Midwives are still the exception in the US. New startups are trying to change that
When Taylor-Rey J’Vera became pregnant with their first child in 2021, they wanted to choose their OB-GYN carefully. “I searched for someone brown and female-bodied, because I thought that would make me feel safer and healthier,” said J’Vera, who identifies as a Black and Puerto Rican plus-sized, nonbinary lesbian.
Instead, their first-ever appointment became a traumatizing experience. The doctor said J’Vera’s weight made them high risk, despite their normal blood pressure and bloodwork. She asked them repeatedly if they wanted to “keep the baby”. And when she realized J’Vera was a lesbian, she made a statement comparing artificial insemination to cheating.
Even so, J’Vera balked when their wife suggested a new maternity clinic called Oula, where the primary practitioners are midwives. “When I thought of midwifery, I thought of people sitting in a ‘kumbaya’ circle while ladies are screaming their head off,” J’Vera said.
Oula quickly dispelled this notion. J’Vera was impressed with the office’s “Gwyneth Paltrow vibe” – buttery-soft textiles in beige, cream and muted pink – but also the sense of welcome; at J’Vera’s first appointment, the midwife gave her pronouns and asked J’Vera for theirs.
In October 2021, J’Vera gave birth to a son, River, after an induction and caesarean. It wasn’t the birthing experience they’d hoped for, but that was less important to J’Vera than their experience of pregnancy as a whole. They weren’t constantly put on a scale. Their medical questions were promptly answered through Oula’s app. They “felt safe and taken care of” throughout. “Not just my body,” J’Vera said. “My heart and my mind.”
Oula has raised $22.3m in venture capital on the promise of its midwife-centered, technology-integrated approach to “modern maternity” care. Its ethos is collaborative, meaning appointments are run by certified nurse midwives at Oula’s offices, while all births take place at the hospital. Two staff obstetrician gynecologists are available to oversee high-risk pregnancies.
The company says its user-friendly app provides patients more control over the maternity experience and its proprietary software increases safety and efficiency. It maintains this modernized approach is compatible with what many midwives call their “sacred practice”: prenatal appointments that emphasize holistic, compassionate care and a low-intervention approach to labor and birth.
Patients like J’Vera are having a better experience than they might at a traditional doctor’s office. But there’s still healthy skepticism, especially from midwives, about this influx of money: is the need – and desire – to scale these businesses really compatible with a slow, relationship-centered approach to maternity care? And do these companies fully understand the challenges of building effective midwifery practices in hospitals, especially when it comes to the most vulnerable patients? •••
Midwifery is having a moment in the US: Oula is one of at least four venture capital-funded midwifery startups that have launched since 2019. Silicon Valley, with its deep pockets, technological savvy and growth mindset, is
bidding to be the disrupting force our country’s maternity care desperately needs.
Numerous studies show that midwifery reduces healthcare costs and improves the quality of care and outcomes, especially for vulnerable patients. And yet unlike other developed countries like the UK and Germany, where midwives assist most low-risk pregnancies, the practice is an outlier in the US. There are only 14,000 certified nurse midwives and certified midwives in the US, compared with more than 21,000 OB-GYNs.
Those numbers are slowly changing. According to the American College of Nurse-Midwives (ACNM), the number of midwifery education programs increased to 46, up from 38 last year, and the number of midwifery students is growing. Ginger Breedlove, a former president of the ACNM, says that interest in midwifery is “exploding”.
There are plenty of reasons for this shift. First, people recognize that maternity care is broken: the US has high rates of maternal morbidity among developed countries, and terrible outcomes for Bipoc patients. We have a 32% general cesarean rate, compared with the World Health Organization’s recommendation of 10 to 15%.Maternity care “deserts” now force families to drive hours to see a doctor.
Second, midwives achieve similar or better outcomes than obstetricians do when caring for low-risk patients, though they’re paid half as much. One 2019 study of more than 23,000 hospital births in low-risk patients found that midwifery care in labor had “significantly lower” cesarean rates than obstetrician-led care, while a 2018 study found that states with more midwives integrated into their health systems had lower rates of cesarean births, pre-term births, low birth weight babies and neonatal death.
Third, systemic changes are slowly working in midwives’ favor. The Affordable Care Act requires Medicaid to cover midwifery services, though providers can be hard to find. And private insurers are testing a global fee model for maternity care, under which the entirety of pregnancy and birth falls under one cost. Even so, most hospitals still work on a “fee-for-service” reimbursement model, in which providers get paid for each visit and procedure.
Anu Sharma, who has raised over $4m in venture capital for Millie, her California-based maternity care startup, says that historically there’s been a “built-in bias with more procedures than necessary”, because proceduralized care equates to higher reimbursement.
Sharma also noted that obstetricians are trained surgeons, and some are biased toward medicalized rather
claiming Trump “stands alone in American history for his alleged crimes. No other president has engaged in conspiracy and obstruction to overturn valid election results and illegitimately retain power.”
“Which is true, and I will also add: no other president tried to overturn the results of a hurricane with a Sharpie before,” Kimmel quipped.
In other Republican news, the “third and sadly not final” Republican debate is scheduled for Wednesday evening in Miami, Florida. “Five non-viable candidates will assemble on stage for no good reason at all. None of them will be president,” Kimmel explained of the lineup, which includes Chris Christie, Nikki Haley, Tim Scott, Vivek Ramaswamy and Ron DeSantis. “What a lineup – it’s like if all the Avengers were Hawkeye,” Kimmel joked.
And Kimmel couldn’t resist a chance to take a jab at one of his favorite punching bags, Ted Cruz, after the Texas senator took a shot at late-night hosts in his new book, Unwoke. According to Cruz, “late-night TV is virtually unwatchable. I love comedy, but watching angry leftists scream about how much they hate Donald Trump isn’t remotely funny. It’s pitiful.”
“Well, all I’ll say is it’s an honor to be called pitiful by a man who abandoned his dog in an ice storm to go to Mexico,” Kimmel responded.
Seth Meyers
On Late Night, Seth Meyers recapped Trump’s testimony at his civil fraud trial in New York on Monday, during which the former president pulled out a piece of paper from his jacket pocket and claimed it would clear his name. “But the judge would not let him read it because, as usual, it was classified,” Meyers joked.
“Dude, you couldn’t have cleared your name if you pulled out a Neuralyzer from Men in Black,” he added. “What piece of paper could possibly clear your name? Was it a birth certificate with a different name?”
Trump’s daughter Ivanka is set to testify on Wednesday, “making it the first thing she’s been invited to in New York in eight years”, Meyers quipped.
In other news, Elon Musk’s brain implant company Neuralink has put out a call for volunteer human test subjects. “Well, actually what they said was ‘fresh’ volunteers,” Meyers deadpanned.
“I don’t think he should be meddling with something he doesn’t understand, like humans,” he added. “Now it’s not called the brain any more. It’s called B.”
And according to the latest numbers, Taylor Swift’s new re-rerecorded album, 1989 (Taylor’s Version), has sold 1.6m units in the US, “and it’s made her almost 8 cents on Spotify”, Meyers joked.