Near 20 years ago my daughter was born upstate NY at home with two attending mid-wives and a room booked at the local hospital, 2 miles away, in case of complications. Dilation stopped for a while so the mid-wives had the mother get up and walk about for a while. in the end all went smoothly and no complications. So a much better experience than some hospital.

Of course we don't represent the possibilities of complications, but the statistics are out there. Not only are the costs higher and the use of interventions higher than comparably advancedf nations but the US isn't close to leading the world in low birth or baby mortality.

The US continues to believe its own propaganda that it is the best in the world in everything no matter the facts.

Congratulations, Nathan, on the birth of your child.

I cannot TELL you how many weird looks we STILL get over our kids' births (they're 5 and 3) because both were born with a midwife. My 3-year old girl was born in our bathtub with just me, my wife, my mom and the midwives in attendance. As you quite rightly point out, this is par for the course in most of the world.

I live in Miami where there seems to be some weird "cult of the all-knowing doctor." Caeserean rates are among the highest in the nation and it seems as if the medical profession treats pregnant women like they're ILL instead of just pregnant. Midwives, breast feeding, home births- we are the "weird"family because we did all that stuff. I thought we were just being regular.

Oh, well. I guess I will just take my uber-healthy, curious, vegetarian (another way we're weird- our kids have never eaten meat), happy, energetic kids and beat into their heads that they need to take pills for whatever might ail them and never once look inward for the source of dis-ease. It's so much easier to let them cut things out of you- worry about the symptoms. Forget the root cause...

Congratulations on the birth of your daughter. It sounds like you had a wonderful experience.

The "medicalization" of birth in the US is a complicated issue. You've hit on a few of the important factors - midwives are not covered by most insurance policies and can be very hard to find in many areas. Generations of women accept birth as a medical event requiring a hospital and a doctor. For this reason and others, the tradition of midwife-assisted / home birth has faded from memory (and there is the small fact that many many women *want* pain relief during labor even if it comes with more procedures/risks, etc).

However, I also want to comment that "medicalization" of birth is not just a self-feeding animal. Infant and maternal mortality and c-section rates are not only a result of unnecessary procedures (assuming that pain relief during labor constitutes an "unnecessary" procedure). By and large, American women *are* at higher risk than women giving birth in many European and Asian countries. For one, our teen pregnancy rate remains high. But probably more important, our obesity rate is significantly higher - and is affecting younger and younger women. With maternal obesity comes diabetes, hypertension, toxemia. Poverty and obesity are co-incident as is poverty and lower rates of prenatal care. All factors which can impact a "normal" labor and delivery.

Access to quality healthcare would benefit both issues simultaneously. Access and affordability of midwifery and non-hopsital settings would be improved as would pre-natal and preventive care.

Congratulations, Nathan! Just one warning. In some states, midwives are inadequately regulated, and I know somebody who had a baby die due to completely incompetent midwives.

Nathan, thank you for sharing your joyous experience with us... as well as your thoughts on the medicalization of birthing in the US! I would add this to yours: Medicalized birthing is not good for the newborn. Joseph Chilton Pearce wrote a wonderful book, MAGICAL CHILD, in the early 80s (a revised edition is now in print) detailing the negatives of medicalized birthing vis-a-vis the baby. For you, and readers interested in the topic, I highly recommend MAGICAL CHILD to you. NB: The book covers many topics beyond birthing that are important to all parents of newborns and young children.

Now a personal story... In 1949, my mother, a registered nurse, gave birth to her first child stillborn because of the dr's use of medications to speed the delivery after a mere 12 hrs of labor. So, I grew up hearing how Dr X killed my oldest sister and hence, as a young adult, studied the issue. In the late 60s my mother became a certified nurse-midwife and subsequently delivered over 1,900 babies before her retirement in 1995 in a stand-alone birthing center, all without complications.

Two of my kids were born in England and one in the US, which offered me an interesting comparison in terms of different obstetrics styles and costs. 

Births #1 and #2 took place in one of the premier teaching hospitals in London, the Royal Free Hospital.  The first birth had some complications so can be excluded for comparison purposes.  But those complications were managed competently and cost us very little out of pocket.

