This month, Britain's national health service advised women with low-risk pregnancies that it was safer to give birth under the supervision of midwives than doctors, as the latter are more likely to perform interventions like forceps deliveries and cesarean sections that carry risks of infection and surgical accidents.
Photo Credit: Jaybird via flickr | CC BY-NC-SA 2.0
Two recent articles in the New York Times present compelling cases that births should be overseen by midwives instead of doctors. The first does so by way of reportage, detailing the decision by Britain's National Institute for Health and Care Excellence to "[reverse] a generation of guidance on childbirth" by advising "healthy women that it was safer to have their babies at home, or in a birth center, than in a hospital." The second, written by the New York Times Editorial Board, does so more overtly, calling on Congress to pass legislation that would increase women's access to midwives "in a time of spiraling medical costs and increasing demand for health care."
Both pieces are bolstered by studies that support changes to existing birth practices that would see more deliveries presided over by midwives instead of doctors. So why aren't midwives delivering more babies?
There are two common explanations. The first has to do with doctors losing patients (and, presumably, money) to midwives. Here, a comparison between Britain and the U.S. is instructive:
[Dr. Jeffrey L. Ecker, the chairman of the committee on obstetrics practice for American College of Obstetricians and Gynecologists, said] that he did not believe the British-style guidelines would come to America anytime soon. If such a recommendation were made in the United States, doctors might worry about losing patients to midwives.
That concern is absent in Britain's taxpayer-funded system. "There are no financial incentives in the U.K. for doctors to deliver in a particular setting because there is no personal gain," said Dr. Baker of the health institute. Childbirth is "effectively an N.H.S. monopoly," he said, referring to the National Health Service, Britain's public health system.
The second reason (which – significantly, I think – doesn't cast doctors as money-grubbing) is that low-risk pregnancies can develop complications that require swift, specialized medical intervention. This is an important and valid concern, but one with what seems on the surface like a straightforward solution:
Some medical centers are trying to have the best of both worlds by allowing midwives greater autonomy within the hospital. The Mayo Clinic, often a pacesetter, lets midwives handle low-risk pregnancies independently and hand off to doctors any cases that become complicated.
Why aren't midwives delivering more babies? Whatever the reason, the United States has some of the highest infant and maternal death rates in the industrialized world, and yet it costs more to deliver a baby here than anywhere else on Earth. With statistics like that, it would be rash to go on ignoring what a growing body of evidence continues to support: That, under certain well-defined circumstances that apply to roughly 45% of pregnancies, midwives are a safer, more cost-effective option than doctors when it comes to birth.