Saturday, June 19, 2010

History repeats itself

An overview of obstetric and midwifery history will show one thing quite clearly: doctors don't like midwives. In fact, most doctors wish that midwives didn't exist, and they most certainly wish that they weren't allowed to practice.

For most of the past 150 years, obstetrics won. For decades, midwifery was (in America) nearly a lost art. It began to revive in the 60's and 70's, enjoyed a bit of a heyday in the 80's, and has stolidly refused to die out, even in the face of tremendous pressure from obstetricians and insurance companies.

Ideally, obstetricians and midwives would work together, referring patients to each other for the best outcome for each individual woman. Low risk cases to midwives, high risk cases to obstetricians. It could be done. It should be done if we care about cost control, best outcomes for babies, and quality care for women.

And it seems utterly out of reach. Yet again, history attempts to repeat itself. In the state of New York, the closure of a large, midwife-friendly hospital (St. Vincent's in Manhattan) has imperiled the ability of midwives to practice. State law currently requires that all midwives have formal, written practice agreements with a back-up obstetrician. With the closure of the hospital, most midwives have been unable to meet this requirement. A bill to amend the law was expected to pass easily, until it met with opposition from the American College of Obstetricians/Gynecologists. Why? Is it a safety issue? Have new studies emerged showing midwifery to be dangerous? No. ACOG is opposing the legislation on the grounds that it "has the ability to pave the way for midwives to open their own independent birthing centers."

The hubris utterly amazes.


Myrnie said...

That's amazing, really. I'm wishing for a doula/midwife for our third baby. My first two were complication free, and I'm dreading the doctor visits the third time around. Husband...isn't so sure, just in case something goes wrong.

Amber said...

Wow, that's really unfortunate. It is sad to see a group so insistent on maintaining monopoly, even to the point of being contrary to what the patients want and what is the best medically for the overall population.

What I find interesting is that this isn't the case in many other countries. I wonder how it is that they have learned to co-exist in places like the Netherlands and such whereas there is such animosity here? Most likely it is the profit motive, which makes the whole thing even more tragic and pathetic.

Ma Torg said...

It really is shocking. In England, (and remember, this country has nationalized health care), a woman can choose whether or not she wants to give birth at home, a birthing center or a hospital. She can also switch at any time if she changes her mind. I was extremely jealous of my pregnant American friends over there who had no idea how annoying maternity care is back home...

Elena said...

I'm discovering Ivan Illich, who has a fascinating perspective on all this. He says that with many technologies, there are two watershed moments--one where the benefits grow enough to outweigh the costs, and a second one where the costs grow enough to outweigh the benefits. If you want your tools to serve you, rather than being a slave to your tools, it's important to identify those parameters, and live within them.

And it's bad for everybody when the government becomes complicit in enforcing "radical monopolies" where everybody is forced to participate in certain technologies, whether they wish to or not.

I'm awfully glad that I can give birth in the comfort and safety of my own bedroom, but with an oxygen tank on hand just in case, and with the security of knowing that the ER is just a few miles down the road if anything goes wrong.

I wish every woman had this range of childbirth options, and I hope that this freedom continues.