Call the Midwife

Over at The Federalist, Joy Pullmann summarizes the case in favor of expanding opportunities for midwives to offer their unique style of woman-oriented health care: “First, it’s low-cost. Second, it creates more flexible health-care arrangements for both providers and clients that greatly increase satisfaction and positive health outcomes. Third, it has the potential to ‘disrupt’ the woman’s health-care industry and thus improve women’s health-care as a whole, with potential also to improve basic health care for everyone. Fourth, the ethos of midwifery is genuinely empowering and life-affirming, to women both individually and holistically, in the context of their whole families.”

After unpacking those four points, Pullmann observes, “My state has a strong industrial health lobby. They have fought hard to marginalize midwives and add enough regulations to their practices so as to convert them into just another arm of the health-industrial complex instead of a vibrant competitor.”

My state too. Alabama allows home birth (how could anyone prevent it?), but does not allow home births attended by obstetricians or midwives. Two midwives have been prosecuted for practicing midwifery without a licence, so, even though there’s no law against midwifery, it is illegal.

I admit that I have a personal investment in the issue. My wife used midwives for a number of our kids, and she worked as a midwife in Idaho. Even making allowance for my bias, it seems clear that in a state as rural and poor as Alabama, outlawing midwifery makes no sense. It is more a sign of the power of the medical lobby than of the state’s interest in women’s health. 

Pullmann nails it: “The major impediment to the innovative potential of midwifery is the medical establishment, which has obvious incentives to keep out low-cost, high-satisfaction competitors.”