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Tuesday
Oct252005

Saving Babies, Saving Dollars: Why Midwives Should Be a Larger Part of Our Health Care System

My English Essay from 10/14/05:

Claudia, dancing her labor into increased productivity, swivels her hips, bends her knees, and moans her birth song through the halls of the hospital. Anxious family members down the corridor listen and furrow their brows or whisper words of concern about her well-being. Back in the room, her midwife holds her hand and wipes her brow while knowing how beautifully Claudia is laboring. She is bringing a baby into the world – just as 600,000 women are at the exact same time all over the globe (England and Horowitz 137). Sweating, clinging to the birth bar attached to the bed, Claudia looks up after an amazing contraction and asks the midwife,
“Is everything alright? That one was so long and hard.”

Her midwife looks deeply into Claudia’s tired eyes and smiles gently, nodding and repeating the phrase every midwife around the world says on a daily basis: You can do this. You are doing this.

Outside the door, Dr. Schmidt glances at his watch, ticking off the moments until Claudia has run out of time – his time – until she is wheeled into the operating room, anesthetized, and sliced open so he can remove her baby and get on with his golf game. This labor, while trudging at a slower pace than many would prefer, is certainly within the realm of normal, even in the obstetric sense. What is not normal, however, is the reasoning behind thrusting women into an operative suite. Greed – with time and money – as well as fear of lawsuits have driven surgical birth rates to a level many never imagined a mere twenty years ago.

Midwives, women (typically) who have specialized training in normal obstetric care, can change the pregnancy and birth experience from one of fear, anxiety, and isolation, to joy, empowerment, and increased ease in stepping into her place as a mother via this all-important rite of passage. Midwives offer aspects of care not typically seen in obstetricians as they spend time listening, explaining, establishing a relationship with the client and offering a type of support that requires considerable emotional, yet surprisingly little, economic cost. Studies abound demonstrating the cost-efficiency of midwifery care even in a collaborative relationship with obstetricians, yet in the United States, obstetrical associations and physician’s organizations fight with every ounce of their being to keep midwives out of what they consider to be their territory. However, by employing and utilizing midwives, billions of dollars could be saved for consumers and insurance companies. Savings include fewer cesarean sections and their inherent surgical complication expenses as well as far fewer women experiencing postpartum depression and the necessary medications and therapists to mend their spirits (Jackson, et al.).

The scope of reasons for physician and midwife tension reach much further than this paper would allow, but include, as mentioned above, greed of money and time – including kick-backs by pharmaceutical companies to highly encourage women to take narcotics and regional anesthesia such as an epidural in labor, the compulsion to speed women’s labors up with medications (which then requires pain medications because labor becomes intolerable), and manipulating statistics that say interventions are not only appropriate, but the proper way to treat women. None of this even begins the discussion regarding silencing women with medications because there are not enough nurses to support, either emotionally or physically, each laboring woman (Goer 44-6). It is far easier to silence women in pain than to witness their labors. Most maternity nurses would agree. Other powerful issues include the acceptance of women choosing a cesarean section for no medical reason and even more baffling, their allowing women such as Britney Spears to choose to have a first child by scheduled cesarean, again, with no medical reason and the issue of control – over nurses, administrations, patients, legislation, and insurance rates. A dizzying array of topics that converge into a spider web of confusion clients find themselves in when they are merely having a baby.

Midwifery care differs greatly from obstetric care. Midwives spend an average of forty-five minutes during a prenatal visit with a woman while her doctor colleague spends an average of six (Giving). Physician care for a woman birthing in the hospital might include the doctor walking in when the baby is about to be born and leaving as soon as the placenta is removed. All other contact during labor is with nurses via the telephone. Midwifery care in labor affords the woman nearly continuous bedside attention (even though many midwifery clients do not get into bed until after the baby is born!) whether that birth occurs in the hospital, birth center (an out-of-hospital birth setting), or the woman’s home. Physicians typically work in a group with each doctor taking “call” (being the one to answer phone calls or go in to the hospital when someone is admitted). While this is beneficial for the doctor, the woman in labor might be faced with someone she has never met as she brings her baby into the world. Midwives strive to offer continuity of care to their clients and rarely are not the person in attendance during the birth.