For birth #2, we paid virtually nothing except for a few hundred pounds to make sure my wife had a private room after the birth.  The only doctor my wife saw before the birth was the anesthesiologist.  The only person in the delivery room with my wife, besides me, was a single midwife, who managed the birth from beginning to end.  After the baby was born, the midwife did not feel comfortable with the look of the baby (he had a low Apgar score) so she pressed a button in the delivery room.  Within ten seconds, a doctor appeared in the room and examined the baby.  After a few minutes and a few tests, he pronounced the baby was fine and gave him to us.

Birth #3 took place in a community hospital in suburban New York.  As soon as my wife went into the final stages of labor, an obstetrician (in practice for 30+ years) managed all aspects of the birth.  Two things struck me about the way he managed things.  First, he was clearly impatient to get things going, so he prescribed potocin to induce the birth, even though we had only been there a few hours.  Second, he observed one thing that represented a slightly elevated risk factor, the presence of a bit of mecomium (fetal stool) in the amniotic fluid.  Because of that, he requested a neo-natologist to observe the birth as well.  Added to that, the anesthesiologist was also in the room during the final delivery.  That meant that for a relatively routine birth with no complications, which resulted in a baby with no problems at all, there were THREE physicians in the room, all racking up costs.

Now I am well aware of the shortcomings of the way medicine is practiced in the UK.  The treatment my grandmother got at the end of her life was nothing short of criminally negligent.  My aunt suffered partial paralysis in her arm from a botched IV placement and got nothing in the way of compensation (and she's a top London hair stylist, which has meant a lifetime of overcoming this injury).  And don't get me started on the dentistry.  But it is clear to me that as far as obstetrics is concerned, there is no question the British National Health Service is several orders of magnitude more cost-effective, and has results that are as good or better than the far more profligate US system.

Nathan, I'm so happy for you and your family! Your baby daughter is beautiful. Health and much happiness to all of you. Thanks for sharing this story with us.

Jude

J. McCutchen

CONGRATS!!!!!!

Congratulations, and thanks for posting the beautiful pictures. I had one hospital birth (for my now eleven year old) and one home birth with midwife in attendance (for my now eight year old). The home birth was by far the better experience and the brutality and anomic nature of the hospital experience is what led me to it.

One thing I'd like to add is that the medicalization of birth and the focus on *doctors* means that the patient's time with the doctor becomes as costly and as rationed as surgery. There are no doctors in this country who have ever attended a whole birth all the way through from labor's inception through delivery. Doctors are generally servicing several women at once and are only called in at the last minute. Every woman who has had a hospital birth that lasted more than a few hours will tell you that they either never saw their doctor, or went through shifts of doctors each with their own protocol and their own method for handling the labor/birth. With a midwife you get a committment to the whole patient, whole child, whole birth. Any midwife has attended more whole labors than any doctor and has much more experience in managing the labor. Barring complications, a midwife enabled birth is an amazing and empowering experience. The complete opposite of the hospital/doctor managed birth.

Congratulations to all of you. Your baby looks beautiful. To a long and happy life.

aimai

the first midwife to lose a baby at birth in America will put them all out of business, because some John Edwards type is going to come along and sue her out of house and home. Midwives simply cannot afford the liability premiums. They don't have a 6-figure practice to keep them afloat.

I have a doctor friend, active in Democratic politics enough to be on a speaking basis with Bill Richardson and he also rolls his eyes at me when I say I like Edwards.

But, whatever the merits of the cases Edwards argued, he was not out to put health care professionals out of work. There is another side to these stories, you know. There's the fact that a lot of people are mistreated and that they have no recourse but the courts. Those people need representation and, more than that, they deserve it.

thosethingswesay.blogspot.com

Seems to me that this is really unnecessary.  Is it the best you can do: use a celebratory occasion to sling mud at John Edwards.  Perhaps it is the best you can do. <shrug></shrug> 

aMike

Hmm. Would that be post hoc ergo propter hoc, cum hoc ergo propter hoc, or simply, magical thinking?

Or -- as the subjects of an engaging kaffeeklatsch the anecdotes are mildly interesting. But as examples which are intended to be exemplars -- and if not so intended, why mention them in a general discussion of birthing practices -- of the outcomes of the one to two hundred million births which have occurred over the period of BradtheDad's diminishing transatlantic fecundity, they aren't even that.

