary C-sections that bring in revenue.
“Midwives are more hands-on, less invasive and so those births may take up a little more time. Therefore holding up, you know, usage of more of those (hospital) rooms,” said Karie Stewart, a midwife at the UI Health hospital system on the Near West Side. Murdock is one of her patients.
But if more hospitals want to lower their C-section rates, which is a push across the nation, midwives are key, Stewart argues: “I think it’s determining what the priority is: finances over options and desires of the community, or vice versa.”
Even if hospitals want to bring on more midwives, it’s not that easy. There’s a generational divide over work-life balance, a battle over pay and a lack of awareness about what they do — by patients and by peers.
“I think the whole profession sometimes is a little misunderstood,” said Molly Kavanaugh, a midwife in Chicago for nearly a decade. “Even by people that are in the business often are like, what do you do again?”
Where are all the midwives?
Across the country, the number of midwives is slowly growing, but in Illinois, midwives attended only about 9% of births in 2020, the most recent data from the American College of Nurse-Midwives show. That’s higher than Indiana and Missouri, but far lower than Alaska, Vermont and New Mexico. In those states, a midwife attended at least one in four births.
“Illinois clearly has not really embraced midwives,” said Karen Jefferson, director of midwifery practice and education at the American College of Nurse-Midwives, which tracks midwifery trends around the nation.
Most hospitals in this region have only a small number of midwives, up to 10 or so, or none at all. That lack of midwives who deliver at hospitals is particularly stark on Chicago’s South Side, where there are already few places to have a baby. University of Chicago Medical Center, an academic research-focused hospital in Hyde Park that treats the most complex patients, has one midwife. There used to be more.
U of C declined an interview request, but in a statement said “midwives are an integral part of the women’s health team and provide unique care for patients with healthy pregnancies.” But many patients who deliver at the hospital are considered high-risk, the statement said.
Kathleen Harmon, a midwife at UI Health for 23 years, now oversees all the midwives at the hospital. There are 18 midwives on staff — perhaps the most of any hospital in the area — and another eight midwives who either take shifts delivering babies or help treat patients in clinics.
Harmon remembers a time when the midwives weren’t always supported there.
“A lot of it does have to do with who is at the helm, who is head of the OB-GYN department,” and the hospital leadership team, Harmon said.
The way she sees it, midwives take on low-risk patients, freeing up OBs to treat high-risk patients who might need closer monitoring.
Harmon said midwives can also influence how doctors manage their patients. In 2022, about 14% of patients who saw midwives to deliver their babies at UI Health ended up with C-sections. At least 20% of patients who gave birth with doctors had a C-section.
Without the midwives present in the hospital’s labor and delivery unit, showing how vaginal deliveries with few interventions can be done, Harmon said the C-section rate could be higher. A 2018 study of more than 14,000 births in the U.S. found similar conclusions about the presence of midwives.
Illinois public health data and WBEZ reporting supports that conclusion as well. Hospitals with midwives here tend to have lower C-section rates than those without them.
Despite evidence that underscores what they can do for patients, midwives still lobby for a seat at the table with hospital leaders. Annette Payot is director of midwifery at PCC Community Wellness Center, whose midwives deliver babies at West Suburban Medical Center in Oak Park.
Payot said the midwives are embedded at the hospital, delivering about 40% of babies and training medical residents. She herself is a fixture on hospital committees.
“Part of that is I want everyone to practice the midwifery model of care, but part of that is about survival,” Payot said. “I want to make sure we’re valued.”
If the midwives disappeared, Payot worries, it would have a ripple effect on the hospital and its patients.
Changes and staffing challenges
Many patients were outraged after Swedish made big changes this summer, combining its midwifery group with the OB-GYN physicians’ group. Swedish has declined interview requests, but in a statement the hospital attributed the shift partly to a declining birth rate across the region and a nearly 50% decrease in the number of births that midwives attended at Swedish between 2016 and 2022.
But the statement didn’t mention the reduction of midwife staff in that same period. Swedish had 10 midwives at its peak around 2015, and by this year, several had left for other jobs and the hospital laid off two others, according to former longtime Swedish midwife Bridget Davidson. She said there are just two midwives left. The hospital’s website lists two midwives as well.
Davidson was a midwife at the hospital for 11 years before quitting. She left in July. She said the hospital was pushing midwives to be more productive to bring in more money, such as spending less time with patients as they labored, Davidson said.
