Out of hospital births with Utah licensed Certified Professional Midwives (CPMs): Outcomes of planned vaginal birth after cesarean (VBAC)

Background: The rising cost of malpractice insurance has led to a decline in the number of US physicians providing obstetric care, reducing access to care for all women, with the profound decreases occurring in underserved communities. Though the number of obstetricians is decreasing, the number of certified nurse-midwives midwives (CNMs) and certified professional midwives (CPMs) is increasing. CNMs are licensed in all 50 states and the District of Columbia. CPMs, however, do not have the same legal status, and are only licensed in 25 states. Utah began licensing CPMs in 2006 with a provision that midwives submit birth outcome data to the Division of Occupational and Professional Licensing. There is controversy over CPMs attending VBACs out of hospital due to higher risk status. Objective: Researchers evaluated the data from births that occurred under Utah-licensed CPMs between 2006 and 2008 to ascertain if women who previously gave birth by cesarean section were at an increased risk of an adverse outcome compared to those with no history of prior cesarean delivery. Methods: CPM patients with history of cesarean delivery were matched with patients with no history of cesarean. Incidence rates of adverse outcomes were computed and compared between the groups by ANOVA. Results: Health outcomes for women and newborns cared for by CPMs are good, even among higher-risk VBAC patients. Conclusion: Increasing licensure for CPMs throughout the country may help expand access to midwifery care without decreasing quality of care.