National Review Online recently featured a roundtable on how to foster woman-empowering healthcare that could replace Planned Parenthood’s predatory, vicious, anti-woman model. It included many positive ideas, including the helpful note that community healthcare clinics outnumber Planned Parenthood locations by ten to one; but it didn’t discuss my favorite, woman-empowering and life-affirming source of women’s healthcare: Midwives.
Midwives do a lot more nowadays than assist women in prenatal and post-natal care (although of course that’s their primary occupation). Most of the half-dozen I’ve seen also offer well-woman care, such as pap smears, annual physicals, fertility management, hormone analysis, nutritional analysis and treatment, and mental-health referrals. How they are trained and licensed depends on state laws, but all are at least privately trained and licensed by national and international networks that ensure world-class standards of care. Some midwives are also RNs, and almost all also partner with RNs.
I see four major benefits to expanding opportunities for midwives to offer their unique style of woman-oriented healthcare. First, it’s low-cost. Second, it creates more flexible health-care arrangements for both providers and clients that greatly increase satisfaction and positive health outcomes. Third, it has the potential to “disrupt” the woman’s health-care industry and thus improve women’s health-care as a whole, with potential also to improve basic health care for everyone. Fourth, the ethos of midwifery is genuinely empowering and life-affirming, to women both individually and holistically, in the context of their whole families.
The major impediment to the innovative potential of midwifery is the medical establishment, which has obvious incentives to keep out low-cost, high-satisfaction competitors. Another is the fertility-industrial complex, which makes more money exploiting women than by actually meeting our real needs. Let’s talk about each of these items in turn.
1. Midwives Are Inexpensive
Most midwives operate on a cash basis. Many do not accept insurance or charge extra if a woman wants to bill her insurance, which keeps prices low for everyone else. The average cost for full prenatal care, through birth and to the six-week baby checkup, is about $3,000 with a midwife, or a third of the cost for the same through a hospital or conventional birth center.
The low cost is not because midwifery offers worse care. It’s because midwifery is a much leaner operation than its conventional counterpart. For the typical, low-risk pregnancy, having a baby with a midwife is just as safe (or safer, given the reduced rate of birth interventions) as having baby in a hospital. In England, where midwives are an integrated and normal part of the country’s health-care system, national medical guidelines support midwifery, noting “the risks of over-intervention in the hospital may outweigh the risks of under-intervention at a birth center or at home for the majority of expecting mothers.”
Midwives can offer at least comparable care to the conventional system at far lower and actually transparent prices. They attend births with normal medical supplies such as Pitocin and oxygen. My midwife just told me recently that, although she doesn’t accept Medicare, she has some patients who are on Medicare paying her out of their pockets because they could afford her low prices and preferred a stable relationship with her to getting bumped around from Medicaid provider to provider.
Imagine what getting shuffled from doctor to doctor each monthly prenatal visit does to both the quality of a woman’s health care and her pregnancy experience. There’s a much bigger likelihood someone, somewhere doesn’t transfer all your information, so you either have wrong or repetitive information in your file. You have no relationship to speak of with your provider, so you’re extra nervous about the major life event that is pregnancy and birth. That anxiety and discomfort is going to make your labor just dandy, right? No wonder people are less likely to die or get sick paying for their own health care than using Medicaid.
I’m not saying everyone needs to get a midwife (although…I kind of do want everyone to consider it, just because I love mine so much). I’m saying that it’s a low-cost, good-outcome option for many women, and they should be free to evaluate whether it’s a good one for them.
2. Midwives Foster Flexibility
Because they are the medical equivalent of a single-proprietor or partnership-style business, midwifery practices offer a vast amount of flexibility both for providers and for their clients. Midwives can set their own hours (except for the inevitable occasional overnight when babies decided to enter the world), work loads, and atmosphere. Some midwives essentially work part-time, so they can both help support their families with money and with their presence. Some will schedule you a routine checkup and other non-emergency care for just about any day of the week; others hold office visits just one or two days per week. She gets to choose her working terms and environment in ways no doctor or nurse in the conventional system can.
As you might guess, this makes for really happy health-care providers, which in turn makes for really happy and well-cared-for patients. One nurse-midwife I met raved about her job arrangement because, in her previous hospital job, she had been required to see at least 20 patients per day. That left her hardly 10 minutes to see each person. My midwife schedules an hour for our routine prenatal visits. This makes me feel like a person instead of a sickness unit, and we are able to establish a real relationship that pays off significantly during labor, because I know, like, and trust her. This also lets her get to know my unique health needs very well, so that she’s very in-tune when even something little is off.
You really can’t imagine what a massive support this is for a woman during a time of deep vulnerability in her life. My midwives, for example, taught me how to nurse my first newborn. The strange newness of that skill was made worse by the fact that it really, really hurt. Learning how to manage not only kept me nursing my (eventually enormously fat and prodigiously healthy) first baby, which gave us a relationship I still remember with joy, it also set me up to nurse the babies that came after with little need for further coaching.