If midwifery care is so terrific, why do women look to doctors over ninety percent of the time during their pregnancies and births?

Economics and public relations are key to how women choose their maternity care provider. Many insurance companies will not pay for midwifery care, but pay enormous amounts to physicians. A brief scan of the cast of characters on insurance company boards of directors demonstrates that at least one quarter are physicians. Doctors stand to gain an enormous amount of money by utilizing technology and manipulating the system as well as convincing women the only safe place to have a baby is in the hospital and the only safe provider has an M.D. after his or her name. Hospitals support the high cost (to the patient and insurance company) of interventions since labor and delivery suites account for about eleven percent of their total income (Hanold). Inductions (chemically beginning labor), continuous fetal monitoring, epidural anesthesia, cesarean sections and longer hospital stays all feed the ravenous beasts who stand to significantly gain from the plethora of medical offerings in a hospital setting.

Midwives, on the other hand, minimize all the above interventions. Women applaud their ability to keep their births as low-tech as possible; therefore, midwives should be the first line of defense in maternity care as it is in Europe where over seventy percent of births are attended by midwives (Mayo). Satisfied women become repeat customers and that makes great economic sense.

While the emotional benefits of midwife-attended births is difficult to accurately measure, economic benefits to the client are not. According to 1999 statistics, a home birth cost between $2,300 and $5,000, birth center births cost between $3,500 and $8,300, hospital birth cost $4,300 and $16,000, while cesareans cost between $9,300 and $26,000. Today, in San Diego, those numbers are much higher with hospital births costing $10,000 a day, excluding an epidural; I have seen the bills. An interesting note, however, is that the home birth and birth center costs mentioned above include all prenatal and postpartum care whereas the hospital and cesarean birth prices are specifically care done in the hospital; prenatal and postpartum care is an additional several thousand dollars (O’Mara 322).

Far-sighted politicos join with midwifery organizations, local, regional, and national legislative organizations and even the World Health Organization in searching for ways to not only save the taxpayers money, which midwifery care most certainly does, but also in helping to save lives around the world (American). Reporting in the American Journal of Public Health, researchers, who consider midwives “resources” and prenatal care and uncomplicated birth “procedures,” state, “Because these resources and procedures are major determinants of the cost of perinatal care, managed care organizations, state and local governments, and obstetric providers should consider inclusion of collaborative management/birth center programs in their array of covered or offered services” (Jackson, et al.). Collaboration in this sense would include utilizing each profession for its skills: midwives for normal and uncomplicated pregnancies, births, and postpartum periods and obstetricians for the complicated cases. Collaboration in obstetrics also translates into each professional demonstrating their forte even as variations of a client’s or patient’s health fluctuates. For example, if Monica, four months pregnant, develops a urinary tract infection so serious she requires hospitalization, the obstetrician is available for admission and care while she is hospitalized, yet primary care returns to the midwife upon clearance from the doctor once all signs of infection have resolved.

Just because midwives lower costs for women and insurance companies, is that reason enough to require them in our health care system? Nearly across the board, statistics have proven the safety of midwifery care, even in high risk situations when accompanied or managed by obstetricians. Obstetricians certainly dispute even the most comprehensive statistics proving a midwife’s safety record. A growing consumer movement questions - no, resents – the doctor’s holier-than-thou attitudes and insatiable desire to oppress, and even extinguish, midwifery care for women who choose it. Even our own state of California laws regarding midwifery are being debated next month at the Medical Board of California’s quarterly meeting. The board will be making a decision about a midwife’s role in medical care – either severely limiting it (as physicians are strongly fighting for) or widening it (as midwives and consumers are begging for). Lines of consumers – women who have had babies with midwives – are scheduled to speak on behalf of midwives. Many of these women have felt betrayed and abused by the medical system we now have and demand change. Change requires leadership, regulations, and appropriate punishment for those not following the rules lain out by the policy, policies midwives and women alike struggle to obtain. In Martin Luther King’s articulate “Letter from Birmingham Jail,” he says, “We know through painful experience that freedom is never voluntarily given up by the oppressor; it must be demanded by the oppressed” (King 801).

