According to Declercq, the high rates of surgery and other unneeded interventions have led to increased interest in the midwifery model, which is lower-tech, less invasive, and less inclined toward intervention without a clear medical need; a 2011 study in the journal Nursing Economics found that births led by midwives in collaboration with physicians are less likely to end in a C-section than births led by obstetricians alone. According to Ginger Breedlove, the president of the American College of Nurse-Midwives, the real reason for this difference is in the approach to care: Midwives typically promote patience with the natural progress of labor and discourage intervention to speed the birth process. “It’s a different model,” she explains.

Popular media is also playing a role in the rising popularity of midwives, Breedlove says. The 2008 film The Business of Being Born and TV shows like the BBC’s Call the Midwife, for example, are helping to subtly reframe the concept of midwifery in the American mind, moving it from a fringe profession to something closer to mainstream.

Though still a relative novelty in the U.S., midwife-led maternity care is the norm in other developed countries, including most of Europe.* In England, for example, midwives are the lead care providers at more than half of all births. (There, midwife care is considered fit even for royalty; last month Kate Middleton gave birth to her daughter Charlotte under the care of two midwives.) “In England, what they say is, ‘Every mother deserves a midwife, and some need an obstetrician, too,’” Declercq says.

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One of the major differences between obstetricians and midwives is the philosophies that ground their training, Breedlove says. Medical education is fundamentally disease-based and curative; as a result, “[OG-GYNs’] focus is more on the sick woman who either has healthcare needs through the lifespan or has complex obstetric needs,” she explains.

In midwifery, by contrast, training focuses on caring for the majority of mothers who have healthy, low-risk pregnancies. Childbirth is accordingly seen as a natural occurrence, not a medical event, and midwives emphasize the importance of prenatal education and developing a strong relationship with their patients. “[It’s] very personalized, high-touch, low-tech care,” Breedlove says.

As a result, Declercq explains, midwives tend to ask different questions about birth than do other medical professionals. For example, in most physician-attended hospital births in the U.S., mothers are hooked up to continuous electronic monitoring equipment to track the baby’s heartbeat and identify possible signs of distress. A 2006 review of three decades’ worth of data, however, found that continuous monitoring offered very little benefit for the majority of births—it was correlated with “reduction in neonatal seizures,” the authors wrote, “but no significant differences in cerebral palsy, infant mortality or other standard measures of neonatal well-being”—and was actually associated with a higher rate of C-sections and vaginal deliveries with forceps. Midwives, because of their training to intervene only when it’s medically necessary, tend to question the necessity of continuous monitoring and typically favor intermittent monitoring instead, Declerq says.