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U.S. Childbirth Outcomes Awful; Midwifery Solves?

Last updated on 2015.12.12

According to the Big Push for Midwives campaign, South Dakota remains one of 23 states in which government interferes in women's health care decisions by overly restricting the practice of midwifery.

Midwives attend only 5% of U.S. births, compared to nearly half of all births in the Netherlands. America's reliance on doctors and hospitals to bring the vast majority of us into the world must have some practical advantages, right?

Well, we're not saving lives...

Despite spending more than any other nation on childbirth, the outcomes we get are awful relative to other countries, and they are getting worse. The United States ranks 41st in neonatal mortality and 50th in maternal mortality, and the maternal mortality rate in our country has doubled since 1987 from 7.2 per 100,000 live births to 15. So far the dominant policy response to these outcomes seems to be more medical intervention, more technology and fancier neonatal intensive-care units. That's probably precisely the wrong prescription. All those fancy tools and facilities have to be paid for, and so the pressure to use them is strong. And it's hard to turn your back on the profit motive. One of the more prominent ob-gyns in Kansas City is said to have a nice boat on the Lake of the Ozarks named Sea-Section [Mark Funkhouser, "Our Dangerous, Expensive System of Childbirth," Governing, 2013.04.18].

...and, as with our overhyped, overpriced health care system as a whole, we're not saving money:

It's certainly a lot more expensive to have a baby in a hospital. The average cost for a vaginal birth at a birthing center is $2,277. The cost at a hospital is $10,166, and the cost of a Caesarian delivery is $17,056, according to the Transforming Maternity Care Partnership. Not only are hospitals expensive, but they also can be dangerous places, and one reason for the better outcomes for my wife and for [midwife and activist Ina May] Gaskin is probably related to that fact. In hospital births, a doula advocates for the mother and supports the couple as they deal with the seemingly inexorable pressure for medical interventions. In Gaskin's case, the explanation is simpler: She does home births. In the Netherlands, 30 percent of all births take place in the home, and that country's rate of maternal mortality is 6 per 100,000 live births, a lower rate than has ever been achieved in the United States. Holland's neonatal mortality rate is 3.73 per 1,000 live births, compared to a U.S. rate of 6 [Funkhouser, 2013.04.18].

My mostly conservative Legislative friends took another stab at expanding midwifery in South Dakota this year; House Health and Human Services killed that bill, HB 1065, early in the session.

If Governor Daugaard wants to fight South Dakota's high infant mortality rate, he might want to ask the 2014 Legislature to revisit the midwife issue.

2 Comments

  1. DB 2013.04.19

    Be careful with mortality rates. Every country has their own description, and even though we may lose more, we classify some as losses that other countries don't. The method of birth has very little to do with our infant mortality rate. That correlation, as your article suggests, is highly illogical. Most studies I have read point to low birth weight and short gestational age births as the leading cause in the US. It is becoming more common as well. That has more to do with our culture and how we treat ourselves during pregnancy. Throw in some ethnic and racial disparities and you find out why comparing to other countries is complete crap. I support midwifery, but you need a better argument. Our IMR is more likely related to the lack of medical access, not the lack of the ability to escape medical access.

  2. David Newquist 2013.04.19

    Infant mortality is just one of the metrics that should be of concern. While we have been congratulating ourselves on our exceptionalism and the superior American way of life, our children have, in fact, slipped down to be among the most disadvantaged in the developed world. From the Washington Post:

    "...one of the [UN] report’s more alarming findings for the United States is the degree to which income inequality has increased the population of children who grow up in relative poverty, meaning that America’s famously abundant wealth does not equally benefit all children. Economists rate the U.S. economy as one of the most unequal in the Western world."

    http://www.washingtonpost.com/blogs/worldviews/wp/2013/04/18/unicef-u-s-kids-worse-off-than-many-of-their-western-counterparts/

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