Health Care Reform Begins at Birth

December 29, 2008

“If the United States is serious about health reform, we need to begin, well, at the beginning,” writes Jennifer Block in this L.A. Times op-ed that argues the United States health care system could save billions by overhauling the American way of birth.

Block, the author of “Pushed: The Painful Truth About Childbirth and Modern Maternity Care,” continues:

The most cost-effective, health-promoting maternity care for normal, healthy women is midwife led and out of hospital. Hospitals charge from $7,000 to $16,000, depending on the type and complexity of the birth. The average birth-center fee is only $1,600 because high-tech medical intervention is rarely applied and stays are shorter. […]

Currently, just 1% of women nationwide get midwife-led care outside a hospital setting. Imagine the savings if that number jumped to 10% or even 30%. Imagine if hospitals started promoting best practices: giving women one-on-one, continuous support, promoting movement and water immersion for pain relief, and reducing the use of labor stimulants and labor induction. The C-section rate would plummet, as would related infections, hemorrhages, neonatal intensive care admissions and deaths. And the country could save some serious cash. The joint Milbank report conservatively estimates savings of $2.5 billion a year if the caesarean rate were brought down to 15%.

To be frank, the U.S. maternity care system needs to be turned upside down. Midwives should be caring for the majority of pregnant women, and physicians should continue to handle high-risk cases, complications and emergencies. This is the division of labor, so to speak, that you find in the countries that spend less but get more.


  • “Midwives say the same economic forces that have led consumers to stay home instead of shopping is hitting the birthing business, albeit on a small scale,” reports the Salt Lake Tribune. A sidebar piece notes that although Utah has the the nation’s highest fertility rate, there are just two licensed birth centers in the state. Midwives are trying to open more.
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