What’s the connection between health care reform and midwifery care?

My first article is up at The American Prospect, about Certified Professional Midwives and health care reform. I talked to some amazing advocates in reporting for the piece, including Michelle Bartlett, an Idaho midwife who helped push through licensing legislation in her state.

Michelle Bartlett is not the typical Washington high-stakes health-care player. She’s probably not on the radar of anyone in Congress or the Obama administration. Bartlett is a midwife in Idaho, but in the last few years, she’s been trying her hand at lobbying. This came after a night spent in jail for using medication during a home birth she attended in 2000. Bartlett was the second midwife to be charged for this type of practice in Idaho, and thanks to her efforts, she will be the last in her state. “I’ve done a lot of hard things in my life, and giving birth was one of them,” Bartlett says. “But giving birth to a law was really hard.”

On April 1, Gov. C.L. “Butch” Otter of Idaho signed legislation allowing certified professional midwives (CPMs) like Bartlett to administer medication during births. Unlike certified nurse midwives who are able to practice in all 50 states and generally work in hospital settings alongside obstetricians, midwives like Bartlett are referred to as “direct entry” midwives, and practice exclusively outside of hospitals, mostly in homes or birth centers. These CPMs spend three to five years training and meet the standards for certification set by the North American Registry of Midwives.

State licensing fights may be the first step for these midwives, but it’s not their last. Now they’re turning their attention to the federal health-care reform debate, and a look at the maternity-related health-care costs quickly explains why. Childbirth is among the top five causes for hospitalization, and the No. 1 cause for women. According to Childbirth Connection, Cesarean section is the most common operating-room procedure, and in 2009 the C-section rate hit an all-time high according to the Centers for Disease Control and Prevention, at 31.8 percent of all births. These rates account, in part, for the increasing cost of maternity care in the U.S. Maternal and newborn charges totaled $86 billion in 2006, 45 percent of which was paid for by Medicaid. The federal government is already footing a huge portion of the U.S.’ maternity-care bill, and these midwives think they can help reduce costs significantly, and not just for low-income women.

Check out the rest of the article here.

If you want to join the advocacy efforts mentioned in the article, check out The Big Push for Midwives and The MAMA Campaign.

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3 thoughts on “What’s the connection between health care reform and midwifery care?

  1. talkbirth July 13, 2009 / 10:58 am

    This was a great article. Thanks!

  2. Dawn. July 23, 2009 / 7:58 pm

    I loved your article, Miriam. It was well-researched and thought-provoking. I had never given much thought to this side of the reproductive justice movement, despite being adamantly pro-choice since I was fifteen (I am twenty-two now). Now Radical Doula is bookmarked as one of my favorites. I want to become more informed about home births, doulas, CPMs, and the demonstrated need for alternatives to the normative in-hospital birth experience.

    It seems like many pro-choice organizations are reluctant to associate themselves with radical doulas/natural birth advocates/midwives. I think that’s a shame because I see them as part of the same reproductive justice movement and advocating for the same things.

    On a personal note, I’ve been thinking a lot recently about something that may have been misinformation on the part of my former university’s gynecologist. After my pap smear, I asked him some general questions about the birthing process, and whether it’s healthier to have a home birth (I didn’t know what a doula was and I was eighteen at the time), because I’d recently heard of women using birth pools at home. He told me my cervix and my vaginal canal were too narrow and small so I’d probably have to have a c-section. Do you think this was misinformation? Is it even medically possible that my cervix AND vaginal canal are so small that I’d HAVE to have a c-section? I know this sounds stupid and isn’t directly related, but it’s been bothering me lately. Could I really be too small, as an otherwise normative young adult woman, to have a baby vaginally? My personal experiences with sex and masturbation have confirmed that I am quite small. Was he an idiot or was he right?

  3. radicaldoula July 24, 2009 / 9:45 am

    Hi Dawn!

    Thanks for commenting and visiting the site. I’m glad you like it!

    As for what your doctor said, I’m not a medical expert but I think it sounds fishy. The idea that many women’s bodies are simply too small to handle labor and delivery just seems wrong to me, and undermines the incredible stretching and accommodating the pelvis and vagina do during labor. No one’s vagina is big enough to deal with a baby normally!

    I would definitely get a different opinion when you are actually looking to have kids, and maybe a midwife would be good to consult.

    Good luck!

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