Health care reform and midwives

Below find an open letter from Suzy Myers, midwife and women’s health care pioneer. Certified Professional Midwives, whom she represents, are the midwives who practice independently, outside of hospitals, i.e. at home births or freestanding birth centers. The other kind of midwife is nurse midwives, who largely practice in hospitals. If CPMs are federally recognized, covered by Medicaid, and become more widely used, the U.S. could save millions, perhaps billions, of dollars on childbirth while improving care.

June 20, 2009

We are at a moment in history that could affect the future of midwifery for decades. We have the opportunity to positively influence health care legislation to ensure access to midwifery care or be left behind as details of a reformed system are established in law in the next few months.

The M.A.M.A. campaign is a historic coalition of the key midwifery and consumer organizations in the U.S. unified behind the goal of achieving federal recognition of Certified Professional Midwives. Our specific goal in the next weeks is inserting an amendment into the health care bills that are moving through congress right now to mandate Medicaid coverage for CPM services on the federal level.

This multi-faceted campaign is being directed by a steering committee of dedicated volunteers, and paid staff: an experienced lobbyist in Washington D.C. , campaign coordinator and a project consultant with national health care reform experience and connections.

This week Amber Ulvenes, MAWS lobbyist and midwifery consumer, and I are participating in a country-wide “fly-in” of midwives and advocates to DC to work with the campaign’s federal lobbyist to amend this language into the Senate Finance bill when it goes to committee mark-up the week of June 22nd.

In addition to mobilizing grass roots support, right now funds are urgently needed to sustain this work through the next few months when legislation is being drafted.

What you can do:
1. If you are a midwife, talk with each of your current clients about the M.A.M.A. campaign. Give them the link to the web site: http://www.mamacampaign.or g/. Ask them to sign up, endorse, give money and volunteer to pitch in. If you have an e-list of past clients, please send a personal message asking for their support and directing them to the web site.

2. Send this message to everyone you think supports increased access to midwifery care and ask them to join the M.A.M.A. campaign and donate.

3. Sign up yourself! Numbers count. Dollars count. This is a moment when we must mobilize all available resources!

Thank you,
Suzy Myers
Midwives Association of Washington State Board of Directors
National Association of Certified Professional Midwives Board of Directors

Childbirth: the low-hanging fruit of health care reform

Quick, what’s the number one reason to be hospitalized in this country? Heart attack? Car accident? Here’s a hint: It’s not a disease. It’s not even an injury.

The answer is childbirth. And what’s the most common operating room procedure? C-section.

Given that 85 percent of women give birth and it’s no secret how 240 million Americans arrived in the world, this shouldn’t be a surprise. Nor should it really be a surprise that maternal and newborn charges are far and away the nation’s number one hospital cost, $86 billion in 2006, according to Childbirth Connections. Given all this, you’d think that, as talk of health care reform, and especially containing health care costs, fills the media, childbirth would be a major topic.

You’d be wrong. I haven’t read a peep about it in all the newspaper and magazine articles on Obama’s drive to cut health care costs, except for a couple of good articles in USA Today last December, generated by a report from Childbirth Connections.

There’s been a lot of attention paid to the ways the country pays too much for the wrong kind of care. A recent article in the New Yorker made the point that some parts of the country spend much more on medical care than others, without being healthier for it, the moral of the story being that we can cut costs while improving care. Obama reportedly passed this article around to members of Congress (hallelujah, an intellectually curious president for a change).

Yet oddly the article didn’t mention childbirth, even though C-section rates vary wildly by region and by hospital, and the nation’s C-section rate is over 30 percent, more than double what the World Health Organization recommends, which is to say that half of all U.S. C-sections are unnecessary. USA Today estimates unnecessary C-sections per year cost the nation at least $2.5 billion a year, but that is surely conservative, given that there are probably 700,000 unnecessary C-sections, each costing at least $5,000 more than a vaginal birth (not to mention the costs from additional medical complications). Add in the other childbirth interventions—such as episiotomies or continuous fetal monitoring—that are routinely done far in excess of what evidence recommends, and there have to be tens of billions of dollars that could be cut from our spending on childbirth each year while improving care.

As a doctor put it to USA Today, "Fortunately, maternity care is a place where good care and good economics come together."

Why aren't other media covering this?

Thank you, Dr. George Tiller

I’ve been thinking all week about George Tiller. As sad and angry—particularly at the negligent law enforcement officers of Wichita—as his murder makes me feel, what I know about George Tiller’s life uplifts me. That there was a man who, knowing he was risking his life, dedicated himself to helping women gives me new love for half the species. Reading the newspaper—yet another story of a man who murdered his children to get back at his ex-wife, or hired someone off Craigslist to rape his wife at gunpoint—I often find myself consumed with misanthropy. (Wrong word, I know—it’s not humanity I’ve got a beef with—but there isn’t the right word. No coincidence, that.)

George Tiller reminds me that while men too often consider women’s freedom a threat to be countered with brutal violence, men are also capable of making the highest sacrifice to defend the right of women to self-determination. Thank you, Dr. Tiller.

Dr. Tiller was one of only four doctors nationwide who provided the kind of late-term abortions he did. As Salon asks, where will women—and sadly, girls—go now?

"We always sent the really tragic cases to Tiller." Those included women diagnosed with cancer who needed abortions to qualify for chemotherapy, women who learned late in their pregnancies that their wanted babies had fatal illnesses, and rape victims so young they didn't realize they were pregnant for months. "We sent him 11-year-olds, 12-year-olds."

To make a donation in Dr. Tiller’s name to the National Network of Abortion Funds, to help provide the kind of health care he did to poor women and women facing major obstacles to getting abortions, go here.