Due to overwhelming commentary on the health care reform bill, I am attempting to read it all and highlight the main ‘talking points’. Although I agree that the bill has it’s flaws, it is a great step in the right direction.
The Constitutionality of the Health Care Bill
Opponents of the Health Care Bill, including the Attorney Generals of several states are planning to sue the government over the ‘unconstitutionality’ of the bill. “They are expected to sue over the bill’s mandate that requires everyone to buy health insurance” saying that it infringes on ‘state sovereignty’. Yet federal law always trumps state law.
Furthermore, under the commerce clause (Article I, Section 8 of The Constitution) Congress has the power to regulate activities that, taken cumulatively, have a substantial effect on interstate commerce. People not purchasing health insurance unquestionably has this effect. Everyone, at some point in their lives will need health care, and requiring people to have health insurance to offset the costs of taxpayers having to pay for people who don’t have health insurance creates a scenario where no one will be an undo burden on the government. You would think that republicans would like this as it is a lesson in personal responsibility.
Democrats were successful at passing the first major health care legislation since the New Deal. This is great news for moms and babies. The law has added the following provisions related to maternal/pregnancy and birth health care:
Medicaid reimbursement will be available for Certified Professional Midwives working in licensed birthing centers. I am hoping this will open up the door for midwives to open up birthing centers all across the nation, allowing low income women living in rural and underserved areas better access to midwifery-based maternal and child care. This is a win-win situation for women and midwives-hopefully providing choices in health care that more effectively address the cultural differences in the communities where these women live. When women feel honored, and are being cared for and served by providers that understand their culture, language and social norms, it will create an environment of support and empathy-rather than one that may leave women feeling scared and powerless at a very vulnerable time in their lives. Midwives can now effectively serve these women knowing that their work will be paid for by insurance.
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.
The title says it all. Today, Medscape released a paper ‘Science and Sensibility’ outlining the recent studies related to the safety of home birth vs. hospital birth while discussing the barriers that home birth practitioners, and women who want home births are facing.
Recently, women are choosing or are interested in home births at a greater rate than in the past several decades. The paper discusses ‘planned home birth’, which refers “to the care of selected pregnant women by qualified practitioners within a system that provides for hospitalization when necessary.”
Today it was announced that Wyoming is seriously considering passing a bill that would allow midwives to legally practice in the state.
A Virginia attorney, Andrew Emrich who moved to Wyoming was dismayed not to have the option of a home birth midwife when his wife became pregnant with their fifth child back in 2005. It was then he learned that ‘midwifery is illegal in Wyoming’.
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.”
The University of New Mexico’s Nurse-Midwifery Program is in danger of closure due to budget cuts if the House Appropriations Committee of New Mexico votes to axe its funds.
Nurse-Midwives deliver 30% of New Mexico babies. 61% of UNM graduates stay and work in New Mexico.
There are approximately 160 Certified Nurse-Midwives working in NM. One-third of them have graduated from UNM.
The Nurse Midwifery program is targeted for $117,000 cut– 33% of its budget.
This vote is happening tomorrow.
Thank goodness for the ACLU. They have taken on the case of Samantha Burton, who at 25 weeks started experiencing premature labor and was told by her doctor to remain on bed rest for the rest of her pregnancy. When she explained that she had two toddlers at home and would unlikely be able to achieve complete bed rest and did not want to stay in the hospital, she was court ordered by the hospital to remain on bed rest to “preserve the life and health of [her] unborn child.” Sadly, she miscarried three days later.
On Nov. 9th their was a protest outside the Australian Prime Minister’s office. Apparently the Australian government has announced its intention to make amendments to the Medicare for the Midwives Bill that will force private midwives who attend home births to work in collaboration with a doctor.
This excerpt from the report:
Australian College of Midwives president Jenny Gamble told protesters an amendment to the Medicare for Midwives Bill will give doctors the choice about how women give birth.
The American College of Certified Nurse Midwives (ACNM) and Midwives and Mothers in Action (MAMA) and other organizations that support Certified Professional Midwives (CPM’s) appear to be having quite a tif.
In July, the ACNM submitted a letter to members of congress opposing Federal Recognition of CPM’s for serving Medicaid and Medicare recipients. At first glance this might seem like a cat-fight, so I thought I would highlight the issues.