MIDWIFERY’S RENAISSANCE
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. As midwifery becomes better established in the United States, it becomes more difficult for the obstetric establishment to perpetuate the myth that midwives are not as safe as doctors. Pushing the “safety” issue has backfired as a way for obstetricians to protect their territory. As more state legislatures look carefully at the data and realize that they have been denying families a safe maternity care option, momentum will grow and laws that support and protect midwives will spread to other states. Another reason midwifery is going to grow: Americans believe in a free market economy with open competition. Obstetricians and midwives both offer primary maternity care. Finally, midwifery will continue to grow as more women come to appreciate that maternity care is not primarily a health issue but a women’s issue. Midwifery plays an important role in strengthening women’s control over their own bodies and reproductive systems. Excerpted from Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First (University of California, 2006).
