Photo via New York Times.

Danielle Pergament recently published a piece in the New York Times about whether or not opting for a midwife is becoming indicative of social status (at least in some pockets of society).

“The perception of midwives has completely shifted,” said Dr. Jacques Moritz, director of the gynecology division at St. Luke’s-Roosevelt and a consulting obstetrician for three midwife practices. “It used to be just the hippies who wanted to go to midwives. Now it’s the women in the red-bottom shoes.”

And like any status symbol, a pecking order has emerged. Just as getting your toddler into the right preschool requires social maneuvering, getting into a boutique midwifery clinic has become competitive.

“We constantly have to turn women away,” said Sylvie Blaustein, the founder of Midwifery of Manhattan, a practice on West 58th Street that has its share of well-heeled clients. Opened in 2003, the practice now has six midwives on staff. “Because of the quality of care, we can only deliver about 20 babies a month.”

“It sounds bizarre,” Ms. Blaustein added, “but midwifery has become quote-unquote trendy.”

You can read the entire article here! What do you guys think: is having a midwife for your pregnancy and birth indicative of social status?

Comments on Are midwives status symbols?

  1. I would say that where I am from midwives are still for a fairly distinct group (hippies, earthy, blah blah).

    But, where I am from midwives have only be legislated for a few years (legislated for us, means that they are covered under our health care so we don’t pay), and there are very few if any practicing midwives in most regions.

    In a neighbouring health region, midwives have been funded for a few years now and they have way more midwives. There midwifery is more acceptable among everyone, including the trendy and hip.

    I don’t think its a bad thing though, more midwives will get trained and supported in the local health system, and in other health regions. It’s another option, and trendiness just makes that option easier to access.

    • Oddly enough I think here Doula’s are a bigger status symbol because you pay out of pocket for their services. Generally it means you have money in order to have one, though you can get a student doula for free (my girlfriend did, and loved her experience).

    • I wonder if the insurance coverage has to do with state regulations (or lack thereof) around midwifery licensing. Some states require a CNM degree, liability insurance, continuing ed and other things that are pretty standard for medical professionals. Other states will license you (or not prosecute you for practicing medicine without a license) if you have proof that you took a weekend class.

      With the number of med students going into OB GYN residencies, it would make sense to encourage midwifery, which is a good choice for low-risk pregnancies.

  2. I would think so, depending on the area. Being in the USAF, the area we were stationed the rich could afford to go to Tricare standard and have midwives where as the poor could not afford the $1000-$1500 copays and had no choice but to use the base hospital and OBs they’ve never met before to birth their children.

    • It really does depend on the state in which one lives. The laws are so drastically different from state to state. NY has some of the most pro-midwifery law in the country. While, here in PA, right next door, we were the last midwives to be granted prescriptive authority and even that law put more constraints on midwifery practice than we had previously.

  3. I do not think that is the case where I am (Portland, Maine). I see a pretty good variety of folks at my midwives’ office. I would wager a majority of them would fall into the more crunchy/hippie category, but there are business women, mamas with tattoos and piercings, stay at home moms, hipstery couples… a little bit of everything!


      But I agree. At my hospital (in Lewiston) we get all sorts – the ‘granola’ moms, and the ‘normal’ I-don’t-wanna-do-anything-fancy,-just-have-a-baby moms.

      I think what most people don’t get about a midwife is that the ‘I’m not interested in doing a ton of stuff, I just want to have a baby” is the perspective most midwives work from, from my understanding.

      I think maybe in places like NY, it’s a social status thing because these women want to be the best and give their child everything – so they do a lot of research into the best hospital, best pediatrician, best gear, best birthing style…

      Honestly, more informed, educated mothers is not a bad thing.

      • ‘I don’t want to do anything fancy, just have a baby’ is a perfect description of me. Definitely using next time someone asks why I have a midwife and not an ob. 🙂

        I’m in VA and have health insurance through work, which covers my care so I don’t see the choice as a status symbol at all.

  4. When I had my daughter I had a midwife. It w was covered by state medicaid. I think it really just depends on the area. If I didn’t have so many medical issues this time I would be going to a mid wife again. I definitely think a doula is more of a status symbol. But even those, I know people without allot of money being able to afford.

  5. If you don’t have insurance, a midwife is probably a lot cheaper than giving birth in a hospital, so I wouldn’t say it’s really a status symbol. On the other hand, I do think it’s a bit trendy. Or more precisely, it’s a part of a bigger trend of doing things more “naturally,” whether that’s eating whole foods, cloth diapering, etc.

