Still Up Against the Birth Monopoly

A New York Times story about the prosecution of an Indiana midwife notes that 10 states still prohibit birth assistance by anyone other than a doctor or nurse. In those states it is legal to give birth at home, but it is illegal to hire anyone without one of the requisite medical degrees to help you, and people who have those degrees tend to insist on hospitals or birthing centers attached to hospitals.

Reason has been following this issue for many years: Sarah Foster made the case for decriminalizing midwifery in the September 1982 issue; a decade later, in the March 1992 issue, Archie Brodsky took a fresh look at the legal barriers to midwifery. (Neither issue, unfortunately, is available online yet.) For a more recent update, check out Midwifery Today.

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  • ||

    I am in favor of banning midwifery...because I'm sick and fuckin' tired of seeing these smug assholes driving around with "I'm a midwife, I'm so great, look at me!"-esque bumperstickers on their cars. It's high time we put an end to this highfallutin horeshit. Nobody gives one fuck whether you're a midwife, or whether you're a goddamned stoned-out crackwhore. What is it about midwifery that makes them want to announce it to the world?

  • ||

    While in law school in Chicago, some of my fellow students and I told some girls in a bar that we were midwives. We thought it would go over better than saying that we were law students, given the six law schools in the city and the 500,000 lawyers. Although none of us were dishonest enough to actually not admit that we were kidding after a while, I was surprised how long they bought the story. Especially the way we told it ("Men have been involved in the art of miwivery for many a year. Really").

  • ||

    I recently met a midwifery activist. It was weird to meet somebody who was clearly just as passionate about his obscure cause as I am about mine. I thought to myself "Damn, am I really that freaky when I start talking about my non-mainstream ideas?"

    Don't get me wrong, I'm all in favor of your right to do whatever you want, and I'm quite willing to believe that midwives are fine, talented professionals who can keep you perfectly safe during labor, etc. etc. Still, it was just kind of weird to see how very passionate he became about it.

    Also, while I'm all in favor of your right to do what you want, and while I'm sure that there are very good midwives out there, the guy that I was talking to gave off an air of crackpot when he started talking about medicine. Again, you can do whatever you want as far as I'm concerned, but some of the things he was saying made it clear that the guy was kind of nuts.

  • ||

    What is it about midwifery that makes them want to announce it to the world?

    Evan, it's possible that they're a little more vocal because they're on a campaign to gain legitimacy.

    I'll admit that I find "midwifery" smacks a little of "natural childbirth" and "organic food" and hence a little of quackery to me sometimes. But when I really stop to think about it I think that midwives could serve at the majority of births, which occur without complication, at a lower cost than an ob/gyn and thus provide a significant cost saving.

    But then I think that nurse practitioners could provide many of the functions of primary healthcare with a lot less supervision from an MD than they currently have (and dare I say it no supervision at all) at a considerably lower cost.

  • ||

    Isaac-

    Yep, I have no reason to doubt that experienced midwives are every bit as good as experienced obstetricians in most cases. I'm all in favor of people's right to do what they want.

    But the activist that I met, well, he reminded me that sometimes activists are a cause's worst enemies. It was clear that he wasn't just a guy who has seen some evidence and supports the right of pregnant women to choose a safe and cost-effective method of birth. For him, there's some additional factor that goes beyond just believing that this makes good sense so let's do it. It has some sort of ideological or emotional aspect for him.

    Again, I'm all in favor of the right to do what you want, but meeting this activist reminded me that when you get really passionate about something outside the mainstream, it's easy to jump off the deep end.

  • Timothy||

    Again, I'm all in favor of the right to do what you want, but meeting this activist reminded me that when you get really passionate about something outside the mainstream, it's easy to jump off the deep end.

    Sort of like when I thought to myself that I don't think I (or anyone else) has any obligation to call an ambulance if some guy is having a heart attack in the mall. I couldn't decide if that meant I really believed in freedom of association, or if I'm just that big a jerk.

  • ||

    I am in favor of banning midwifery...because I'm sick and fuckin' tired of seeing these smug assholes driving around with "I'm a midwife, I'm so great, look at me!"-esque bumperstickers on their cars.

    What?? I thought this was humor, but then I wasn't so sure.....

  • ||

    Again, I'm all in favor of the right to do what you want, but meeting this activist reminded me that when you get really passionate about something outside the mainstream, it's easy to jump off the deep end.

    This is possibly what I have in mind when I mentally associate midwifery with crunchy granola and shopping trips to Whole Foods and demonstrating against nuclear power or genetically modified foods. It's one of those vague, even unconcious, thoughts that in the end I find cannot really support intellectually.

    And every so often I do shop at Whole Foods.

  • ||

    Isaac-

    Yep, the guy gave me that vibe when I met him.

    I suspect that an excellent case can be made for his side of the issue on grounds of cost and safety. I also suspect that for him it has more to do with standing for a particular approach to life than the material benefits (cost and safety). Then again, if all he cared about was money and safety he'd probably find some other issue.

    I have to rethink a few things about the way that I prioritize issues and argue in favor of my stances.

