September 22, 2023

What happens if you are pregnant and there are no midwives?

Disappearing doctor looking at an ultrasound scan of a fetus.

Several U.S. hospitals have closed their labor and delivery wards, leaving pregnant women with limited options. (Illustration: Aisha Yousaf; Photo: Getty Images)

It is common practice during pregnancy to visit your local midwife and give birth at a nearby hospital. But a growing number of hospitals across the country have closed their labor and delivery units to cut costs, leaving expectant mothers with limited options.

A recent report from health consultancy Chartis found that 217 US hospitals have closed their labor and delivery departments since 2011.

At the same time, the maternal mortality rate in the US remains one of the highest among developed countries – an unfortunate trend that has continued for years. Data collected by the Commonwealth Fund found that the US had the highest maternal mortality rate of any country surveyed, with nearly 24 deaths per 100,000 live births. The data is particularly bleak for black mothers in the US, for whom the death rate exceeds 55 deaths per 100,000 live births.

This raises an important question: what happens if there are no ob-gyns and hospitals equipped to meet the needs of pregnant women?

Doctors say this puts the health of women and their babies at risk – and it can even be fatal.

“We see some of the worst birth outcomes come from nursery deserts — areas where there are no labor and delivery hospitals — and it’s not hard to see why,” Dr. Amanda P. Williams, ob-gyn and medical director of maternity support service Mahmee, tells Yahoo Life. “If you don’t get routine care during pregnancy, birth or postpartum, you’re much more likely to have a high-risk complication. Most concerns during pregnancy and postpartum are treatable, but not without proper care.”

Dr. Michael Cackovic, a physician of maternal-fetal medicine at Ohio State University Wexner Medical Center, agrees. “This is a threat to both mother and baby,” he told Yahoo Life. Cackovic says many health problems occur after childbirth and proper hospital care is required. “If you look at maternal mortality over the centuries, it started to come down when women went to the hospital to give birth,” he says.

What options are available to expectant mothers if there are none? obgyns nearby?

If there is no midwife nearby, expectant women should go to their GP or a local midwife for maternal care, says Cackovic. That can be fine for low-risk pregnancies, he says. “Midwifery is part of primary care training — these doctors are trained in obstetric care,” he points out. “If they have to do it, they can do it.”

But if someone is considered high risk, which includes all mothers age 35 and older, they should see an ob-gyn, says Cackovic. That can mean traveling an hour or more to find the right care, something that can be difficult for those without major financial resources or childcare, as well as being unable to take time off from work.

What delivery options are there?

This is where things can get complicated. “Low-risk births can take place with midwife support, if there is time to plan and such providers are available in the community,” says Williams. “In hospitals, low-risk deliveries can take place in an emergency room.”

But, she says, this can be trickier than it sounds. “Emergency rooms often lack specialized equipment in case complications arise for the parent or baby [and] births can go from a low-risk to a very complicated pregnancy in minutes,” Williams points out. childbirth facilities can have catastrophic consequences for both parent and baby.”

Williams notes that hospitals with labor and delivery units often do more for expectant mothers than just deliver their babies. “Hospitals also provide the necessary training and support,” she says. “Patients are missing out on lessons about childbirth, newborn care, counseling about warning signs of postpartum depression, and support from health care providers such as lactation consultants, who provide vital information and technical assistance in feeding babies.”

All of this “is having an outsized impact on women of color, who are more likely to live in areas where hospital services are lost than white women, compounding an already dire racial disparity in maternal health outcomes,” says Williams.

What to do if you live in an area with no ob-gyns and no labor and delivery unit

Again, your GP or a midwife (if available) can provide care if you have a low-risk pregnancy. “I wholeheartedly encourage expectant and new parents to connect with non-medical pregnancy care providers, such as doulas, pregnancy wellness coaches, and care coordinators,” says Williams. While these professionals do not replace traditional obstetric care, they are essential for a safe and affirming birth experience. These providers can help you find birth and delivery options in your area and assist you with resources such as transportation to and from appointments .”

But things get complicated with high-risk pregnancies and premature births.

If you’re able to travel for care before giving birth, Cackovic suggests doing just that — and it could involve a scheduled induction for labor at a hospital you’ll need to travel to. But if you go into labor unexpectedly, Cackovic says you should call 911 or travel to your local medical center and have them call for help at a nearby hospital with a labor and delivery unit, which will transport you by ambulance. “We have some patients who come from two to three hours away,” he says. “The best thing you can do is go to the nearest medical facility, whether it’s an emergency room or a hospital, and let it take over.”

Cackovic warns against driving yourself or letting a family member drive away for hours while you’re in labor. “I was volunteering in South Dakota and patients had to travel for hours to get to a labor and delivery unit,” he says. “Patients often try to go it alone. That’s ultimately not the safest thing — the baby could come early, the mother could have complications… Go to a medical facility and let them ask for help.”

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