    • To be fair, though, to say it’s cheaper to have a baby one way or the other is sort of like saying a broken hand is better than a broken foot — to the holy-crap poor, there’s not a fundamental difference is how much debt you’ve got to go in to get a baby out safely.

      Plus, in specific areas, the poor have the option to get temporary insurance during pregnancy. (In Kansas, it’s called Healthwave; that’s how we got the small child out. I have no idea what it is elsewhere.)

      I think its a curve; at a certain level of poverty, your only option is ‘whatever gets the baby out.’

  6. In my case, using a midwife might be considered a reverse status symbol. I got pregnant after being laid off & taking the first job is had since I was 19 without insurance. So we got a midwife mainly because it was the care we could afford out of pocket & even that measly $1600 was a stretch on out budget.

    Not to say that I wanted a hospital birth, quite the contrary. It worked out well & we’ll hopefully go the same route for our next child. Only next time with insurance.

    I think at least in my community in Colorado, it’s still seen as a bit hippie & granola, which isn’t a bad thing. In our town, there’s a huge population of conservative Christians & a bulk of the population is military so the demographic is skewed. Regardless, the few midwives I’ve met & worked with are always busy & seem to do quite well for themselves. More power to them.

  7. Head-scratching a bit at this article (trendy?) but that aside, I don’t feel like it’s seen as a status symbol to have a midwife vs OB. In fact, our midwife/birth center combo is about half the price of a hospital birth! I think it’s all about education and knowing that you’ll usually be cared for differently by OBs vs midwives.

    • Totally love your reaction — Ariel had the same one when I pitched the article to her! She wrote a great piece on Bride called Are offbeat weddings trendy? that I love — bottom line: even if something IS trendy… why does it matter?

      On top of that, I think the wording is strange as well — I would have LOVED for them to frame this around women having more options in birth, or feeling empowered and making their own decisions, or whatever. Not to say that having a midwife means you’re more empowered than someone who has an OB, but that it is cool that if there is a rise in midwives at births, it’s more because women are choosing what feels best for them personally, and not because they’re following a trend.

      Again: trends are awesome, but when it comes to who’s there when you give birth… I think most women are thinking of bigger things than whether or not they’re being trendy.

      • I don’t have time to give this an real sustained thought right this second, so this is quick and off-hand: I think the New York Times too — sometimes frames things really really strangely. I am thinking of the whole article in the Times two months ago about Ina May Gaskin and home births that had a title about the “Mommy Wars.” There seems this real odd fixation on framing things as about conflict or about trends that kind of misses the boat on how so many women think about these deeply personal decisions. This is a good critique of the
        “Mommy Wars and the New York Times” from a blog a friend of mine follows:

      • I find the NYT frequently does these ‘trend’ pieces, which contain no data, just assertions. They also seem to revolve around the choices women make in their lives. And appear to spring from a conversation the writer had over lunch with a friend who kinda knows this woman who totally thinks this is true.

      • Yes! “Trendy” can be good, as it often helps regulate a particular industry and get the word out – by the time it’s out of the spotlight (although I think trendy can soo easily be confused with ‘on the rise’) there’s usually better rules, regulation, and education. That said, at the VERY least this article made me do a tad bit more research on present-day midwives, and there are actually quite a few different types. Who knew?

  8. It probably depends on where you’re from. I have a friend in NY doing doula work for underprivileged young/teen mothers who are having home births and she’ll be doing part of her midwife training as an intern in the Phillipines next summer. I think there must be pockets of midwives who cater to a certain clientele, but then you have midwives who care for other demographics as well. However, I think the fact that more women want midwives is a good thing, and what is a trend now might be a movement soon.

  9. I think it can be. I live in an area that doesn’t license CPMs and has extremely strict requirements on CNMs that often renders them into glorified nurses that most obey whatever their backup OB wants to do. It’s hard to get insurance to cover even a portion of their fees. While there is the argument that copays and deductibles can easily add up to what a midwife charges overall, especially in the case of a surgical or otherwise complicated delivery, hospital copays are often not paid. Going further with that, many aid programs will cover hospitals births with an OB in full with no copay for disadvantaged families. There are few programs in the USA that include midwives in that, much less homebirth midwives. On the other side, some midwives will work with those who truly can’t afford the full fee, fees can be saved over extended periods of time while TTC, or payment plans can be set up. All of those options are dependent on a planned pregnancy with a forgiving midwife, however, and that’s not always a luxury everyone has. Then there is the issue of ethnic and racial background. You can find an OB that is from your own culture in almost any area, especially if it’s urban. When it comes to midwives in the USA, it seems that most areas are limited to white, middle to upper middle class, straight, Christian, American women who may have little to no cultural sensitivity.

