Health in childbirth policies: Congruence and discordance between physicians and midwives

Background/significance: With the expansion of the Affordable Care Act, the US faces a healthcare provider shortage in maternity care.  Policies that foster increased access to midwives are often opposed by physicians. Despite the modernization/professionalization of midwifery, objections from the medical community pose an obstacle to midwifery expansion.

Objective/purpose: To examine how physicians and midwives (Certified Nurse Midwives [CNM] and Licensed Midwives [LM]) perceive one another and how economic competition, past experiences, background knowledge and differing models of pregnancy and birth may impact these perceptions.

Methods: Data collected from 10 semi-structured qualitative interviews with physicians, CNMs and LMs were analyzed thematically by two researchers to explore patterns across interviews and draw connections between midwives’/physicians’ experiences and their perceptions of medicine/midwifery.  

Results:  Emergent themes included lack of understanding by physicians about training and licensure of LMs; competition was not claimed by respondents, yet subtexts suggested that could be an underlying issue. CNMs saw more alignment with physicians, and the groups diverged on knowledge privileged.  

Discussion/Conclusions: Few scholars have directly examined physicians’ perceptions of midwifery. Examining physicians’ perceptions shows how they formulate opinions while examining midwives’ perspectives provides further insight into the relationship between the two professions. A key factor in this relationship is the different kinds of knowledge privileged by midwives (who value experiential knowledge) as opposed to physicians (who value technical knowledge especially as it applies to interventions such as C-sections). The results of this study contribute to efforts for improving relationships between physicians and midwives to help relieve provider shortages.