As I continue to read through the evidenced-based maternity report, I am more and more convinced that moving towards midwifery based care and free-standing birthing centers could be the answer to many of our country’s healthcare woes. Charges for childbirth vary considerably depending on the type and place of birth. “The average hospital charge in 2005 ranged from about $7,000 for an uncomplicated vaginal birth to about $16,000 for a complicated cesarean section, yet out-of-hospital birth centers were about one-quarter of the charges of uncomplicated vaginal birth in hospitals ($1,624 in 2003, when the national average charge for uncomplicated vaginal birth in hospitals was $6,239) three-quarters of the expense concentrated in the hospital stay.”
“Cross-national comparisons from the World Health Organization and the Organisation for Economic Co-operation and Development clarify that many other nations are doing a better job with measures such as perinatal, neonatal, and maternal mortality, low birthweight, and cesarean rates. Nonetheless, per capita health expenditures for the United States far exceed those of all other nations. These outcomes, together with costly, procedure-intensive care, have been called the “perinatal paradox: doing more and accomplishing less.”
“Comparing current maternity care practice and performance in the United States to lessons from the best available research and to performance benchmarks reveals large gaps.”
The report found that “consistent with common patterns of innovation in medicine (McKinlay 1981), obstetric practices such as episiotomy (Graham 1997) and electronic fetal monitoring (Graham et al. 2004; Hoerst and Fairman 2000) were adopted prior to adequate evaluation. Many practices that are disproved or appropriate for mothers and babies only in limited circumstances are in wide use. Use of specific maternity practices varies broadly across facilities, providers, and geographic areas. This is primarily due to differences in practice style and other extrinsic factors rather than differences in needs of mothers and newborns.” As I have mentioned before, because of the way doctors are trained in US medical schools, the values of “autonomy” of practice reign supreme over evidence. This, coupled with a culture of medicalized birth where most woman believe that birth should take place in a hospital have created a very expensive and unnecessary reality that costs the US government billions of dollars a year in maternity care. Medicaid pays for 42% of the birth-related expenses in the US.
“With over 4.3 million births every year, childbirth is the leading reason for hospitalization in the United States, exceeding such prevalent conditions as pneumonia, cancer, heart failure, bone fracture, and stroke.”
“Hospitalization is by far the largest component of health care costs, and hospital charges for the current style of childbirth are considerable. Combined hospital charges for birthing women (about$44 billion) and newborns (about $35 billion) totaled $79,277,733,843 and far exceeded charges for any other condition in 2005 (Agency for Healthcare Research and Quality 2008). 49 percent of all hospital procedures performed on all individuals aged eighteen to forty-four were obstetric procedures, and six of the fifteen most commonly performed hospital procedures in the entire population involved childbirth. These include medical induction, manually assisted delivery, and other procedures to assist delivery repair of current obstetric laceration, cesarean section circumcision, fetal monitoring, and artificial rupture of membranes.” Midwifery practices use these medical interventions sparingly and only when absolutely necessary-keeping the cost of labor and delivery down, and the outcomes the same or better than medicalized birth.
“The national cesarean rate rose by 50 percent from 1996 to 2006, setting a new record each year from 2000 onward. From 1990 to 2005, the proportion of medically induced labors rose by 135 percent, from 9.5 percent to 22.3 percent
the most common gestational age among singleton births in the United States fell from forty to thirty-nine weeks.” The drop in gestational age means an increase in health care costs to care for premature babies. The higher instances of c-section always mean longer hospital stays, greater chances of complications arising from major surgery and a much greater cost to US taxpayers.
Additionally “women who gave birth in U.S. hospitals in 2005 reported high rates of numerous new-onset physical and mental health problems in the first two months after birth, with many problems persisting to six months or more postpartum.” I attribute this to negative birthing experience, and a medical model of care (where doctor patient relationships are superficial, brief and generally unsupportive). There is already evidence that a midwifery model of obstetrical care where midwives build true relationships with their clients and are offer support during and after pregnancy really work and add to maternal wellbeing. As the saying goes…..it takes a village to raise a child. Well, it also takes a village to birth a child and deal with the often trying time of major adjustment right after the child is born. No one should do it alone, and with a midwife, no one will.
I had always heard that at our local hospital birth was a big money drain. Our unit (women’s services) was a liability rather than a money maker. With these statistics, I am perplexed. It sounds like hospitals and doctors would be losing a large revenue source if normal birth was moved out to the home or to birthing centers. What the general public doesn’t know or talk about is that we as US tax payers are paying for nearly 50% of these births through Medicaid, and allowing the doctors to perform unnecessary tests and interventions at alarming rates just jacks up the bill and makes birthing women feel scared and out-of control.
Of course the American Medical Association (AMA) is a huge, and strong lobby. And now, as sanctioned by our own lovely Supreme Court, they can lobby to their hearts content to keep their agendas intact. Their agenda includes limiting (or in a perfect world, eliminating) midwifery, or keeping us on a very short leash. Using fear, and baby-hating propaganda, they have systematically led women to believe that they are unable to birth effectively without intervention or drugs, that they are ‘selfish’ and irresponsible if they demand a birth experience on their own terms, and that birth outside a hospital is dangerous and reckless. These ideas and beliefs are now firmly entrenched in our society and it’s going to take a village to change people’s minds.
Thankfully, there are many women who value midwives and midwifery and home birth or natural birthing practices. Our own organizations are making efforts toward transparency in birth through things like The Birth Survey, and midwife-friendly reports based on evidence. If evidence-based practice does gain support and ground with the US government and the people, only then will we be able to start a real dialogue about what birthing practices are best for women, babies and the US pocketbook.