    I’m someone who made it work to pay for a midwife, despite a less than optimal family income. I had a terrible experience in going with what my insurance would pay for with my eldest, and anything short of total bankruptcy would have been worth it for me. I have trouble thinking of her purely as a status symbol because of that, but I also know that had I not had the luck of finding a midwife who was willing to let me set up a payment plan and give me a discount, I would have been choosing between charity care and an unassisted.

  10. I think it depends where you are. A lot of things can be “trendy” when you are rich and live in Manhattan if TV has taught me anything. I am in Ontario (Canada) and in our province midwives are covered by provincial health care. So getting a midwife is partially luck (because we don’t have enough for the demand) and partially preference. I don’t think its a status symbol here. It also doesn’t correlate to the “type” of birth you have either. Midwives here have hospital or home birth privledges. They transfer care to an OB/GYN if you need a c-section (like me) or induction or a variety of other things for the birth, then care is transferred back to them post partum. So I think its location specific.

    • Very big YES to this comment. I’m also from Ontario, and I don’t think midwives have anything to do with status, because they’re covered by our provincial health care system-getting one is more a combination of luck, timing, and where you live. I was very lucky to get in with my community midwives, as about 50% of the women in my region who want one can’t get one due to the fact that there simply aren’t enough midwives to go around (and because the hospital has a cap on the number of midwife assisted-births), and because my baby was born during the holiday season, when midwives take longer off-call days. In my case it was a heads-or-tails situation-midwives or my GP. I consider myself extra lucky because my GP still has a labour and delivery practice, as this seems to becoming increasingly rare. I might feel differently in a few years, if my husband and I move back to the Maritimes where midwifery isn’t really integrated into the health care system, forcing some women to go ‘under the table’ and pay out of pocket.

    • similar here — but I’m in Nashville. There’s a fairly large midwife practice that is directly associated with the Vanderbilt Medical Center and takes all sorts of insurance, as well as out-of-pocket payment. I was super excited to find them, as they seem to meet a middle ground I was looking for: a midwife-type philosophy, but in a hospital setting (and directly working with OBs) should something go amiss.

  11. I don’t know that ‘trendy’ is the right word…But definitely having a midwife is becoming more of a norm, at least where I’m from (Vancouver, BC). I had a midwife with my son and the older generations of my family thought it was strange, since in their day there was so much stigma around midwives. I had a hospital birth (health care here pays for either a midwife or dr, your choice). It was the level of care that sold me on having a midwife over a dr, and I think more and more people are realizing how much more care they receive with a midwife.

  12. As a mama on Medicaid, I definitely don’t feel like my midwife is a status symbol! The midwifery practice at my local hospital works with woman across the economic and social spectrum: low-income parents on Medicaid, insured, middle class mamas from the local university, uninsured/underinsured artists, teen mamas, you name it. We are paying for a doula out of pocket, but our doula group works on a sliding scale and accepts a very generous payment plan, so that doesn’t really feel like a status symbol either. Living in a community with a pretty large income disparity probably necessitates this arrangement, though–the midwives really make an effort to work with everyone.

    • I had a really similar experience when I was pregnant — my midwife worked at a hospital, and we were on Medicaid at the time, so it definitely didn’t feel swanky. But she was the BEST, and I was so thankful that I had the option. I ended up with an OB after I went into labor early, but my midwife stayed with us the entire time.

      • Exactly! I feel so lucky to have access to the midwives because their care is the absolute best. We also get to take advantage of
        prenatal centering
        , which has been amazing for us. Yay for accessible midwifery! (Hope the link comes through okay…)

  13. Here in the UK midwife-led care is the default. Unless you have complications you could never see an obstetrician. But the services are desperately over-subscribed so there are endless midwife horror stories. That said, I’ve been nothing but impressed with all the midwives I’ve seen. And I’ve moved between 3 districts so had a good sampling!

    Midwives are considered the experts. They see far, far more deliveries than doctors and then provide community care.

    I’m currently 34 weeks and on obstetrician-led care due to other health probs but still, it’s the midwives who are my first point of contact.

