This presentation has two distinct parts with both focused on the role of midwifery in maternity care systems. First it will look at cesarean rates and trends internationally, drawing on data largely available on the website It will examine common explanations for a rising cesarean rate and whether those reasons are empirically based.  These justifications, typically made in industrialized countries like the U.S., include that cesareans are rising based on: maternal request for cesareans; the increasing age of mothers; an increasing number of multiple births as a result on the use of artificial reproductive technologies; the increasing size of babies; and that mothers are less healthy than they have been in the past in large part because of rising obesity rates. Relying primarily on U.S. data, the presentation will show that most, though not all, these points turn out to not be evidence based.

The second part of the presentation will examine the potential for midwives to serve as the linchpin in maternity care because of their unique ability to work effectively in both the community as well as in facilities. This is where midwifery can play a role in reducing unnecessary cesarean rates in industrializing countries and preventing a similar rise in emerging and developing economies. The key is the provision of women’s health care and not just prenatal and intrapartum care. Midwives can then build a relationship that can help ensure surgery is done when necessary, but minimize non-medically justified cesareans. I’ll argue for the need to recruit and train midwives who can work effectively in the community and medical facilities.