Midwifery's Renaissance
(Page 5 of 6)
Utne Reader March / April 2007
Marsden Wagner, Born in the USA
Midwives, like doctors, are human. They have bad days and they make mistakes. Science now tells us, however, that overall, midwives are safer than doctors for low-risk births. If a woman is among the 80 to 90 percent of all women who have normal pregnancies, the safest attendant for her hospital birth is not a doctor but a midwife.
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In the past two decades we've seen a renaissance of midwifery in the United States. Each year, the number or births attended by midwives increases.
The more the practice of midwifery grows and succeeds, the more threatening midwives are to the obstetric monopoly, so, predictably, there has been an obstetric backlash. Now, a hundred years after Hanna Porn was persecuted, we have another American witch hunt against midwives. In many states, doctors are reporting midwives to various authorities as dangerous.
In many cases, these attacks are simply attempts by doctors to eliminate the competition. Cases against midwives are, with very rare exceptions, not initiated by the families the midwives serve, as is typical of litigation against obstetricians. Instead, they are initiated by physicians. In the past several years in many states, including Illinois, Utah, California, Vermont, Virginia, Nevada, Oregon, Indiana, and Ohio, police have arrested direct-entry midwives for practicing nursing or medicine without a license.
Maternity care in the United States is changing, and one of the most important changes still in progress involves who will catch the 3.5 million babies a year whose mothers have had normal pregnancies. That is, who will be the primary birth attendant for low-risk births? In the past decade, the percentage of births attended by midwives has gone from 5 percent to 10 percent, and there are a few places where it is closer to 25 percent. HMOs are hiring more and more midwives. Kaiser Permanente, one of the largest HMOs in the country, has many midwives on its staff. There are several reasons for the growth of midwifery in the United States, and a big one is money.
Midwifery is far cheaper than obstetrics for two reasons. On average, obstetricians take home a net income in the neighborhood of $200,000 a year, whereas midwives earn about one-quarter of that. Equally important, the cost of the obstetric interventions, such as induction and C-section, performed unnecessarily can easily be cut in half by having midwives, rather than obstetricians, assist at normal births. Health care in the United States is very much driven by the bottom line, and slowly but surely the insurance companies, managed health care organizations, HMOs, and even state and federal government agencies are realizing that the obstetric monopoly is wasting enormous amounts of money. The day that truth fully sinks in will be the day the obstetric monopoly is on its way out.
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