    • I’m in the UK too, but from America and the reaction of my family to finding out I’d have midwife-led care was skeptical. There were mostly polite ‘oh! didn’t know you were going the midwife route’ with a side of ‘are you sure that’s a good idea?’ before I explained how it’s the way everyone goes. All that’s to say at least in working/middle class NJ just outside NYC, it’s not a ‘trendy’ thing just yet.

      On a side note, when my doctor confirmed my pregnancy, he told me ‘The Midwives will be in touch’ like that, with the capital letters in his tone. And they were, of course, with letters and appointments and such. It made me think of them as a worldwide care group, like the opposite of a James Bond conspiracy group.

      • Yes!

        And there does seem to be a teeny bit of rivalry sometimes between doctors and midwives. In fact, I have an obstetrician friend who had an elective C-section, she claimed, to avoid the midwives!

        The only downside is how overworked and underfunded the midwifery teams are. There just isn’t the funding to have as many midwives as there are women who need care – this leads on occasion to rushing of births and interventions when just waiting could have solved many of the “problems”.
        I have to say, I’m loving joint care between obstetrician and midwives. But I also paid for private antenatal classes with an ex-NHS midwife who is AMAZING

    • It’s like that in Australia, too, although I think it’s a bit easier to see an obstetrician if you have private health insurance.

      In fact, from what I’ve seen I’d say the opposite is true – obstetricians are the status symbol.

  14. I’m a Kaiser member here in Southern California and midwifes are what everyone starts out with. You don’t see an OB unless you’re high-risk, which I was with gestational diabetes and advanced maternal age (I’m 36). But, no doctor ever showed up to my delivery room. The midwife and nurses did it all. With Kaiser midwifes are the standard.

  15. I agree that it depends where you are. Where I am it is indicative of social status because you usually have to pay out-of-pocket for the services. My insurance will technically cover a midwife, but there are none within at least 50 miles that are on my plan! For families on a budget (even if it is a moderate budget vs. living paycheck to paycheck who have insurance to cover maternity and newborn care, the cost of a midwife is also the cost of a whole lot of diapers, day care, groceries, etc.

  16. I just have to say, I was POOR AS SHIT when I sought prenatal care, and I feel like I got the best of care in Portland, Or…for FREE. Oregon Heath Plan temporarily covers pregnant mamas and their babes, and I am so thankful for living in this state. And for excellent midwives who helped me get health coverage when I needed it. Here, the attitude is like “midwives, meh, hospital, meh, just have the baby whatever way you want, man.” Why does everyone (NYTimes) have get their panties in a wad about stuff that’s just people making decisions in their lives?

    • THIS!! This is how I think its around here too. I live in Portland too. The only way that I see having a midwife, homebirth, doula as being a status symbol is because certain, um, friends portray it that way because they want it to be. Its not that way at my doc’s office, they have docs and midwives and I can choose who I want to see and it’s all covered by my insurance. And most people I know (including me) never ask if someone had a midwife or doc when asking the birth story, cause it doesn’t matter as long as mom and babe are safe and healthy. But yes, I know a few people who will put you down and act like you don’t care about your baby if you didn’t get a midwife or have a homebirth. So I think certain people that make midwives a status symbol (especially doulas), but I wouldn’t say it’s the norm way of thinking about midwives or doulas.

  17. I was having a discussion similar to this the other night at a baby shower. The soon to be new mom had just found out she was the next name on the waiting list for a midwife. It boggled my mind that their is a waiting list for a midwife. But then after a little conversation a few other women at the party talked about how they had to go on waiting lists for their midwife, doulas and/ or birthing center that have labor pools. What I took away from this article and from that conversation is that it’s awesome that different birth experiences are becoming accepted. It unfortunately shows that we still need more educated and experienced practitioners (midwifes, doulas and OBs)so we don’t have to have such long waiting lists.

  18. Having a midwife in my area of Michigan is not a status symbol. People hear midwife and think, “Not a doctor.” and “Homebirth.” or “Danger Will Robinson.”

    I do love my midwife. Better care than I’ve ever received from an OBGYN.

  19. In my little town, I know that our one birthing center is getting quite the attention, but I believe that it’s because women are beginning to believe that their bodies can handle a natural child birth, and they choose to do it in a medical free zone. I just recently transferred from an OB office to a midwife and there are still hundreds of ladies seeing OBs with no interest in midwives at all.