  • ||

    Issac Bartram,
    What, exactly, do you have against Crunchy Granola? What have naturally grown, albiet synthetically rolled, oats ever done to you? Do you hate all nuts or just Sweet Almonds? Just try to understand where the Dried Cranberries are coming from. Do it for the sake of the raisins and the children of raisins who have died making commercials.

  • ||

    Evan:

    Thanks for providing my afternoon with a soda-through-the-nose moment. My neighbor has one of those midwife bumper stickers--something about thanking one if you have a healthy child, or a similarly inane sentiment. I think I'd rather read about your kid being on the honor roll.

  • ||

    I am torn...

    On one hand, midwifery is the perfect example of why people should be allowed to practice medicine without a licence.

    On the other hand, the people who think widwifery is great are typically the upper-middle class leftist who is rapid on regulation on just about every other issue. It would be nice for them to get burned in the name of "safety" and "THINK OF THE CHILDREN".

  • ||

    Issac Bartram,
    What, exactly, do you have against Crunchy Granola?


    Oh, nothing, Really...err, I mean...err, nothing at all, why...err, some of my best friends eat crunchy granoly.

  • ||

    Yeah, of course there are some nutters advocating midwifery. That doesn't take away from the point that there is a monopoly on health care - birth in this example - by the medical establishment.

    And you don't have to be a kook to feel put off if you've been a family on the receiving end of a hospital's semi-automated, impersonal, assembly-line-inspired childbirth "procedure".

    Or, maybe this is just a big hospital issue. Perhaps if you live in rural Indiana, local hospitals are staffed with nice midwesterners who take the trouble to learn their patient's names and actually care whether you live or die.

    Thoreau, you've got kids, right? Did you guys go to a hospital? How old are they, anyway? (I'm just curious!)

  • ||

    I recently met a midwifery activist. It was weird to meet somebody who was clearly just as passionate about his obscure cause as I am about mine. I thought to myself "Damn, am I really that freaky when I start talking about my non-mainstream ideas?"

    Dude, you are. And there's no point to it, you know - none of those ideas will ever fly with the mainstream. Give in and join them... join them...

  • ||

    Leave medicine to the real medics, not a bunch of granola-and-tofu munching hippie-throw backs. Midwifery stinks of the same newage that brought us crystal healing, reflexology, anti-vaccination fanatics, chiropratic, psychic surgery, Kevin Trudeau, and nutcake claims that AIDS is not caused HIV (yes, I'm talking to you Mr. Gillespie).

  • Rich Ard||

    Leave medicine to the real medics...

    That's part of the issue - that childbirth is looked at as a medical procedure, instead of a celebration of the birth. Having an assistant who is passionate about new life seems to me to be preferable to a rotating staff in a hospital delivery room.

    (Disclosure: My first daughter was delivered by a midwife/OB).

  • ||

    thoreau:

    Be sure that you are tiresome when you defend your ideas. Same as me. Unfortunately most people have a favorite theme of conversation, mainly themselves, and they resent having to interrupt to listen to your reasoning... This is why we must strain to be entertaining to make them forgive our presumption...

    As for midwifery, I am in favor of removing as many routine tasks from doctors as possible. This is a good way to bring down medical bills.

    I do not know if anyone heard of the Aravind eye hospital in India, where they have the model that they have few surgeons, highly paid, who do the surgeries all day, and then an army of eye care technicians who do all the basic work.

    You can read about it in Prahalad "The fortune at the bottom of the pyramid", a book where you end up with the suspicion that India may become the next business giant a few years hence.

  • ||

    Rex Rhino,

    Modern midwives are professional, credentialed medical practitioners. The formal term is "nurse-midwife," sort of like "nurse-anesthetist." They have nursing degrees, plus specialized education - it's roughly equivalent to having a Masters. We're not talking about witchy chicks with peasant skirts.

    In my experience, nurses are best at helping patients get through tasks that the body has do do for itself - healing a surgery incision, giving birth - while doctors are best for tasks that require that something be done to the body - removing a tumor, administerng a course of chemo. Doctors treat a disease, condition, or injury. Nurses treat a person.

  • digamma||

    It's going to be friggin awesome if and when the old issues of Reason go online. Although I bet a few embarassing articles will get "lost".

  • ||

    Don't get me wrong, doctors are fine, they are just not for me. I was a home birth, delivered by a midwife, and have never in my life had to go to the hospital. I've broken fingers and toes, they healed. I broke my collar bone when I was 8, went to the local prompt care after 2 days of pain, got a brace, and left. I am allergic to nothing, I have been sick once in the last 9 years, and i will not take any form of medication (not even advil or aspirin). You know why... what works best for some people does not work for everybody. It probably is a little safer to have a child in a hospital (my future wife has TOLD me that our children will be born in a hospital, don't think I can argue with the birthgiver) but it is not the only safe way. And I hope the medical siders will not be ignorant enough to say that problems don't occur at hospitals, problems that even the almighty doctors can't fix. And the idea that most of the people having home births are upper to middle class hippies...wow, didn't realize it was those people causing all the fuss. I was under the impression, having known other families that had home births, that it was most suitable for families that couldn't afford a few thousand dollar hospital bill or families without insurance. Thanks for clearing that up for me guys. I guess I should of known though, it always seems to be those damn hippies that cause all the problems. Stopping pollution, saving the environment, eating organic foods instead of genetically mutated foods. When will they learn?

