Why Is Birth So Medicalized in the U.S.? Understanding the Connection Between Medicalization, Maternal Mortality, and Midwifery Use

Birth in the United States is notably medicalized—meaning it relies heavily on interventions, technology, and physician-led care, even when not always medically necessary. This medicalization is a key reason the U.S. experiences both widespread criticism of its maternity care system and some of the highest maternal mortality rates among wealthy nations.

To understand this complex issue, it’s crucial to examine the role of midwifery, differences in provider scope of practice, and systemic factors that drive medicalized birth.

The High Maternal Mortality Rate in the U.S.

The U.S. maternal mortality rate (MMR) stands at approximately 32.9 deaths per 100,000 live births (CDC, 2021), significantly higher than other developed countries, including:

• Netherlands: ~3.0 per 100,000
  

• Norway: ~1.9
  

• United Kingdom: ~6.5
  

• Japan: ~4.0
  

This disparity is especially severe for Black, Indigenous, and people of color (BIPOC), who face 2–3 times higher risk of maternal death than white women.

Low Midwife Attendance Correlates with High Medicalization

In the U.S., only about 10% of births are attended by midwives (ACNM, 2023), compared to 70–90% in countries like the Netherlands, Sweden, and the UK. These countries use midwifery-led care as the norm, reserving physician intervention for complications.

Midwife-led care supports physiologic birth—the natural, low-intervention process of labor and delivery—which research links to:

• Fewer cesarean births
  

• Lower rates of interventions such as induction and continuous monitoring
  

• Reduced maternal and neonatal morbidity
  

• Increased maternal satisfaction
  

Scope of Practice: A Key Driver of Medicalized Birth

A major reason for the medicalization of birth in the U.S. is the fundamental difference in scope of practice between obstetricians and midwives:

• Obstetricians are trained to identify, manage, and treat medical complications and emergencies. Their practice focuses on risk management, which often results in early or frequent interventions, even in low-risk pregnancies.
  

• Midwives are trained to support healthy, physiologic birth, emphasizing monitoring and assisting natural processes and only escalating care when complications occur.
  

Because the vast majority of U.S. births are attended by physicians—even for low-risk pregnancies—the culture leans heavily toward intervention and technology use, increasing the overall medicalization of birth.

Systemic and Structural Contributors

Beyond provider roles, other factors reinforce medicalized birth:

• Insurance and hospital policies often prioritize physician-led care and limit out-of-hospital or midwifery-led birth options.
  

• Fragmented care models create barriers between midwives and obstetricians, reducing collaboration.
  

• Racial and socioeconomic disparities exacerbate risks and limit access to supportive care.
  

Toward Less Medicalized, Safer Birth

To improve outcomes and reduce unnecessary interventions, experts recommend:

• Expanding access to midwifery care and integrating midwives fully into maternity care systems.
  

• Encouraging physiologic birth models that respect the natural labor process.
  

• Addressing systemic inequities in care access and quality.
  

• Supporting collaborative care models between midwives and physicians.
  

Conclusion

The high degree of medicalization in U.S. birth, driven largely by the dominant role of physicians trained to manage complications rather than support normal birth, is a major factor in the country’s elevated maternal mortality and intervention rates. Increasing midwifery care and centering physiologic birth practices hold promise for healthier, safer maternity experiences for all families.

References

1. Truven Health Analytics. (2013). The Cost of Having a Baby in the United States.
   https://transform.childbirthconnection.org/reports/cost/
   – A landmark report on birth costs in the U.S. across settings and delivery methods.

2. Listening to Mothers III: Pregnancy and Birth. (2013). Childbirth Connection.
   https://www.nationalpartnership.org/our-work/resources/health-care/maternity/listening-to-mothers-iii-pregnancy-and-birth.pdf
   – National survey results highlighting how U.S. birth practices align with or differ from evidence-based care.

3. Goer, H., & Romano, A. (2012). Optimal Care in Childbirth: The Case for a Physiologic Approach. Classic Day Publishing.
   – Comprehensive resource explaining how systemic structures in U.S. hospitals disrupt physiologic birth.

4. National Partnership for Women & Families. (2016). Maternity Care in the United States: We Can and Must Do Better.
   https://www.nationalpartnership.org/our-work/resources/health-care/maternity/maternity-care-in-the-us.pdf
   – Analysis of U.S. maternity care quality, cost, and overuse of interventions.

5. American Journal of Obstetrics & Gynecology. (2014). Trends and correlates of elective induction of labor: United States, 1990–2010.
   – Evidence showing increased rates of elective (non-medically indicated) inductions and their ties to provider and hospital convenience.

6. Glantz, J. C. (2005). Elective induction vs. spontaneous labor: Associations and outcomes.
   Obstetrics & Gynecology, 105(5), 1113–1118.
   – Documents the risks of increased cesarean rates and poorer maternal outcomes from elective inductions.

7. Davis-Floyd, R. E. (2001). The technocratic, humanistic, and holistic paradigms of childbirth.
   International Journal of Gynecology & Obstetrics, 75(S1), S5–S23.
   https://doi.org/10.1016/S0020-7292(01)00510-0
   – A foundational anthropological review of why the U.S. system emphasizes technological birth and risk management.

8. Centers for Disease Control and Prevention (CDC). (2022). Maternal Mortality Rates in the United States, 2021.
   https://www.cdc.gov/nchs/maternal-mortality/index.htm
   – National statistics on maternal death rates, highlighting systemic failure in outcomes.

9. National Academies of Sciences, Engineering, and Medicine. (2020). Birth Settings in America: Outcomes, Quality, Access, and Choice.
   https://nap.nationalacademies.org/catalog/25636
   – In-depth analysis comparing hospital, birth center, and home birth outcomes and systems across the U.S.

10. Sakala, C., Declercq, E. R., & Corry, M. P. (2013). Pathways to Change: Improving Maternity Care in the United States.
    Women’s Health Issues, 23(5), e287–e295.
    – Advocates for systemic maternity care reform by understanding institutional and reimbursement-based barriers to physiologic birth.