Nathan---
I didn't think you were in any way dissing women who choose pain medication--I really was just replying to commenters later on the list.
You sound like a very supportive husband.

While it is certainly true that teenage and obese mothers face increased risks for certain conditions, it is still the case that most of these women can have healthy and normal childbirth experiences. Additionally, midwives can help to mitigate these risks with the additional time that they spend with patients.

My mother worked for a midwife (my mother is a nurse) for a long time at a free standing birth center where the midwives also had hospital privileges. They were the only private practice providers (that is, other than the hospital clinic) that accepted medical assistance patients.

That meant that women on medical assistance could choose to obtain their care either at the clinic (where all patients turn up in the morning and wait their turn, often for several hours, and where they are unlikely to see the same practitioner repeatedly) or they could come to the birth center, see the same staff and midwives and be treated like more than a number. Not surprisingly, many women chose the birth center.

This meant that the midwives essentially split their practice between the medical assistance patients (who almost exclusively deliver in hospital) and the patients who sought out care from a midwife and likely desired a birth center birth, even if they ended up at the hospital for one reason or another (they also deliver a lot of Mennonite babies, but that's another story altogether).

For the medical assistance patients, the midwives definitely focus their care on improving nutrition, both pre and post natal. At the clinic, they simply don't have the time to spend an hour with each patient, so there isn't as much emphasis on any one thing or follow up one what was discussed at a previous appointment.

C-sections definitely save lives, when they are needed. However, even in higher risk mothers, c-section rates are too high and there are many, many reasons for this (doctors legitimately concerned about malpractice cases, for one).

I think it is very easy to blame teenage pregnancy and obese mothers for the increased rate of high risk pregnancy, but that just doesn't tell the whole story. So many women now are told they are high risk, when that is not medically the case, whether it is because they suffered a previous miscarriage (I am absolutely not referring to women with fertility issues here), because they are over 35 ("advanced maternal age" brings loads of additional testing and additional expense), because they are at increased risk for complications due to being young or obese (until a complication occurs, they shouldn't be treated as high risk), etc.

Access to quality health care would benefit everyone, especially if coupled with patient education as a matter of course.

We have a jury system... you present evidence to a jury and they decide. No reason to apologize for their verdicts after the fact. Also, remember... judges and defense attorneys stand in the way of a plaintiff's attorney ever getting to even present an argument in front of a jury. Given that our system is stacked against plaintiffs, it's hard for me to get worked up over the excesses, if they are indeed excessive, of plaintiff's lawyers.

thosethingswesay.blogspot.com

I have read your post a few times and I think I have a very informed question for you, based on the premises that you so carefully put forward.

Please consider the following...

Wha?

thosethingswesay.blogspot.com

Nathan,

Congratulations to you and your wife! I wish for you a happy, healthy and well rested baby.

I delivered my first child with a midwife in a hospital and am currently planning to deliver my second with the same midwife in a free standing birth center (very close to the hospital in the event of complications). Assuming all goes to plan (because babies are super cooperative that way), we'll be able to go home anywhere from 4-12 hours after he or she is born, depending on how we feel and when we're ready to go.

The good news is that in our area (suburban Philadelphia), there are several birth centers, both free standing and hospital affiliated. My care and delivery will be covered by my health insurance (maybe they've realized how much cheaper it is!).

I didn't go into my first pregnancy thinking that I'd do it drug free (I wanted to see how things went and make the decision to use pain medication if I needed it), but I'm fairly committed to it this round. Not that I'm opposed to the pain meds, but it definitely was good to be able to walk around, etc. etc. I too was able to hold my baby immediately (other than the weighing and measuring) and that was just amazing.

Congratulations again.

Oh, and make sure to always ask your wife if she wants a drink when she's nursing. I speak from the experience of one who ALWAYS forgot to get a drink before sitting down with the baby for an extended period of time!

Laughed so hard I scared the cat.

aMike

I am definitely not "blaming" teen or obese mothers. Only pointing out that those factors may influence the differences in US maternal/fetal outcomes compared to other industrialized countries.