    ...And Evan, you contradict (go look it up) yourself when you say that no one cares when you yourself seem to care quite profusely (as long as you have the dictionary handy)

  • ||

    Wow! I am a nure-midwife. I had no idea that folks were so poorly informed about the life and times of midwives. A good read if one is interested is Midwifery and Childbirth in America by Judith rooks . It is factual and puts things in perspective for those who really care. It can be puchase from Amazon.

  • ||

    Why are fellow liberals so assinine when it comes to basic women's rights in this country? Midwifery and women who choose it are not all granola crunching hippies with candles surrounding their bead-strung heads breathing their babies out. it is a choice, an option that, if paired with a well-trained, educated, experienced midwife, results in a birth experience that is private, personal, and intimate. No loud nurses banging around metal trays, bright lights, people forcing you to push or birth in any position that isn't completely what you want or need. Come on fellows, birth is not dental surgery. It is an intense physical experience that in most cases is a natural as can be, but dammit it is our experience and we should have every right to view all options regarding birth the way we liberals fight for all rights to chose our contraceptive options.
    Not all supporters of homebirth hate hospitals, but they have their place. Mine, located 1.5 miles away, was close enough for me in case of emergency when I gave birth at home. It is isn't just about choosing one over the other, simply about having the option to choose at all. Safety isn't jeopordized as much as one would think when you work with a certified midwife. But, this may not always be the case in States that do not recognize midwives as medical birth attendants and midwives fall out of view of the licensing practices designed to protect women and babies. Then again, my mother's first baby, a healthy daughter, was dropped by the OB onto the floor and died instantly after being forcefully pulled from her womb. So, safety first isn't always 100% in hospitals either.
    You don't have to get it, you don't have to like it, you don't even have to agree that some of us not crunchy people are seeking out midwives and home births at alarming rates condsidering the blind value most Americans hold in the medical establishment...but, step aside and start to look at the right to choose extends beyond pregnancy.

  • kel||

    i agree with kity! I am a homebirth midwifery student and had no idea that there was so much hatred and misconceptions towards this profession.

    the underlying premise of midwifery is the idea that all women have a right to informed choice. it is about allowing a woman to reclaim what her body is capable of without medical intervention and being able to choose what she wants based on all the information out there. it is our job to be gatekeepers to this information and make sure it is as accessible as possible.

    ps. i love granola and i hug trees and i have one of those bumper stickers and i believe in the spirit of the moon and all the other stereotypes that you want to fit me into.

  • Kris||

    For the sake of information, Nurse-midwives HAVE bachelor's and master's degrees, not equivalents. Direct-entry midwives often have a variety of basic and advanced degrees (usually not nursing), and as with nurse-midwives, we have specialized education in women's health care and neonatal care.

    It's really interesting to see the venom spewed at the discussion of midwives. The nature of midwifery demands consumers make informed choices and take responsibility about health care, refuse routine "cookie cutter" care in favor of individual, specialized, and affordable care. Is this a scary prospect for the general public who has been taught the doctor knows best?

  • ||

    I am in favor of women having a choice about where and how they give birth. Studies have shown homebirth to be as safe as or safer than hospital birth. Homebirth cost less than hospital birth and I found it to be a much better experience. Women are going to continue to seek out homebirth; legalizing midwifery will ensure that those women have skilled care available.
    I had the last of my four children at home with a midwife. And I am currently training to be a midwife myself. My household income is over $300,000 per year, my husband and I are college educated, I am a liberal, he a conservative. We eat organic milk with lucky charms for breakfast, and a big ol' organic steak for dinner. Heck, I even buy my clothes at the Gap. I certainly don't fit your stereotypical tofu eating (I hate that crap), hippie, midwife persona

  • ||

    Ah, Ken, you are witnessing how many let themselves be deceived by the wrapping instead of seeing what is offered.

    Midwifery is wrapped in "hippie" leftist trappings, and is therefore bad. Never mind that it expands the market, that it gives customers more choices, and tries to break a monopoly. No, if left-wing types promote it, it must be bad.

    Same knee-jerk reaction to "fair trade" coffee. Because it come with a lot of leftist rethoric, they do not see that the end result is more customer choice, and enhanced quality in the product...

    Somehow people have to stop behaving like Pavlov's dogs.

  • ||

    "I am torn...

    On one hand, midwifery is the perfect example of why people should be allowed to practice medicine without a licence."

    Midwives do not practice medicine. Childbirth is not a medical procedure. It is a part of being a woman.

    The british medical journal published a very thorough study on midwife attended homebirths with hospital births here in the US.

    http://bmj.bmjjournals.com/cgi/content/abstract/330/7505/1416

    Read it. You may find it rather surprising.

    A little quote from the study for those who do not have the time or inclination to read it.

    "Conclusions Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States."

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