(2 of 2)
The advocates of trained midwifery, many of them women who have experienced childbirth in hospitals, are passionately unimpressed by such arguments. Where prenatal screening is properly practiced, they say, most of those births likely to need specialized care can be anticipated—and handled in hospitals. But at least 90% of births are uncomplicated, they assert, and in those cases women often find themselves in the hands of an overworked hospital staff and subject to perhaps unnecessary procedures. Says a registered nurse and lay midwife in California: "Just in case the woman tears, the hospital does an episiotomy; just in case she bleeds, they give her an intravenous solution during labor; just in case she may need a cesarean, they don't feed her." Another frequent complaint concerns the mother's position during labor. In hospitals, the complaint runs, women are strapped to delivery tables, though some women who have practiced natural childbirth find that other positions can be as effective and more comfortable.
Such statistics as exist seem to indicate that midwife-assisted birth is generally safe. During a test period in Santa Cruz County, Calif., 10% of the deliveries were at home by lay midwives. The infant mortality rate was lower than for the county as a whole (3.2 deaths, v. 15.1 per 1,000), though such figures may be misleading because predictably hazardous births were handled in hospitals. To support their claims, proponents of midwifery point to The Netherlands, where midwifery is widespread and the national infant mortality rate in 1975 was only 10.6 per 1,000, v. 16.1 per 1,000 in the U.S., a country admittedly with a much larger and less homogeneous population.
In public at least, those doctors who oppose licensed midwifery do not often speak of one reason that may be on their minds—money. Obstetrics is one of the largest and most lucrative specialties in U.S. medicine. Parents and proponents of midwifery are voluble on the subject of money, however. In California, for instance, the cost of having a baby has risen from $16 per hospital day in 1950 to $175 in 1976, and now stands at about $1,500 per birth. By contrast, the cost of birth at midwife-run institutions like the Los Angeles Childbirth Center is as little as $300. The California department of consumer affairs asserts that even if only 10% of needy parents were allowed to use Medi-Cal money to pay licensed midwives, the state would save $10 million a year. State officials also report that only 37% of California's obstetricians will deliver babies for the poor because they can only pay the $300 allowed under Medi-Cal.
There are always dangers in childbirth, and clearly, in the event of an unexpected medical crisis, both mother and baby are safer with immediate access to hospital facilities. Still, if money talks, and it usually does, the use of properly trained midwives is a service that U.S. medicine and U.S. mothers can hardly afford to do without. Says Dr. Donald Creevy, a California obstetrician who favors the new bill: "The medical profession can't go on saying, 'If you don't accept good care on our terms, you don't get good care.' "