“The messaging was clear,” Davidson recalled. “We’re interested in the numbers.”
Years earlier, the hospital celebrated the midwives’ national recognition for improving patients’ health while reducing costs. Swedish singled out the midwives’ low C-section rates.
But the patient outcomes and the patient experience weren’t enough, Davidson said.
Challenges to hiring midwives
WBEZ interviewed more than a dozen midwives for this story. And for many, the profession is a calling that often entails being on call 24/7 to deliver babies.
But even if hospitals wanted to woo more midwives, there are barriers. Some midwives don’t want to work around the clock, and say the pay doesn’t match the responsibilities they take on.
Leslie Sanchez became a midwife about 10 years ago, but she’s also a nurse with a doctorate degree. She takes shifts at hospitals delivering babies, but she said she hasn’t left her nursing role completely for two big reasons: a midwife’s schedule and paycheck.
“As a midwife, I just get paid so much less,” Sanchez said. “I’m a single mom. It’s just really hard for me to take that pay cut.”
She estimates she makes at least 20% less when she takes shifts as a midwife compared to her regular job.
Sanchez used to deliver babies a few times a month at PCC Wellness’s birth center, where patients give birth on a giant bed in a home-like atmosphere rather than in a hospital, and under the care of midwives.
But PCC temporarily closed the center this summer due to staffing, Payot said. The birth center was one of just four licensed in the state, according to hospital regulators.
Payot said the goal this year is to figure out a staffing model where midwives don’t have to be on call so much.
“The call is not sustainable,” Payot acknowledged. “It’s just too much for people who have families, people who have little kids or people who just want a life outside of midwifery.”
With midwives, patients recall feeling seen and heard
For all the struggles to get midwives into hospitals, patients who have experienced their style of care are a devout bunch. They said they felt seen and heard during their pregnancies, that they had a say in how they would bring a child into this world instead of being told what to do.
When Lizzy Bortoto, 31, of Chicago’s Lincoln Square neighborhood was pregnant with her son, her midwives at Swedish Hospital led a support group for parents whose babies were due around the same time.
“They were building a relationship with me and building trust,” Bortoto said. “I felt like all my concerns were listened to and validated. They believed me. And that’s so sad that that’s like an outlier in a woman’s experience in general, and especially in health care.”
Bortoto said the midwives created a sense of community, and that she felt empowered and educated about what could happen when she delivered.
That support was key when her son was born with the cord wrapped around his neck, and specialists rushed in to make sure her baby was OK.
“But I just remember that the midwives, they were only focused on me,” Bortoto recalled. “They were like my advocates there from start to finish.”
Inspired by a class she took in college, where she saw babies being born in birthing tubs, Rebecca Zemans had three children with midwives.
With her third child, who Zemans said is still a “little stubborn,” midwives let her go two weeks after her due date before they induced her labor.
“They knew that this wasn’t my first rodeo,” said Zemans, 42, who lives in the Ravenswood Manor neighborhood. “They knew my body was made for this.”
She gets emotional recalling how special the moment was when her baby was born, how the midwives let her hold her until Zemans was ready to let go.
With a shortage of OB-GYNs across the country, experts say hiring midwives could help with staffing issues and increase access for patients. Besides delivering babies, midwives also provide routine gynecological care, such as birth control and cancer screenings.
And there’s another hopeful path that leaders who run midwife groups hope will help with staffing woes. Illinois Gov. JB Pritzker has created a path for certified professional midwives to become licensed, though the state is still working on the rules for this part of the industry. This role would not require a nursing degree.
Back at the prenatal group gathering, where a heavily pregnant Murdock met her doula for the first time, Murdock said she didn’t know what a midwife was until she was placed with Stewart and her midwifery team.
Now, she said they’re like family.
“Being comfortable is the most important part for me during this whole process and this program has been that and more,” said Murdock, 25, who lives near the Ukrainian Village neighborhood. “Like being able to be in a group with other moms that are (due) at the same time … It’s just like an energy that you get being here rather than doing it solo on your own.”
As her session wrapped up, Murdock stood up and formed a circle with a few others. They closed their eyes, breathed in, breathed out. Then they said an affirmation.
“I am excited to meet my baby.”
They planned to gather again in a few weeks.
Kristen Schorsch covers public health and Cook County government for WBEZ.