In 2007 Americans gave birth to 4.3 million new babies who are being ushered into a time in our history with great unrest concerning finances. This problem will not go away overnight, and it certainly won't be fixed by one solution to only one part of the problem. There are many areas that are being negatively affected, including our schools, our healthcare, and our families. And when it comes to the latter, we are falling very short of our goals, spending too much money, and not putting our mothers and babies first.
As a woman, a mother, and a sister, I feel compelled to talk about one specific area of healthcare. Since it accounts for 2/3 of the costs of healthcare in the U.S.(apprx. $86 Billion in 2006), it is an important part of our financial burden. Am I talking about strokes, heart attacks, cancer, or brain surgery? No sir -- something much more to the basic 'root' of our society. Pregnancy, birth, and postpartum care cost our country more money than any other area of healthcare. Remember, there were over 4.3 million born in one year alone! Its central to ALL of us -- we have all been born, right?
In Spring of 2008, The Journal of Perinatal Education published a guest editorial entitled, "Maternal Death in the United States: A Problem Solved or a Problem Ignored?" in which author Ina Mae Gaskin (a well-known midwife and advocate for midwifery) states that the U.S. ranks ''behind no fewer than 40 other nations in preventing maternal deaths'' and that we need a ''nationally mandated and funded way to accurately collect data (about maternal death)'' because ''the maternal mortality rate is one of the vital measures of any health-care system and must be monitored from year to year." She goes on to say, "If the amount of money spent on maternity care provided an accurate indication of how well we are doing (as a nation), mothers in the U.S. would be the luckiest in the world (because we spend the most)," yet our maternal mortality rates are far behind many other countries and are not improving. That doesn't reflect on us as a nation very well. We need better accountability in tracking our maternal statistics and Ina Mae suggests we follow the United Kingdom's model of the Confidential Enquiry into Maternal and Child Health to help us raise our own self-evaluation standards.
In the United States today, more than 95% of our pregnant moms deliver in a hospital setting. We consider that the norm and most moms don't think twice to call their local OB/GYN when they get pregnant. Yet, for normal pregnancies, science has proven that it is safer to use a midwifery model of care (in or out of the hospital setting), so why aren't we following the trend?
Trend? Well, look at the Netherlands, Britain, France, and many other industrialized countries all over the world. They are all using a midwifery model of care for normal pregnancies, they are paying less, and they have better outcomes! They aren't using midwives because it's fashionable, they use them because they know that if they want to promote normal, natural birth with the least amount of interventions and better outcomes in the process, with less overall cost, to use midwives! So why aren't we aren't doing it too?
In Marsden Wagner's book Pursuing the Birth Machine: The Search for Appropriate Birth Technology (1994), he sums up the financial cost of the overuse of birth technology. He begins by saying that in 1986, the c-section rate was 24.1%. That means that out of 3.7million births, almost 900,000 were c-sections. According to the World Health Organization, a country should have a goal of a c-section rate of 15% or less. If the U.S. in 1986 had been able to obtain that goal, then there were an an excess of 339,000 c-section surgeries that year, each costing roughly $3000, which cost us an excess of $1 billion.
That is a staggering amount of money, especially in 1986. Today, our c-section rate is 31.8% nationally and the cost of the surgery is even more, somewhere closer to $6,000 on average (with no complications). In U.S. maternity care overall, private insurance pays for 49% and Medicaid pays for 43%. Given this information, that means if we had obtained our goal of a c-section rate of 15% in 2007, we could have saved our country $4.4 Billion in one year alone. Over the course of 5 years, we could save approximately $22 Billion by changing only one part of our healthcare system. Wow. And we are wondering how to improve our fiscal budgets?
In January of 2009, the Midwives Alliance of North America (MANA) made recommendations to the Obama-Biden Transition Team on Maternity Health Care. In their recommendations, they ask, "Are we achieving optimal outcomes with the maternity care services we are choosing to provide?" I think we know the answer to that question already. So the next question inevitably is this: how do we change it? MANA states that to make change, "we need to ask tough questions, and further, that we be willing to change the design, organization, and operation of maternity health care to provide consumers with high quality services and improve outcomes for mothers and babies."A study published by the Milbank Memorial Fund entitled "Evidence-Based Maternity Care: What It Is and What It Can Achieve" suggests that maternity care reform MUST "foster broad access to safe, effective midwifery care" and that using the best available research to help guide maternity care decisions will bring about better outcomes for mothers and babies. Even the PEW Commission on Health Professions stated that "the midwifery model of care is an essential element of comprehensive health care for women and their families that should be embraced by and incorporated into the health care system and made available to all women."
What about the doctors, you ask? Of course, there is still a place in modern maternity care for OB/GYNs. After all, emergencies DO happen and it's a good thing we DO have modern technology there to care for those percentages of women who ARE high risk and need or desire the extra care and monitoring that a doctor and/or hospital setting can provide. But for those women with low-risk, normal pregnancies, they are putting themselves at more risk by allowing the hospital system to use routine interventions that are not proven to improve the process or the safety and are causing more problems than they are solving. We NEED doctors so that those 15% of women who really do need that c-section can get it when that emergency does happen. To solve our problems in maternity care we must first and foremost stop treating pregnancy like a disease with a disaster waiting to happen. We must start respecting it for the natural process that it really is in 95% of women. Will it work? Of course it will! Look at those countries where they DO follow the midwifery model of care. Do you see women there fighting the system and demanding more interventions and more c-sections?
What can we do about this? Get involved in the movement to reform maternity care in the U.S. If you are a pregnant woman (or any woman!), educate yourself about what is proven to be the best for you and your baby. Take classes, read books, find out what your choices are. Read books, research your choices. It's your body and your baby. After you've had your baby, go to www.thebirthsurvey.com and take the short survey about your experience. This will help other expectant moms to find out about what interventions are used in their area hospitals and help guide their choices on where to give birth.
If you are a brother, husband, or father, we need you to stand up for us! Start by asking those tough questions. Don't accept "routine" as necessary. Help your wives, sisters, and daughters to empower themselves and educate themselves. Demand the best for your family, your state, and your country! It will save us all money, protect more of our mothers and babies, and start off our families on a more supportive path.
But it doesn't stop there- we need to let our powers that be know that we want to see our moms and babies treated with more respect. Go to www.mamacampaign.org and find out what our national midwifery organizations are doing. Go to www.govtrack.us and write to your legislators, your Congressmen, and our President! Help all of our daughters and their daughters to have access to what is proven to be better for them. We need to reform maternity care on a national level, legalize midwifery in all 50 states, provide policies for allowing communication between home birth providers and hospital providers, and urge insurance companies to provide coverage to families choosing to birth at home with a midwife. After all, when families choose home birth, it saves them money too!
Today we live in a world where we want the best of everything and yet we're being lied to every day about what is really best for us in maternity care. In our current system, is the focus on the true welfare of the people or in the size of the profit? We're starting to see a trend here, people. But really, let's not point fingers. Let's move forward, let's make changes. Moms and babies will benefit and that's the bottom line. Let's reform our maternity care, improve our outcomes, and start living up to our promises to American families. As Suzanne Arms so poignantly said, ""If we hope to create a non-violent world where respect and kindness replace fear and hatred, we must begin with how we treat each other at the beginning of life. For that is where our deepest patterns are set. From these roots grow fear and alienation -- or love and trust."