One of my favorite healthcare bloggers, Jason Shafrin of Healthcare Economist, has written an article in favor of the midwifery model of care, and I couldn’t agree more. Jason’s article was included in the Cavalcade of Risk this week, and is definitely worth reading.
The controversy surrounding homebirths (and midwives versus obstetricians) has been in the news again lately with the release of a new study that claims that homebirth is associated with a higher neonatal mortality rate than hospital births (registration required to view the Medscape article). This has met with some fierce criticism from people who (rightly so, in my opinion) claim that the study results are politically and financially motivated. The debate around whether births should be attended by OBs or midwives is much like the debate around health care reform. People are very wrapped up in their own beliefs on the subject and become pretty fired up when talking about it. It’s hard to distinguish real science and facts from hype and fear-mongering. It’s difficult for me to consider points made by ACOG on the subject of homebirths as valid, because of their strict stance against homebirths and their obvious financial bias. But I will readily admit that I have a bias in favor of homebirth. Such is the way of human nature when it comes to controversial topics…. if we have opinions on them, we tend to hold tightly to them.
The US c-section rate rose by 53% from 1996 to 2007, although in Colorado and five other states the increase was a whopping 70%. That trend doesn’t show any sign of reversing itself anytime soon. As Jason noted in his article, there is a “cascade of interventions” in hospital birth settings that is steadily driving up the rate of surgical births. In addition, we have a malpractice system that provides a strong incentive for doctors to perform c-sections at the first hint of a problem. With a system like that, it’s hard to fault OBs for taking the c-section route, and intervening in general. We can wring our hands all we want about how we need to reduce the rate of c-sections and medical interventions during childbirth, but as long as our malpractice system penalizes doctors for avoiding c-sections, we won’t make much progress.