I’ve written a great deal about the way that homebirth midwives trick lay people into believing that they are exactly the same as midwives in the rest of the world. They’re so good at confusing people that an insurance executive was hoodwinked to the extent that he posted a paean to birth at a birth center on a health economics website without ever realizing that the birth center was unaccredited, the midwives weren’t real midwives, and they were essentially having a homebirth in someone else’s house.
David Overton wrote A Tale of Two Births for The Health Care Blog. It is a typical rhapsody on the joys of a non-medical (second) birth as compared to the medical annoyances of a previous (first) birth:
I have two sons, both healthy happy boys, both brought into this world in very different ways. I work in healthcare and like many readers of THCB, the business of healthcare is often viewed through the business lens. When we become the healthcare consumer, and are knee deep in the conundrum that is our healthcare system, the perspective changes dramatically.
Overton and his wife had planned a natural birth for their first child, but they were getting their care through the military and had to put up with evil medical interventions like a postdates induction:
The induction was the beginning of the end of my wife’s “natural” experience. The induction led to administration of Fentanyl, which led to an epidural, which led to Oxytocin, which led to contractions so powerful they resulted in fourth degree perineal tears and ultimately the arrival of Ezra…
Of course everything was so much better for baby number 2 born in a “birth center”:
By now, we were out of the military and my wife welcomed the idea of having her real “granola birth” experience. We went out of our network insurance to use a birthing center that was staffed by Licensed Midwives. We paid $4,000 out of pocket because our insurance would not cover due to “liability concerns”. Given that I work for the company that is also the insurer (yes, I work for an insurer), I was able to discover how much a delivery would cost at a hospital in our market; $7,500.
Each visit with the midwife lasted between 45 minutes and an hour. The assessments were very thorough, our questions were answered, and Ezra accompanied us on the visits. We were introduced to a new world of naturopathic healing (this was new to me) for headaches, backaches, and sleeplessness. We had options where we wanted to have the delivery, at home, the birth center, in a warm tub. Birthing positions and techniques were reviewed (on your back with feet in the air was not on the list of suggestions). We were given choices of what vaccinations we wanted, literature was shared on what research has shown on the risk of exposure to group B strep, and we made the decision on how we wanted to proceed. Only two ultrasounds were done, 6 weeks and 24 weeks cutting down on utilization. Emergency procedures were reviewed in case something went wrong, the on call physician would be notified or we would go to the emergency room.
Cue the “uneducated” friends:
40 weeks approached and my wife became concerned, friends and co-workers admonished her for putting her baby at risk. “It’s dangerous” they would say, “this is not good for your baby”. The midwife was never concerned, “your baby will come when he is ready”. We went to 42 weeks before Silas arrived…
The birth was everything they had wanted:
My wife labored for 4 hours with the gentle guidance of the midwife and no medications. She stood up, she lay down, she lay on her side, she walked around, and she was never tied to an IV, nor confined to a bed or birth monitor. At 4:00 am a bathtub was filled with warm water which eased the intensity of the contractions and at 4:30, Silas was born. We had previously decided that the newborn screening and Erythromycin eye ointment were all we wanted him exposed to, vaccinations could wait. By 10:00 am, we were home with the second addition to our family.
What did Overton learn from this experience:
Our healthcare system is broken but it is our own behavior as providers, payers, and consumers that have allowed it to happen. Why would any provider want to induce a mother at or prior to 36 weeks? Who decided elective Cesareans were a good idea? Since when did uncomplicated child birth have to take place in the hospital? Why don’t payers reimburse care that is delivered by mid-levels in a safe environment at a lower cost? I don’t claim to have the answers to these problems, but I do know that until we change our own behavior, we will continue to see the same results.
There’s just one teensy, weensy problem. Overton is clueless that his wife was not receiving care delivered by mid-levels in a safe environment. His wife received care from a lay person with a made up credential, not a midwife; it was not a safe environment because it was simply someone else’s house not an accredited birth center and because homebirth midwives have hideous death rates; and it costs less because it always costs less when you dispense with educated providers and life saving equipment.
Overton and his wife, both nurses, apparently had no clue that this is what they had chosen.
After a great deal of back and forth between Overton and myself in the comments section, he had this to say:
I have enjoyed the commentary on our choice to use a midwife. I am not impervious to fact and it has given me a lot to think about. With that in mind, I will concede to the assertion that it might not have been the safest choice. Touche! We chose to see a midwife because we chose NOT to experience what happened with our first son. Right or wrong from a scientific point of view, it was what was right for our family.
There’s nothing right or wrong with their choice to use a pretend “midwife” and have a homebirth at someone else’s house if that is truly what Overton and his wife were choosing. The problem is that two nurses, one of whom works for a health insurer, had literally no idea they were choosing a second, inferior class of midwife that wouldn’t be considered qualified in any other first world country; they had no idea that they weren’t in a real (accredited) birth center; and they had no idea that in the event of a life threatening emergency, their baby may well have died.
The ultimate irony of the piece is that in attempting to “educate” the rest of us, Overton got a lesson in how truly uneducated he was about homebirth midwifery. If he can be hoodwinked by homebirth midwives, anyone can.
