03.10.2010

Taiwan Midwives-Extinction Inevitable

I usually don’t write too much about international stories as there is so much going on right here in the ol’ US of A, but this story really hit a nerve as it sheds some light on our own midwifery history.

Taiwan used to have a rich and thriving midwifery profession since at least the late 19th century and probably much before that. It is estimated that midwives delivered 400,000 babies annually up until the 1960’s. With the advent of economic prosperity in the 1970’s and the introduction of socialized health care in 1995, many proverbial nails have been put in the midwifery coffin, so much so that the state is planning to cancel the midwifery licensing exam all together as only 7 people in the entire country signed up to take it this year. Where there used to be 20 midwifery schools, now only one remains. Of the 300 registered midwives, only about 1/2 are practicing- delivering maybe a dozen babies a year. It’s very sad.

Most Taiwanese midwives blame the decline on the National Health Insurance (NIH) of which 97% of their population is enrolled. Although it is one of the most cost effective socialized medical systems in the world, midwives were not written into the services. The insurance does not cover private midwifery clinics, and no midwives are permitted to practice in hospitals. (Hospital midwives previously delivered hundreds of babies a month.) Today, most women from Taiwan rely on obstetricians and nurses to assist them with prenatal care and delivery. Hell bent on efficiency, the health care system views midwives as a liability as their skills are specific to the maternity ward, whereas ‘regular’ nurses can float all over to where ever they are needed.

One of the stated problems with NIH is that there are too few doctors and many, many patients making an average visit 2-5 minutes per patient. How on earth can someone receive good, comprehensive care with that short an office visit? Where would this leave a midwifery model of care? Nowhere. I wonder what the women of Taiwan think of this relatively new way of birthing? What price are birthing women paying for ‘modernization and prosperity’ of their country? Are they upset because they have been left with no choices? Culturally, there is such a lock down on dissent that perhaps we will never know.

This all kind of reminds me of how the AMA systematically squeezed out midwives in the US by denying them venues to practice and limiting conditions under which they could work. Thankfully, unlike Taiwan, American women had the right to free speech and organization and have managed to keep midwifery practice alive against great odds until the tides could shift. I believe that just recently, the groundwork is being laid so midwives will only get more rights and privileges and eventually restore midwifery to what it was back in its hey day- a viable, accessible option for nearly every woman. Unfortunately for Taiwan, all the knowledge and tradition of Taiwanese midwifery is endangered to the point of extinction and no one can outwardly mourn the loss. Perhaps when their health care costs skyrocket due to c-sections and premature birth (like ours has) they will begin to rethink their decision to eliminate midwives, but by then it will be too late.

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