In fact, the reason I decided to consider a midwife for my first child was not that I’m a weird crunchy yoga mom. I had planned to do “the normal thing,” but had a terrible experience in my first set of prenatal visits. It worked out like just about every other time I’ve entered the medical-industrial complex: I never had any idea what they were doing, why, or how much it would eventually cost me. They shipped me around from place to place, picking and poking and shoving papers at me. I hated it. That’s called pulverizing female empowerment, not fostering it. I wanted out, and I got it, to my great relief and long-term well-being. More women deserve that opportunity.
3. Midwives Mean Health-Care Innovation
Breaking the mold of health care for women and babies has freed midwives to innovate into serving other health-care needs, in a similarly flexible, inexpensive, and effective manner. In my area, the demand for midwife care has fostered several health-care practices that go beyond midwifery, but apply its person-centered, transparent, inexpensive model. Many of the local midwives work with a wonderful pro-life doctor who has just set up a fertility care and women’s health clinic in our areas. I was just there last week for a quick ultrasound, and the copay was $35. $35! Several of my friends who have had difficulty conceiving receive treatment there that respects and works with their bodies rather than nuking it with chemical cocktails or creating lives they’ll later destroy.
The existence of this clinic has also expanded the health-care opportunities available to women like me who want a low-intervention approach but are not against advanced medical science. We recently discovered our latest baby was breech. That often immediately slots a woman for a C-section. I’m fine with having one of those suckers if it is necessary to keep baby safe, but if it’s not, I really do not want one.
The doctor and his partner ushered me into a local hospital and managed to flip baby around so I can deliver normally. The entire time I was there, the C-section specter hovered in my head: The hospital nurses hooked me up to an IV, “Just in case we have to do a C-section.” They affixed a fetal heart monitor to my belly with a belt, which women who have no risks must wear through their labor if they deliver at this hospital. (I might punch someone if he tried to get a belt on me or make me lay on my back in a hospital bed during labor. Did I mention they don’t allow water births, either? Get thee behind me, Satan.)
But because my midwife, this doctor, and his partner were there, and I knew that we shared the same ideas about medical care and had spent time talking through different scenarios, I felt as safe as I could have, knowing my sheepdogs were there to do the best thing for me and baby. Our relationship paid off for us, because fear makes bodies act up, and mine was manageable. It also gave me access to advanced medical care I might need, while not requiring me to use (or pay for) all that costly equipment if I don’t need it. That’s called “efficiency,” folks, which is one of the hallmarks of market innovation.
Another midwife here created a practice in partnership with a nutritionist and a nurse practitioner, who is licensed to perform some routine medical tasks formerly reserved to doctors, such as administering vaccines and performing routine child and adult checkups, besides ordering tests and other items. So families could stay within a practice they’d developed a relationship with after baby was born, continuing to bring baby (and then child) in for his routine health needs. Oh, and at again wonderfully low, cash-based, and transparent prices. That’s another huge boon to us because we have high-deductible insurance and pay cash for almost all of our health care, including baby delivery (which is totally possible when you’re with a midwife).
So, basically, midwifery can foster and address demand for inexpensive, transparent, routine, and preventative medical care—you know, that thing everyone says they want in health care but no one seems able to find—and reinstate the price signals and competition necessary to make any market work but noticeably absent from our country’s medical mess. What’s not to love? Think about the possibilities were someone to come up with, say, a similar alternative to hospice and institutional elder-care. Mind-blowing. Wallet-resuscitating. Humanity-restoring.
Did I mention also intensely bipartisan? (For those of you who need a political reason to help women.) The crunchiest Gaia-worshippers and the most fundamentalist of the religious Right meet together peaceably, even joyfully, in a typical midwife’s waiting room.
4. Midwives Are Woman-Affirming and Life-Affirming
Just stop for a sec and watch this video, which explains the radical-but-shouldn’t-be philosophy of the midwife profession, which is that childbirth is not a freak occurrence to fear and medicate but something natural and normal that women are made to do. Just think about how woman-affirming and woman-empowering that idea is. In fact, it’s also humanity-affirming, because it treats a baby as not a disease, but a human person, and a miracle. We need more of this in our culture, not less.
My state has a strong industrial health lobby. They have fought hard to marginalize midwives and add enough regulations to their practices so as to convert them into just another arm of the health-industrial complex instead of a vibrant competitor. You can guess why this makes me feel like, as I told my midwife about a recent legislative proposal, “Just show me where to show up with my pitchfork.”
The pressure does push the midwife community to stringently police themselves. They do not put up with cranks and quacks in their midst, because that could endanger their entire profession. But plain old free-market competition also accomplishes the same thing. So free-market people who love women and babies need to do everything they can to deregulate midwives and related innovations in female and infant care. The possibilities it offers for doing an end-run around the current healthcare mess could be limitless. Midwives just need the freedom to keep proving women can do this.
