WHEN CHARLOTTE, FOURTH in line to the British throne, was born last spring, she dropped into the waiting arms of a midwife. Americans may find it surprising the royal family entrusted the little princess to anyone short of the best medical doctor in the realm. Charlotte’s subjects, however, barely batted an eye. After all, midwives attend most births in England.

Now, the British National Health Service has gone as far as to recommend healthy women with low-risk pregnancies are better off out of the hospital, giving birth at home or at a midwife-led birthing center. American obstetrician Dr. Neel Shah, a professor at Harvard Medical School, set out last spring to rebut that counsel in the pages of the New England Journal of Medicine. Instead, his article ultimately argued that giving birth outside a hospital with a midwife could be safer and much cheaper for many American women, too.

“We’re taking excellent care of high-risk women, but we’re leaving low-risk and normal women behind,” Shah told NPR in July. “We’re on the only continent on Earth with a rising maternal mortality rate.” Indeed, British guidelines suggest the risk of over-intervention, such as unnecessary caesarean sections — rife in US hospitals — may outweigh the risks of under-intervention at a birth center or at home for most mothers.

British women are generally referred to a midwife as soon as they’re pregnant. In the United States, midwives only attend about 9 percent of births. Only slightly more than a century ago, the Bay State — in the spectacularly named Commonwealth v. Porn case; the defendant was a Gardner midwife named Hanna Porn — outlawed midwifery altogether.

Home births today are even more rare, but the numbers are growing rapidly. But what would it take for midwife-led births to become commonplace here?

WHEN CHARLOTTE, FOURTH in line to the British throne, was born last spring, she dropped into the waiting arms of a midwife. Americans may find it surprising the royal family entrusted the little princess to anyone short of the best medical doctor in the realm. Charlotte’s subjects, however, barely batted an eye. After all, midwives attend most births in England.

Now, the British National Health Service has gone as far as to recommend healthy women with low-risk pregnancies are better off out of the hospital, giving birth at home or at a midwife-led birthing center. American obstetrician Dr. Neel Shah, a professor at Harvard Medical School, set out last spring to rebut that counsel in the pages of the New England Journal of Medicine. Instead, his article ultimately argued that giving birth outside a hospital with a midwife could be safer and much cheaper for many American women, too.

“We’re taking excellent care of high-risk women, but we’re leaving low-risk and normal women behind,” Shah told NPR in July. “We’re on the only continent on Earth with a rising maternal mortality rate.” Indeed, British guidelines suggest the risk of over-intervention, such as unnecessary caesarean sections — rife in US hospitals — may outweigh the risks of under-intervention at a birth center or at home for most mothers.

British women are generally referred to a midwife as soon as they’re pregnant. In the United States, midwives only attend about 9 percent of births. Only slightly more than a century ago, the Bay State — in the spectacularly named Commonwealth v. Porn case; the defendant was a Gardner midwife named Hanna Porn — outlawed midwifery altogether.

Home births today are even more rare, but the numbers are growing rapidly. But what would it take for midwife-led births to become commonplace here?