Midwife reality check

Although I do not deliver babies or perform prenatal care, many of my family physician colleagues do. Some even perform C-sections. You probably didn't know family docs could do all that, huh. Well, with malpractice premiums going up and payment/reimbursment going down, it's getting harder and harder to find any docs doing maternity care. Even some ob/gyn docs are dropping the ob (obstetrics/maternity care) part and doing more gyn (gynecology).

A story in today's Washington Post is outlining the reality of the medical economic environment for midwifes. Apparently, there are two huge birthing centers that are going to be closing in the Washington area. Seven other birth centers have closed their doors over the past decade.

"There are countless women scrambling to find out-of-hospital birth support," said Mary Beth Hastings, 39, a board member of the new Birth Options Alliance. The group, with about 300 members, will advocate "for a full range of birth options" in the Washington area...

Now, in my experience, most women I've talked with have no problem giving birth at the hospital with their midwife at their side. What's interesting about this article is that it highlights the small percentage of women who are anti-hospital, anti-doctor, pro-birthing center, and pro-midwife. Here is the reporter's bias coming out...

For a relatively small but devoted group of women, the idea of giving birth in a hospital with a physician connotes unwelcome images of being tethered to machines, talked out of natural childbirth or talked into a non-emergency Cesarean section.

A birth center, they say, provides a more relaxed, homelike environment without anesthesia or C-sections. Others say they want the option of an epidural for pain relief in a hospital but believe midwives will provide more personal support and be less likely than physicians to intervene with machines, surgery or medication.

Like I said above, I don't deliver babies nor do I perform C-sections. But, I'm definitely insulted by the statements above. These people want it both ways. Sure, treat my pain and/or if there is a problem - well then I'll see a doctor. Other than that, keep doctors away from me. Why is the perception that midwifes are "better?" Well, it's because they see the less complicated cases - thus the birthing experience may be seen as "easier."

Most midwives treat only healthy women with low-risk pregnancies. Anesthesia, such as an epidural block, and medications to speed up labor are available only in hospitals, and only physicians may perform C-sections.

Here we go. You saw this coming. Starting to make the case for "those bad doctors." It's the bad doctors who are driving the midwifes out of business. Yes, it's the doctor's fault. Here is more bias...

Those same [financial] pressures are felt throughout the health-care industry, but birth centers are particularly hard hit because they operate on slimmer profit margins than most physicians, midwives said. Several also cited problems unique to midwifery, including the growing popularity of C-sections, which they don't perform. Moreover, unlike obstetricians and gynecologists, midwives can't offset lower health insurance reimbursements for office visits with higher-paying surgeries.

This article is so politically motivated it makes me sick. The columnist wants you to think that there is a lack of access to maternity care in the Washington area and that physicians are to blame for this. With smoke and mirrors, it's subtily making the case that midwifes, in an effort to increase access to maternity care, should be given everything from C-section to epidural privileges.

And, oh by the way, doctors should decrease midwife malpractice premiums and increase payment/reimbursement to midwifes. Like physicians have any control over that. Want to make an impact in that, well do what everybody else does and go up to Capitol Hill and lobby Congress like the rest of us have to. Good luck with that.

For too long, physicians have always been the punching bag for the press - and I'm sick and tired of that. Physicians have been the target of every "health care provider" and the reason why physician's scope of practice has slowly been eroded away - especially in primary care. I'd better get off my soapbox now. Suffice to say, I didn't like this Post article and I hope people see through it for what it really is.