Dear Mr. President
President Obama and the Democratic National Committee are asking the American public toÂ share their personal stories and input as Congress prepares to reform healthcare policy this summer. In response,Â I have writtenÂ letters to the President and to Senators Boxer and Feinstein.Â I amÂ asking that midwifery be integrated into the current maternity care model to provide freedom of choice and the highest-quality, most cost-effective care for women and their families.
Dear President Obama,
Midwifery in Healthcare Reform
Please integrate midwifery in healthcare reform policy, so women may have access to the highest-quality and most cost-effective maternity care, both in and out of hospital settings.
As a woman who earned a Bachelorâ€™s Degree and a Masterâ€™s Degree, I considered myself an educated person, an individual with the resources necessary to access information and to act upon that information. However, in hindsight, I (like millions of women in this country) walked into pregnancy quite uneducated, adopting the mindset that I would go along with whatever my doctor suggested and what â€œevery otherâ€ woman seemed to be doing in regards to pregnancy and birth.
I remained unaware of the various maternity care options until a friend shared a list of books, websites, and birth professionals with me. For the remainder of my pregnancy, I worked tirelessly to surround myself with the appropriate people and information to ensure the safest birth possible.
I approached my obstetrician with the information I gathered and asked how the doctors in the practice might support me for the remainder of my pregnancy and in labor and birth. While the practice reassured me that my needs would be met, I felt no genuine reassurance that I, a healthy woman carrying a healthy baby, would be supported in a hospital notorious for the overuse of costly, medical intervention.
In my last trimester of pregnancy, I chose a different hospital and practice with several Certified Nurse Midwives (CNMs) on-staff. Under the midwifery model of care, these CNMs provide primary prenatal care and 24/7 labor and delivery care for all women in this practice, unless a situation requires the additional consultation of an obstetrician. This model of support seemed ideal for a woman in search of the safest, least-invasive, and most cost-effective birth.
Although this collaboration between midwives and obstetricians minimized some of the unnecessary medical interventions I wanted to avoid, the staffâ€™s adherence to hospital protocols (as opposed to individualized care) did result in other unnecessary medical interventions that caused undue harm and injury. This model of care can be a safer and less expensive option than traditional obstetric care; however, further integration between obstetrics and midwifery is needed to ensure the best outcomes for mothers and babies. Had midwifery practices been a more integral part of hospital protocols, my daughter and I would have likely avoided much, if not all, of the physical and emotional trauma we experienced.
As my husband and I look ahead to conceiving our next child and choosing a care provider, we plan on hiring a credentialed, homebirth midwife. For us and many other families, this choice addresses all three of your goals in reforming our healthcare system (i.e. cost savings, choice of care, quality of care), yet out-of-hospital birth is not widely recognized or supported by our current healthcare system.
Whereas obstetric and hospital costs during my pregnancy and birth totaled over $16,000, homebirth midwives provide more comprehensive care for approximately $4,000. Midwifery care inherently costs less because technology and medication are employed only when necessary.
Choice of Care
Whereas obstetricians are ubiquitously recognized by the healthcare system and supported by insurance carriers, CNMs, CMs (Certified Midwives), and CPMs (Certified Professional Midwives) do not receive this same level of recognition or support. Based on their specific needs, women should have equal access to OBs, CNMs, CMs, and CPMs.
Quality of Care
Whereas most women, regardless of health risk, receive maternity care from medical doctors trained as surgeons, only a fraction actually need medical intervention during pregnancy and birth. Women would receive more individualized care if midwives routinely attended low-risk women while doctors attended high-risk women.
With childbirth as the leading reason for hospitalization and the most costly hospital procedures associated with pregnancy, birth, and newborn care (in excess of $86 billion a year), integrating all levels of credentialed midwives in healthcare reform policy simultaneously improves outcomes and significantly decreases expenditure. Please keep this in mind as you meet with your colleagues and work towards a healthier future for our nation.