Homebirth: who pays and who profits?


Let’s make one thing clear: homebirth is an industry.

It’s an industry that involves providers charging large fees for services of dubious worth. If you have any doubt that it is an industry, consider the many groups devoted to lobbying on behalf of homebirth providers and the hundreds of thousands of dollars that are spent on lobbying on a variety of issues that always come back to the same thing: more opportunity for homebirth midwives to make more money.

Homebirth advocacy in the US is chiefly about the opportunities for homebirth midwives to profit. Contrary to the morally grotesque “human rights” argument advanced by homebirth advocates, every women in the US already has the right to have a homebirth and already has the right to be attended by anyone she chooses. Homebirth is completely legal and surrounding yourself with friends or even complete strangers of your choosing is also completely legal. The so called “right” to a homebirth is exclusively about the “right” of a layperson to pretend that she is a midwife, and most important of all, her “right” to charge for her services. In other words, homebirth advocacy is about the “right” of homebirth midwives to profit.

When viewed through the prism of profit, all major homebirth issues come into sharp focus.

The issue of licensing of homebirth midwives, which is currently playing out across the country, is at the heart of the drive to profit. The fundamental goal of the homebirth industry is to obtain access to insurance reimbursements. Insurance companies have deep pockets and access to reimbursement would allow homebirth midwives to collect the outrageous fees they already insist upon and to raise their prices even further.

There’s just a teensy, weensy little problem. Insurance companies will not reimburse providers who are not licensed. Therefore, homebirth midwives are seeking licensure, while desperately trying to avoid the standards and accountability that are always a part of licensing.

Licensing is designed to ensure public safety by standardizing education and training requirements, mandating malpractice insurance, mandating continuing education, and ensuring accountability for those who provide substandard care. That represents a serious problem for homebirth midwives who wish to be able to “practice” without any education and pathetically minimal training. Furthermore, the midwifery leadership has made it very clear that they reject the idea of ANY standards of any kind, and will almost never discipline members of their community regardless of how egregious the malpractice and regardless of how many babies die. And malpractice insurance is out of the question for two reasons; first, it cuts into the profits of homebirth midwives and second, malpractice insurers have standards that homebirth midwives have no intention of meeting.

The drive for profit stands behind homebirth midwives’ opposition any and all regulations of their practice standards and their scope of practice. Practice standards limit the number of laypeople who can pretend to be midwives, and therefore limit who can profit. Restrictions in scope of practice, designed to ensure patient safety, limit the pool of women from whom they can profit. Hence the inane insistence that a variety of high risk conditions (breech, twins, VBAC) are “variations of normal.” Acknowledging the greatly increased risk of these conditions would eliminate the possibility of profiting from them, and therefore is forbidden.

How about women and babies? Do they benefit in any way from homebirth midwifery? The answer is mixed. Women gain nothing directly homebirth midwifery that they didn’t already have. Women have the right to a homebirth regardless of the status of homebirth midwives. Women have the right to be attended by these women regardless of the status of homebirth midwives. What’s at stake is the right of these women to be paid and who will pay them. To the extent that licensing of homebirth midwives could lead to reimbursement, it might allow women to hire homebirth midwives without direct cost to themselves.

Who pays? That’s easy to answer. Women pay and babies pay.

Women pay because they are tricked into accepting substandard care from uneducated laypeople who they erroneously believe have been vetted by the state. They are tricked into paying women who call themselves midwives, but are just lay birth junkies who lack even basic knowledge about childbirth. Women risk complications such as hemorrhage and uterine rupture that threaten their own lives and have led to preventable maternal deaths at homebirth. They pay with months or years of bladder and bowel incontinence from unrecognized and unrepaired perineal tears. Women pay money, pain and suffering to finance the fantasies of a group of laypeople who misrepresent who they are and what they can do, with tragic results.

Of course no one pays as much as the babies. As the statistics from Oregon and elsewhere show, homebirth has a dramatically increased rate of preventable neonatal death. Extrapolating from the Oregon statistics leads to the horrific conclusion that nearly 90% of the babies who die at homebirth would have been saved in a hospital.

Homebirth is an industry. It’s an industry devoted to creating and expanding opportunities for lay birth junkies to profit from their fascination with birth. It is an industry that rejects regulations, standards, and malpractice insurance because all of them cut into the profits of homebirth midwives. And it is an industry built of deceiving women and letting babies come to harm.

The homebirth midwifery credential, the CPM, is a trick and it was designed to be a trick. By putting letters after their names, uneducated birth junkies dramatically increased their ability to fool women about their credentials while simultaneously rejecting the standards and accountability that credentialing implies. That’s why the CPM must be abolished and most surely will be abolished. The only open question is how many babies will die before the profits of these poseurs are eliminated.