Today, the oppressed – midwives and women wanting more birthing options - are a minority, but movement towards more humane healthcare for everyone has begun and shows itself in cancer wards as dying children stroke borrowed dogs and cats, as hypnotherapists teach chronic pain sufferers coping mechanisms as alternatives to narcotics, and prayer, once seen as reserved for the devoutly religious, has now been proven effective even when atheists recite simple requests over and over. Women in labor deserve to be tended to, understood, and respected. Doctors simply do not have the time to sit with a woman during a twenty-two hour labor. Doctors, in my experience, would never want to and have told me as much over two decades of work in hospitals.

Aware of increasing consumer pressure, administrators prettied-up labor and delivery rooms with “home-like” atmospheres, champagne celebration dinners, and compact disc players in every room. But, is interior design enough to convince women to submit to care that excludes the best money has to offer? Will the battle for patients/clients escalate to a place of bribery and cash incentives similar to programs that encourage single, unwed welfare mothers to marry by paying them off? Katha Pollitt, in “$hotgun Weddings,” says, “The very fact that welfare reformers are reduced to bribing, cajoling, and guilt-tripping people into marriage should tell us something” (Pollitt 351).

Transposed over a delivery room, that comment might read:
The very fact that obstetricians are reduced to ignoring evidence-based medicine to support their costly interventive care, outright lying to women about their health and well-being so patients schedule inductions or cesareans, and the ever-increasing flow of women complaining of impersonal, disingenuous, and emotionally vacuous care should tell us something.

Hearing the cry of a newborn behind the door, the watch-tapping Dr. Schmidt harrumphs his frustration at “wasting” several hours in the hospital. Tip-toeing in and peering around the curtain, he sees a new mother and father holding their still-wet baby girl close as the midwife steps back, allowing them time – to catch their breath, to bond, to look into each others’ eyes – and this midwife, patient even under obstetrician pressure, smiles to herself that another woman averted the knife – the knife of greed and politics.

The tug-of-war between midwives and obstetricians is not likely to end any time soon. Without clear leadership from the highest levels and intense consumer pressure, conflicting agendas muddy the boundaries into which each profession must conform – midwife and obstetrician. Until such a time evolves, women continue shouting in order to be heard over the enormous behemoth that is today’s obstetrics.

Works Cited

(removed to lower chance of plagerism)

References (1)

References allow you to track sources for this article, as well as articles that were written in response to this article.
  • Response
    Response: Phil St Ores
    - Navelgazing Midwife Blog - Saving Babies, Saving Dollars: Why Midwives Should Be a Larger Part of Our Health Care System

Reader Comments (4)

I've been lurking here for a little while, and I just wanted to say that I really enjoy your writing, both essays and journal entries.

Thank you 8 )

October 26, 2005 | Unregistered Commenterrubberneck

Very, very well said.

October 28, 2005 | Unregistered Commenterladyelms

Rubberneck - who are you?! I read through your blog and LOVE it! (Okay, YOU are now personally responsible for my not studying Psychology OR for my Anthropology tests - feel guilty?! *laugh*) I don't know who you are, what you're studying... you have the vocabulary of 23 of me! I am so jealous! (Maybe if I hadn't taken Quaaludes, Phen-Fen, 20 years of antidepressants, and painkillers I'd have more of a brain?)

Thank you for reading! You can bet I'll be reading YOU, too!

And ladyelms: Thank you!!!

(it's just wrong that I have to do the word verification on my own blog)

October 28, 2005 | Unregistered CommenterNavelgazing Midwife

Y'know, I don't think I can be personally responsible for both of us not studying *g*

As for your other question, I'm studying to be a physical therapy assistant. I'm also trying to write a novel and looking to get knocked up, which is why I've been lurking around the blogs and sites of midwives and doulas lately (especially those back in school--it's good to read about other people having to study *g*).

I cruised through your 20 years of birth stories in a few hours, ravenous for them after all the hospital-based stories I'd heard growing up. Stories are how we make life make sense, and since I'd decided to go the midwife/birth center route, I wanted a foundation of those kinds of stories to fall back on, with all their variation and their sameness.

October 31, 2005 | Unregistered Commenterrubberneck

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