Trends and characteristics of births attended by midwives.

In 1994 there were 218,466 births attended by midwives in the United States more than seven times the number in 1975 (29,413). The percent of all births attended by midwives rose from 0.9 percent in 1975 to 5.5 percent in 1994. The vast majority of midwife attended births were by certified nurse-midwives (CNMs) and occurred in hospitals. Births attended by other midwives comprised only 6 percent of all midwife-attended births (down 11 percent since-1989) and are becoming increasingly concentrated in out of hospital settings, particularly residences. Due in large part to population characteristics, the proportions of births attended by midwives varies markedly between states. The percentages range from 19 percent in New Mexico to less than 1 percent in Kansas Louisiana Missouri and Nebraska Mothers with midwife attended births in out of hospital settings generally had demographic and lifestyle characteristics that were lower risk for obstetric complications and poor birth outcomes compared with mothers with physician- or midwife attended births in hospitals. That is these mothers were more likely to be married older more educated having higher order births and were less likely to smoke and gain and adequate amount of weight during pregnancy. However women with midwife attended births regardless of type of midwife or birth setting were more likely to initiate prenatal care later in the pregnancy and have fewer overall visits than were women whose births were attended by physicians. Despite less prenatal care a smaller proportion of babies whose births were attended by midwives were preterm or were of low or very low birth weight.