  20. Grrr arrg this article. Not only does it seem to miss the mark outside of liberal metropolitan communities, but I hate that it reduces a very complicated choice to following a trend. I hate that in reading this article, I find myself resenting privileged women for whom the choice to become a mother probably feels as intensely personal as it does to me. WHY is this a trend? Is it a trend because women in Manhattan love a good bandwagon?

    This article is really touching upon an interesting and important shift in the economics of birth; the women in this country for whom there is there greatest variety in birth options available (wealthy, insured, in a major metropolitan area with lots of providers, etc) are in increasingly larger numbers rejecting the current standard of healthcare. How insulting to suggest it’s because they’re mindlessly subscribing to a trend. Trends aren’t interesting because things being trendy makes my hipster heart butthurt – but it seems like when the articles are about women’s choices, that’s the focus.

  21. Semi-unrelated…but I think it says a lot about the author and their potentially warped view of privilege when myself and 5 co-workers had to Google the phrase “Now it’s the women in the red-bottom shoes”, because we had no idea what it meant. (Apparently a super expensive designer brand has red soles?) One pair of these shoes is as much or more than any of our paychecks….

    So I feel if you are going to talk about status symbols and privilege the author should maybe check her own privilege before proceeding and think that maybe she has a skewed point of view to begin with?

    Oh and where I live in West Virginia if you don’t live in one of the big cities you aren’t getting a midwife, period, no matter how much cash you have. They just aren’t a thing here yet. But then again for a lot of people in my state having a hospital birth is still a sign of privilege…..

    • WHOOOA, such a good point! I didn’t even notice that part of the quote, actually — can you link me to the shoes? I’ll put a link in it so other people have a reference point. But you are totally correct. Nicely done! I wonder if the author of the article even thought of that?

    • You have to remember that living in New York City, as many of the writers for these fluffy “social trend” pieces do, makes it easy to lose any sort of perspective about how people outside of New York live.

      I don’t follow fashion at all, but I got the red shoe reference. If I didn’t live in the city, I absolutely would not have.

      Having just moved out of New York, I both identify with the article and realize that it’s a particularly narrow view.

      • A) That’s like saying that if I were to write an article like this without acknowledging that I was writing from the perspective of an academic living in a rural Appalachian state (a very small demographic) that would be a-OK. As a nationally recognized newspaper I expect a little more awareness from NYT, even in their “fluff” articles.

        B) There are poor people in NYC too. They might know what the red soles mean, or they might not.

        I have noticed that a lot of acquaintances that have moved to NYC and made good, seem to think nothing exists outside of it….

        • Oh, I’ not saying that it’s OK at all for the NYT to be this tone deaf. I’m just saying it’s unfortunately very common, given my experience in the city.

          I’m not sure how pervasive the understanding of various NYC status symbols are (e.g. Loubotins), but I think it has more to do with following pop culture than socioeconomic status.

  22. Here in NZ midwives are the default and you see one throughout your pregnancy and birth. To me an OB seems excessive? I find it totally strange that every woman as a gynae, every child has a pead! Here you’d only see these specialist doctors if there was a problem.
    As for midwifery becoming trendy in the US! Yaaay! Maybe it’ll catch on and over take OB care soon 🙂 isn’t that how the OBs first took over from the midwives in America, status?

  23. Yes, it’s a status symbol where I live in Brooklyn.

    (But we don’t wear Louboutins here. But I did know which shoes were being referred to.)

  24. I love when midwifery is viewed in a positive light in the news. If the past is indicative of the future, having midwives as a status symbol means in a few years everyone will use us instead of doctors. That is how birth ended up in the hands of doctors, using a doctor was a status symbol. 🙂

  25. Ah, yes, the NYT trend piece, or what rich (usually) white people are doing these days!

    I find it irritating that they talk about midwives but don’t bother to distinguish between home-birth midwives and the CMNs (certified nurse midwives) who practice in hospitals. I went to CMNs, who are plentiful here in the Boston area, and they are essentially like OBs in cost and in the fact that they practice in hospitals and have access to all of the same medical tests and practices – they just tend not to use them as much. Home-birth midwives, from what I understand, have a totally different setup and cost factor, as well as in some cases different medical training.

    And with my first midwife, I have a feeling that I was one of her wealthier clients, though I am not wealthy by any stretch. With my second midwife, I was probably on the lower end economically. The only difference? One was at a downtown Boston hospital and one was in the suburbs. So, no trends here that I can see.

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