Midwives: by choice or for savings?


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This is a news report initially published in Colombian newspaper La República. I translated the report from Spanish to English, because it was part of my application to the M.A. in International Affairs at The New School in New York.

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Midwives: by choice or for savings?

  1. 1. EE.UU. The expensive health care system generated a large number ofwomen opting for births attended by persons dedicated to this service.Midwives, by choice or for savings ?By: María Ximena Plaza mplaza@larepublica.com.co Bogotá 2007Few minutes before giving birth, Jennifer* was walking around her apartment,until she leaned against a wall and, while standing up, she delivered a beautifulgirl, who still remained in the bag that protected her in the womb.Dawn Rogula, a midwife that travels around Florida, United States, cut theumbilical cord and felt she had accomplished her job: to guarantee the chosenmethod of labor by the mother, a personalized attention that, according to themidwife, you cannot find in any hospital.In the United States some women prefer bringing their baby to the world withthe assistance of a midwife. According to a report carried out by the NationalCenter for Health Statistics and the Center for Disease Control and Prevention,between 1979 and 2002, births attended by women dedicated to this serviceincreased from less than one per cent to 8,1 per cent in 2002, although in 2004it descended to 7,9 percent.Eugene Declercq, professor in the Public Health Department at BostonUniversity, pointed out that midwives assist women, who don’t have any accessto health care. He said that the health care system is “private and fragmented”and that most insurance depends on the job you have.If a woman is not working or isn’t related to a small enterprise offering thebenefits of insurance, she will have problems to enter to the health care system.
  2. 2. The specialist affirmed that some employers provide a health care package tooexpensive, given that they don’t offer any kind of compensation.Some insurance packages require for women to indicate during renewal if theyare going to use maternity benefits and if so, they must make an additionalpayment. If they are expecting a baby without any notification, the pregnancyhas no coverage, said Declerq, though he clarified that the Government offerssupplementary plans such as Medicaid.According to a study carried out by the Agency for Healthcare Research andQuality, a natural birth in a hospital may cost more than six dollars and one thatincludes a c- section with complications may have a value of more than 16thousand dollars.Meanwhile a delivery in a Birth Center, where a large amount of midwives work,can cost around 1.600 dollars, according to figures from Childbirth Connection.Childbirth Connection Director, Carol Sakala, assured that a large part of thepopulation seeks doctors, but in the birth centers “there is no conflict betweenwhat’s the best care for mothers and their babies and the cost of this service.”Medical ProceduresThe fear of overcoming medical procedures like a c - section has influencedwomen’s choice of a midwife, as this practice does necessarily imply a surgicalintervention , said Rogula.C-sections increased five percent in 2005, reaching 30,2 percent of all the birthsin the nation, a high level, according to preliminary figures of the Center forDisease Control and Prevention for this year.The World Health Organization established that no region in the world isallowed to have a c - section rate superior than 10 to 15 per cent. Therefore the
  3. 3. United States has tried to decrease it by leading the “Healthy Persons 2010”campaign, however great advances in this matter have not yet been reported.Sakala argued that hospitals benefit enormously of the recovery days after thesurgery, more over when it is a planned procedure, in which they can controlthe staff of nurses.“Moms want to receive an attention that doesn’t depend on others interests,instead according to their own concerns”, she said.Although, Declrecq pointed out that midwives dedicate more time during andafter the pregnancy, therefore there are more expenses.He also insisted that the c- section issue is a marginal matter and not a priorityfor around four million moms in the United States.Declrecq prefers to attributethis situation to highly medicated births.PoliticsThe cost of medical service is the biggest concern for Americans, according to apoll carried out by NBC and the Wall Street Journal.According to Childbirth Connection Director “the system is out of control interms of expenses”.Last week, in an attempt to change this situation, the White House proposed adeduction of taxes for those who buy private medical insurance, one of the mostimportant initiatives for this year.“It’s by far the fair and hoping option, though if you want the Government to bein charge of everything, this would be a mistake”, U. S President, George W.Bush, said.
  4. 4. The tax decrease would be 15 thousand dollars for one family and 7.500 dollarsfor individuals who acquire a private insurance. On the other hand, theinsurance sponsored by employers would receive a higher burden.* The source asked her name to be changed.