Community Midwifery Postpartum Care: National Data From Community Practice

The United States is a global anomaly in its lack of postpartum care. Community midwives' scope of practice generally includes maternal and infant care until 6 weeks after birth, although research on community midwifery postpartum care in the United States has been limited. The purpose of this analysis was to further describe community midwifery postpartum care using a national quantitative data set.

This analysis uses data from the Midwives Alliance of North America Statistics Project, birth years 2004 to 2009. The data include 20,720 pregnancies, with home or birth center as the planned place of birth at the onset of labor. We used standard descriptive statistics. The main variables of interest to characterize postpartum care were the number of postpartum care visits and the number of weeks of postpartum care. We used Kruskal-Wallis tests to assess whether number of visits or number of weeks of postpartum care varied by subgroup.

Breastfeeding initiation occurred for 99.3% of infants; 83.8% were exclusively breastfeeding 6 weeks after birth. The median number of postpartum visits with midwives was 4 (IQR, 3-5). Only 0.7% (n = 142) had no postpartum visit with a midwife; 3.1% (n = 508) had only one visit. The median number of weeks of postpartum care with midwives was 6 (IQR, 6-7); one-third of families received midwifery care after 6 weeks postpartum. There were small but statistically significant differences in the median number of visits and the median weeks of care by payer, midwife credential, parity, hospital transfer, and state regulations.

Community midwives provide postpartum care consistent with World Health Organization guidelines. Future research should explore comprehensive, midwife-led postpartum care in diverse families, including after perinatal complications. Although a majority of US births will likely continue to occur in hospitals, community midwives could provide home-based postpartum care regardless of birth location.