Michael H. Wilson at Evergreen Libertarian:
A 2005 report from the National Center for Health Statistics rates 29 other countries, mostly European ahead of the U.S. with lower infant mortality. The best European country is Sweden with 2.4 deaths per 1000 live births where 85% of infants are delivered in hospitals by midwives. In the Netherlands with an infant mortality rate of 4.7 about 30% of infants are born at home. While here in the U.S. where less than 10% of infants are delivered by midwives we have an infant mortality rate of 6.9 deaths per 1000 live births, and higher numbers for minority infants.
According to the Department of Health the infant mortality rates in Washington for the years 2001 thru 2003 are for American Indian and Alaska Native infants 10.7, native Hawaiian and other Pacific Islander infants is 10.3, Blacks 9.7, Whites 5.2, and Asians 3.8 per 1000 live births.
One way to improve the situation is to bring back a tried and true practice that most of the civilized world uses but most states have, including Washington, tried through regulations to push into the shadows. That is midwifery.
Virtually all the studies conclude that midwives can be a benefit. In 1998 the Journal of Epidemiology and Community Health published a study titled Midwifery care, social and medical risk factors, and birth outcomes in the USA “After controlling for social and medical risk factors, the risk of experiencing an infant death was 19% lower for certified nurse midwife attended than for physician attended births, the risk of neonatal mortality was 33% lower, and the risk of delivering a low birthweight infant 31% lower”.
In the late 1800s and early 1900s there was an effort by the medical establishment to push midwives aside. Of course money was at the center of this effort. Doctors would get to keep the profits if they managed to grab the business of childbirth. Without going into the details it was done by regulations and describing midwives as ignorant and unhealthy. Untrue as it may have been since many of the midwives had been educated in Europe and probably had better schooling in childbirth than most doctors.
Today in the U.S. Certified Nurse Midwives can practice in all states, if they can gain entry to a hospital, but direct entry, or Certified Professional Midwives, can only practice in some 28 states. The legal descriptions used to for Certified Professional Midwives change from one state to the next, often based on the law, but regardless they are not nurses.
It is time to put mothers back into control of their child’s birth, and give them a choice. Unfortunately there are a lot of barriers in the way; everything from licensing fees to the difficulty midwives have gaining hospital privileges. While it may take time to repeal all the laws requiring licensing, we should demand it as a matter of public health, and start work immediately to lower fees and other barriers to midwifery.
According to the Kaiser Family Foundation in 2003for Washington State 45.6% of births were paid for by Medicaid, while nationwide the number is 41% as of 2003.
The costs of a birth attended by an OB/GYN can vary considerably nationwide due to a number of factors. Generally the costs run anywhere from a $4000 to $11,000 depending on the circumstance. The more complications the greater the costs, but regardless, midwives costs are about one-third to one-half of that charged by an OB/GYN and a delivery at home may cost as little as $1000.
Additionally mothers who use midwives for their prenatal care usually have babies who come into the world at higher birth weight, which means the child starts life healthier, and in the long run has fewer problems.
Michael H. Wilson is editor of Libertarian Party of Washington State News & Views