Cost of hospital birth far outweighs risk of employing midwives

In the old days, babies were made on the cheap. A couple bucks were paid to a midwife, a few prayers were said and then a kid was squeezed out on the kitchen table.

Breakfast was never the same after that: "You will eat your porridge. You know what I went through on this table for you?"

It is easy to look at the practice of midwifery like a relic of the Dark Ages - something people did before they learned better. At the turn of the 20th century, maternal death rates were at nearly one in 100. In the United States today, that number is at about 13 out of 100,000. In that time, births have progressively moved from home to hospital. Newborns are being caught more often by physicians and less often by midwives. Many conclude the hospitalization of the birthing process has been a good change.

But in one of those weird twists of history, too much of a good thing, in this case institutional medicine, might not be as good as it would seem.

According to the National Committee to Prevent Infant Mortality, the U.S. mortality rate for infants 28 days old or younger in 1989 was slightly more than 10 per 1,000 live births. Despite having the most sophisticated and expensive system of maternity care in the world, that same year 20 other countries with less technology had more babies survive. Many of those countries, like Holland and Denmark, use midwives as the primary caregivers for healthy women during their pregnancies and births.

The cost of a standard hospital delivery is nearly $8,000. C-sections bump that price tag up to nearly $12,000. In 2006, more than 30 percent of U.S. deliveries were done surgically, a number far higher than years past and even more astonishing when compared to the 10-percent figure in other developed countries with lower rates of infant mortality. In that same year Missouri had 771,690 uninsured citizens, and baby-making is not just for the insured. Talk about being born into debt.

Midwifery costs, on the other hand, begin at about $1,000. And although this line of work probably deserves a certain amount of skepticism, is it so unnatural to want a healthy birth aided by a trained professional without the killer price tag?

In the U.S., there are two main divisions of modern midwifery. The first, nurse-midwives, have a master's degree in nursing, public health or midwifery and provide gynecological and midwifery care to healthy women who can expect a normal pregnancy. These nurse-midwives often work in hospitals and work closely with obstetricians. The second, direct-entry midwives, are not certified as nurses but are educated about the birth process through self-study, apprenticeship, a midwifery school or a college. Under this umbrella of direct-entry, there is a sub-class of Certified Midwives who must pass the same exam as the nurse-midwives.

Direct-entry midwifery is unlawful in Missouri. Practicing without a nurse-midwife license is a felony. These are some of the harshest penalties for out-of-hospital birthing in the nation.

In May 2007 the Missouri Legislature passed a bill intended to increase private health coverage for the uninsured. Tucked into this legislation was a one-sentence provision added by Sen. John Loudon that effectively legalizes certain direct-entry midwifery. Through the unnoticed use of the word tocology, the practice of obstetrics and childbirth, instead of midwifery, Loudon was able to seemingly legalize what had been thrown out by prior legislation. Last August, a judge ruled the midwifery law illegal - a just move because of Loudon's sneaky tactics.

But now Loudon is taking a new approach, pushing a bill that would create a state midwives board that will certify legal practice in the state. As expected, his proposal is being sidelined.

However, Missourians should give midwifery a second look. Home birth research studies indicate much lower rates of infection in the mother and the baby than are likely in the hospital, where antibiotic-resistant diseases are known to thrive and painkillers are prescribed that can harm the child. Not only this, the experience with a midwife is more intimate, less complicated, safe and much cheaper.

In the end, autonomy should win. If a mother is healthy, it should be her decision how and where she has her child.

Phil Jarrett is a senior communication and philosophy and religion major from Chesterfield, Mo.