“We are the first state to have equal reimbursement for CPMs written into law. Women on Medicaid now have expanded birth options. And CPMs are now a Medicaid provider type! We have a great birth center licensure bill that other states can use as a model. What an incredible journey.” says Kate Saumweber, who works assisting Midwife Amy Johnson-Grass at Health Foundations Birth Center.
Last year, Minnesota was the first state to allow Certified Midwife assisted births to be covered by Medicaid. Now, looking at a health care budget that has gone broke, Minnesota is taking things a step further.
Recognizing that for most women, a hospitalized birth with routine early inductions, invasive testing and practices, high cesarean rates, and higher costs is unnecessary and often causes more birth related consequences, the state of Minnesota is looking at a revolutionary reform that has the potential to change birthing practices in the United States forever.
Life after broke.
It’s unfortunate that it takes being financially bankrupt to get people to open their eyes and see the truth about birth practices. The truth is though, that the current birthing industry is easily twice as financially expensive and exponentially as physically and emotionally expensive as it needs to be.
Does this mean that birthing reform will put new mothers and their children at risk?
According to the CBC, a new Canadian study by Dr. Patrician Janssen from the University of British Columbia found that the rate of death per 1,000 births in the first month of life was:
- 0.35 for planned home births
- 0.57 for hospital births with a midwife
- 0.64 for hospital births with a physician
The Canadian Medical Association Journal declared in their 2009 September issue that planned midwife assisted home births have impressively better outcomes than hospital births. The researchers studied over 2,800 planned home births that were assisted by registered midwives over the course of four years and compared the statistics to hospital births in the same area of the country.
What they found was that the home birth group experienced significantly less:
- Artificial rupturing of fetal membranes
- Use of oxytocin
- Electronic fetal monitoring
But those statistics shouldn’t be surprising. What may be surprising is that the home birth group also experienced fewer incidences of:
- Birth trauma
- Meconium aspiration
- Need of resuscitation at birth
- Need for oxygen therapy beyond 24 hours.
- Postpartum hemorrhage
- Maternal health problems
- Severe tears
Yup, that’s right, I said that home births are less likely to result in death.
Among the hospital birth group, there were six incidences of infant death during delivery. Among the home birth groups, there were zero.
That’s not to say that infant death cannot occur in a home birth setting, but infants are conclusively less likely to die with a midwife assisted birth than with a hospital birth.
For all the nay-sayers, it should be noted that this was a highly controlled study of comparable birth circumstances. In addition, this is only one of dozens of similar studies that all conclude the same way:
Home birth is safer.
So, now we have to mull that over as Americans.
Midwife assisted births are safer than hospital births. Midwife assisted births are nicer than hospital births. Midwife assisted births are gentler than hospital births. Midwife assisted births are CHEAPER than hospital births.
Oh, wait… did you catch that Medicaid?
Midwife assisted births are CHEAPER than hospital births.
Judging from the birth reform happening in Minnesota right now, it’s apparent that they finally caught on.
Look around at your state. Does your state have a bounty of cash to pay twice as much for a hospital birth as it would for a midwife assisted birth? No? Maybe it’s time for some letters to law makers.
This whole time, I thought explaining to the state lawmakers that a more natural health care system was beneficial physically and emotionally would do the trick.
Time to take the rose-colored glasses off, I guess. Time to step away from my ideals for the betterment of our nation.
I never even thought about the money.
Yet, that’s almost all that they think about. I guess, if we want reform, we just need to start talking their language.
***raising my glass***
“Here’s to life after broke!”
I am SO happy to hear about this! I had to pay out of pocket for my home birth and I had medicaid at the time. I remembered thinking how completely ridiculous it was that they’d cover a $9,000+ hospital birth but not a $2000-$3000 home birth. It cost me $2700, but it was one of the best purchases Ive ever made! Im glad that women who want a home birth these days don’t have to worry about coming up with the fee themselves. And yes, its totally sad that it has to come down to money, and not quality of care. When I was planning my home birth I actually had to stop telling family and friends. I kept getting horrified looks and questions like, “But what if something goes wrong?” It started to freak me out so I just stopped talking about it with others. People think that a hospital birth guarantees that nothing will go wrong. That’s a big misconception.
Right. Statistically, it means your MORE LIKELY that something will go wrong or your baby will die if you deliver in a hospital.
Just wanted to add a little food for thought here….
There are some women who are statistically more likely to have complications during childbirth due to pre-existing medical conditions. These women are less likely to choose a homebirth because they usually understand that they’re more likely to need medical intervention during birth that would not be available in their home. Even those who decide against a hospital birth are often “risked out” of birth centers and many midwives refuse to attend births in their homes because of the risks and liability involved. These patients account for the higher death rates in hospital births. It’s not the hospital care that killed them; it’s the unique medical situation that killed them- the same thing that caused them to choose a hospital birth in the first place.
That being said, the statistics prove that home births are safe for most women. That doesn’t make them safer for all women, though.
In the actual study that was done, they took this very important factor into consideration. They only used non-high risk, healthy pregnancies among healthy women of similar demographics for each study group. A midwife will not actually allow you to deliver with them if you have a condition that makes it unsafe, so that had to be factored into the test. This study was brilliant in that it took these factors into consideration so the statistics are just that, women of similar health, demographics, with healthy pregnancies etc…
Thanks for that input, I was wondering because that wasn’t clear in the blog post.
I would have like that the study include also birth center births though… maybe it’s the same rate than home births?
That would be interesting. Though, I would assume it’d be a similar rate given it’s the same midwives assisting there. The home-births in the study only included certified midwives, not lay midwives.
I really liked your blog and I hate to be a nag but Medicare (you refer to this program a couple of times above) is actually the health care coverage program for elderly in the US. You have to be 65 or older to receive so I doubt many woman are having babies under this program. Medicaid (the program I believe you are wanting to refer to) covers the elderly if they are low-income but also covers low-income families and children. Just an fyi….
Hahaaa! I actually DO know the difference, and I can’t even believe I did that! How embarrassing!
Oh my gosh, I just reread it, and I just both terms as though they were interchangeable! I used medicaid twice and medicare three times! Must’ve been a late night writing and the brain just skimmed past it looking for actual grammar issues when proofreading. I fixed the three errors!
This is an excellent article, Dawn. Thanks for sharing it with me. I will add it to my list of resources for my birth preparation students!
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Excellent article! Could you tell me the name of the Canadian birth study that had the .035 death rate for babies born at home with a certified midwife? That’s ammunition I’d like to load into more than a few articles 🙂
In Minnesota we have great advances with legal practice of Midwifery, but the hospitals still have a c-section rate up around 35% where most babies are born. I’m always looking for solid studies on home birth with good outcomes for the moms I help in my Doula practice, and the hospitals I work with. The hospitals, to give them credit have included some midwife model practices in labor and birth, but are still running on the doctor’s ticking clock. The more they know about positive outcomes with the midwifery model of care, the better!
TITLE: Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician
AUTHORS: Patricia A. Janssen, PhD, Lee Saxell, MA, Lesley A. Page, PhD, Michael C. Klein, MD, Robert M. Liston, MD, Shoo K. Lee, MBBS PhD
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