There’s nothing to add. She said it all. Thanks Whitny!
When searching for ‘news’ about midwives today, I came across this article which was originally published in 2003. I have no idea how it popped up on this week’s google news, but it did. Named “An Illegitimate Birth” it chronicles the life path of a direct-entry midwife while simultaneously following a couple through prenatal care, and then a water birth. It was a beautifully written story. I should have guessed that it wasn’t from this day and age, as it’s rather lengthy and delves into the issues, and creates a mood-rather than just delivering sound bites. In my opinion, it’s a must-read for anyone considering midwifery as a profession, or a midwife assisted home birth. I wish I knew the name of the ‘real midwife’ as I would love to know what she is doing today. I looked up the current Illinois direct-entry midwife laws hoping they had changed, and found that indeed they haven’t but are (ironically?) back in the legislature THIS WEEK.
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.
Kaiser Permanante, a large hospital chain, recently introduced a new nurse-midwifery program to their Hawaii hospital. The nurse-midwives work in a team with doctors where the midwives are assigned to women who are expected to have a normal, uncomplicated birth. The doctors are available should any unforeseen situation arise. So far, the birthing women love the new arrangement and the doctors are ‘ecstatic’. WOW! That’s just great! It’s just another example of how changes in approach and attitude can work wonders in the favor of birthing women, midwives and doctors. It didn’t hurt that the head of obstetrics at KP saw the integration of midwives as “a big dream I had from years ago.” He was partially trained by midwives while in residency, and midwives have been an integral part of the team at several hospitals he worked at.
Did you know that in 1940, 44% of births were home births? In 1969 (my birth year), the percent of home births was just 1% and has remained that low until recently. The trend of out-of-hospital birth (one that happens either at home or in a free-standing birthing center) has increased by 3% since 2004 (up until 2006-which is the latest data they have). In 2006, 61% of home births were delivered by midwives—16% by certified nurse midwives (CNMs), and 45% by other midwives.
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’.
In California, what is supposed to be among the most ‘progressive’ of our 50 states, is banning certified nurse-midwives at at Camarillo Hospital– driven ‘by concerns of patient safety’. WHAT?
I guess they haven’t read the studies, or paid any attention to their own statistics. They cite the reason as ‘ doctors worry most about midwives who specialize in home births and rely on hospitals for backup when complications arise.’ But meanwhile, the midwives in question only do hospital birth. The change leaves only two hospitals in the county, St. John’s in Oxnard and Community Memorial Hospital in Ventura, where midwives deliver babies.
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.”