Madera County Midwifery Project

The Madera County Midwifery Project occurred - like the title implies - in Madera County, California in the 1960s.

Prior to 1960, the only birth attendants in Madera County were family practitioners.

The birthing population was mainly poor agricultural workers whose general level of risk was

higher than average

Positive examples of midwifery based care in other parts of the country - such as Frontier Nursing School - stimulated the development of new midwifery services for the poor. A good example of such a program is Madera County.

Because midwifery was illegal in California at the time, a special law was passed which authorized employment of 2 CNMs to provide care to the county's medically indigent agricultural workers, half of whom were receiving late or no prenatal care.

Beginning in 1960 until June 1963, the CNMs were attending 78% of hospital births. During that time, prenatal care, hospital births and postpartum visits increased substantially. Under the midwives care, the neonatal mortality rate dropped dramatically and the prematurity rate decreased.

The California Medical Association sought the termination of the funding for the Madera County Midwifery Project and arranged for the midwives to be replaced by OBGYNs.

Immediately upon the arrival of the new OBGYNs, the outcomes worsened dramatically - see chart below

This well-documented example of the Madera County Midwifery Project is very significant; It is a rare opportunity to compare the performance of three kinds of birth attendants:

OBGYNs

Family Practitioners

Midwives

Remember, all of these birth attendants were dealing with the same population under the same kind of circumstances. They all practiced within the same setting - in a hospital.

The population and the risk factors being identical for all three attendants, the difference in outcome cannot be explained in terms of the OBGYNs having dealt with high risk patients while the CNMs dealt with low risks patients.

The Madera County study clearly demonstrates that all variables being equal - the safest birth attendant is a midwife.

Note that OBGYNs would be hard pressed to push this study aside...

... Since the source for this data was one of their own medical journals - the American Journal of Obstetrics and Gynecology!

Midwives have attended births for thousands of years and they prove to not only be a wonderful and valid choice but also to be a safer "alternative."