Again, I think this is a complicated issue. Medical liability plays a role. Expectations (even potentially unreasonable ones of a pain-free labor and perfect baby) of pregnant women are a factor. Access and acceptance of midwifery needs to be addressed (see points one and two). And, last but not least, increasing rates of higher-risk health issues impacts birth processes and outcomes. Ideally, changes over time will involve all these areas.

I completely agree that increased access to quality healthcare is probably the most pressing need and would have a tremendous potential benefit.

I'm rather surprised to hear the percentage of midwife births in the US is so low; in the Minneapolis hospital where my son was born, they are pretty much institutionalized, fully paid for on my modest HMO plan. It wasn't quite as personal an experience as you might expect; in this hospital, the midwives were on rotating shifts, and we dealt with several. The one we'd been seeing for several months was on Christmas vacation, and my son was also born at 12:23 am (amazing coincidence!) so our midwife had just started her shift. But it was still way better than any other encounter I've had with the medical profession.

I think the "perfect baby" liability issue might be lessened if we had universal health care. If the family is planning on both parents working, a baby with health problems isn't just a "disappointment" but potentially also a financial disaster. A baby with serious health problems can cost tens or hundreds of thousands of dollars in just the first year, and probably one of the spouses will have to become a full time caregiver, between the doctor appointments and the fragility of the child (it is dangerous to put a premie infant in day care where there will be exposure to a lot of pathogens).

Often families with health care issues have a choice of suing for malpractice or filing for bankruptcy. They need a lawyer either way. Sometimes it comes down to a choice between stiffing the old doctor or stiffing the new doctor.

Anyone interested in more information about doulas can find it at www.dona.org.

While I'm at it, anyone looking for more information about midwives and or birth centers can visit www.birthcenters.org, www.midwife.org or www.midwifeinfo.com.

Non potty trained picketers would have to be a whole new form of non-violent protesting! Maybe my potty training resistant three year old would like to volunteer.

Nathan Newman wrote: "Changing who is paying for health insurance away from for-profit entities to the government is one step."

"Profit" is a bookkeeping term, the difference between total revenue and total cost. If an orgtanization has no line in its balance sheet for "profit" it must attribute all receipts to costs. "Profit" says very little about human motivation.

Nathan Newman wrote: "Notably, our health insurance company didn't cover our midwife services, so we had to pay more for out-of-network coverage, despite the fact that the costs of our birth were very low compared to most births. But this problem in maternity care just reflects that change is needed throughout the system, from doctors to hospitals to make the real cost savings needed for our health care non-system."

Nathhan Newman's anecdote works against the argument for State-supplied medical care. If you purchase services with your own money in an unregulated market, you can buy whatever you want and can afford that anyone will sell. "Does anyone want service __X__ (fill inthe blank)?" and "What resources does __X__ require?" are empirical questions which only experiment can answer. A competitive market is an ongoing experiment in matching resources to customers' wants. A State-monopoly system is like an experiment with one treatment and no controls: a retarded experimental design. Neither State agents nor State-regulated industries can supply medical care without a definition of "medical care", but then patients and healers are bound by the State's definition.

Both of you are off the track, mho. What's the difference if a service is not available under private insurance or not available under public insurance? In both cases, certain procedures are not going to be covered, and you end up paying for them out of pocket if you want them.

The point is that virtually no one has a health insurance plan any more that doesn't practice "rationing" already.

I really don't understand why the private/profit advocates can't see that. It's the future, there's just too many expensive techniques and treatments available, it's growing as a part of GNP all the time. Insured medical services WILL be rationed, whether insurance is public or private, get used to it. Only the rich will be able to pay out of pocket for certain special treatments, whether we have public or private insurance, get used to it.

Chances are nil that the rare type of socialist plan that doesn't allow for people to buy services that aren't covered is going to be enacted in the U.S.A. No chance cosmetic surgeons are not going to go out of business. I'm willing to bet you that neither botox injections nor experimental gene therapies are going to be covered under both most private HMO's and Medicare in the near future. Get it?

Yes, I agree, a single payer plan might or might not cover midwives, depending probably upon how strong their lobby is. (Heh.) But his plan doesn't cover it now, and hiring a lobbyist won't even help. The only option you have with private companies when they deny care is to get a P.R. campaign going, trying to make them look bad in the news and TV.