THE STUDY 

This study will document Midwife-Assisted out of hospital birth utilization and underutilization amongst African American Women.

 In the United States, 8% of births are Midwife-Assisted and 1% is outside of hospital settings 1. 

 The question is how many of those women who births outside hospital settings are amongst women of African American Descent.

 In a small study done in 2005, amongst 12 New York homebirth practices less then 5% of each practice served women of African American Descent.  

During that study the only free standing birth center data showed that less then 30% of its users of the labor and birth center were of African American Descent.

Those numbers are shockingly low given the history of birth in the United States amongst People of African American Descent. Up until the late 1940s most African American Families were born at home by a Midwife.  During this time the infant mortality rate in the United States was at an all time high. Instead of examining and or addressing the socioeconomic factors that at that time had contributed to the high infant mortality rate, the department of health led by a Nurse blamed the Midwives and began a national campaign that literally destroyed and almost eliminated Black Midwives aka Granny Midwives.  

 Interestingly enough, the infant mortality rate remains high in the United States.

The United States internationally ranks 23^rd for infant mortality in comparison to other industrial nations. A rate that is 6 times higher then in other industrialized nations such as Japan and Canada.

We fair poorly considering we are one of the top ranking industrialized nations in the world.  In fact, amongst most European nations where Midwives are utilized 75-80% vs. U. S. 8% the infant mortality rate is far less. 

 In the hospital with the use of medication and instrumentation, women are at a far greater risk for surgical intervention i.e. Caesarean section and a greater risk for maternal and infant morbidity and mortality4.

Ironically, the C-section rate consistently remains highest amongst African American women in almost every inner city within the United States 1.

 Nationally, low Birth Rate, constantly remains a point of concern in most African American communities.  In addition, the high Infant Mortality rate in most African American communities is at times two to three times as high in comparison to women of European descent 1.

 Contrastingly, Midwives positively impact these birth indicators. Midwives impact birth indicators in a way that radically and tremendously change birth statistics.  Midwives historically have been documented to have dramatically different birth outcomes.  For example a 12% lower Caesarean Section rate 3. , a lower episiotomy rate, a 19% lower infant mortality & morbidity rate 4.

 Overall, Midwives are less likely to interfere with the normal process of birth using less medication and instrumentation.   

  Perhaps the history availability and knowledge of Midwifery Management may not be as readily available to mainstream Americans.

 This study will attempt to identify behaviors, reasons and the variables that influence decisions for hospital versus out of hospital and or homebirths.

This study will attempt to address the reasons for the underutilization of out of hospital births by African American Women.

 1.        Department of Health New York, Louisiana, South Carolina, Mississippi, New Jersey 2003-2007

2.         BMJ 2005:330 (18 June)

3.        Public Citizens Health Research Group

4.        National Center for Health Statistics