This summer, federal legislators will decide on the future healthcare plan that President Obama will enact. Most suggestions for cutting costs or improving the system will be modest, as presenters play the game of cutting costs without cutting care.
There is one proposal, however, that would save taxpayers $9.1 billion while improving maternity care to its recipients. The proposal also requires no up-front costs or ongoing costs and would reduce the most common surgery, cesarean section, in the United States.
That proposal has been brought to the Senate Finance Committee and the change it would require is for more women to give birth outside of the hospital, using Certified Professional Midwives (CPMs).
Specifically, the fact sheet for the proposal writes, “Research consistently shows that low-risk women planning to deliver their babies at home under the care of CPMs experience outcomes equal to low-risk women who deliver in the hospital but with far fewer costly and preventable interventions, including a fivefold decrease in cesarean section.” The fact sheet adds, “Babies delivered under the care of CPMs have significantly reduced rates of prematurity and low birth weight, two of the leading contributing factors … in costs associated with long-term care.”
The proposal only asks that as Medicaid eligibility is expanded, CPMs be included in that list of care providers. This would make CPMs eligible for insurance reimbursement and allow women to easily birth with midwives outside the hospital.
Right now, CPMs are legal in 26 states, making it difficult for women who give birth outside the hospital to get reimbursed. Even in states where midwifery is currently legal, some insurance companies will not cover midwives if they are not working in a hospital, creating a real-life catch 22 for the nation’s maternity care.
Midwives are the method of choice among nations whose maternal and fetal childbirth outcomes dramatically outrank the United States. The United States currently ranks low among developed nations in both maternal and fetal outcomes.
According to Pushed: The Painful Truth about Childbirth and Modern Maternity Care, in the countries with the best maternal and infant outcomes, like the Netherlands, Sweden, and Denmark, “The vast majority of laboring women get individual support from a midwife.” In addition, these women are “free to move about and birth in whatever position feels best, and are rarely induced, anesthetized, or cut.”
This is a rather stark contrast to the United States, where C-sections are performed in almost one out of every three births and, according to an article in Pregnancy & Childbirth, drugs like epidurals are being used in up to 90 percent of patients in some hospitals.
In 2006, the British Health Secretary began encouraging U.K. women to “challenge the assumption … that the safest place to give birth is in the hospital,” reports The Independent. The report says that doctors are now told “to offer all women the chance to deliver their baby at home with the help of a midwife.”
The proposal for encouraging out-of-hospital births with CPMs is likely to ruffle some feathers along the way and may be opposed by some groups.
According to a 2008 ABC News report, the American Medical Association (AMA) and the American College of Obstetricians and Gynecologists (ACOG) have approved legislation in the opposite direction, suggesting, “home births are not safe.” Gregory Phillips, spokesman for ACOG, states, “We are against home births, period.”
What David Anderson, a professor of economics at Centre College with a research specialization in the cost of out-of-hospital births, has presented to Congress may be strongly opposed by the AMA and ACOG, who have a team of lobbyists arguing their case. Professor Anderson calculates that if 10 percent of the nation’s births were performed in birth centers or at home using CPMs, rather than in hospitals using obstetricians, the health care savings would amount to a whopping $9.1 billion.
He is just one of many volunteers helping The Big Push for Midwives Campaign, whose mission is to build advocacy for CPMs in all 50 states and educate national policy makers about the reduced costs and improved outcomes associated with out-of-hospital maternity care.
The potential impact of this proposal simply “floors people,” said Katie Prown, Ph.D., campaign manager for The Big Push for Midwives. “We have yet to see other healthcare professions present a solid plan for reducing the costs of healthcare with no strings attached,” she remarked in an interview. “The only issue will be whether the influence of the AMA and ACOG clouds the judgment on Capitol Hill.”
James and Kim are certified nutrition and lifestyle coaches who assist pregnant moms and new parents to achieve optimal health. They can be contacted at FitForBirth@gmail.com or through their websites GetFitForBirth.com and SecretsofPainlessChildbirth.com
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