Support for the Midwifery Profession: Pros and Cons
The tradition of midwifery virtually disappeared in Canada during the early part of this century. Several generations of women gave up childbirth at home to the medical profession. They did this in the name of safety and pain relief, or simply because the option of being cared for by a midwife no longer existed. Midwifery should be re-instated as a legal and honourable profession. With healthy pregnancies and under normal conditions, women should give birth at home with the professional assistance of a midwife.
The most common argument against home births and midwifery are perpetuated by the medical establishment. As a profession, they openly oppose to lay midwifery, and as Dr. William Hall, president of the College of Physicians, said, he and the college oppose home births because they feel it is unsafe. (Ramondt, 1990)
Undoubtedly, the medical profession is correct in protesting home births in certain cases. Some pregnancies are difficult and some births are problematic. It is not difficult to concede that there are times when sound medical intervention is a necessity and a blessing. To insist, though, that every birth requires a hospital setting and the attendance of a doctor with ten years training is, as many experts in the field agree, rather ludicrous. A study done by Dr. Lewis Mehl (cited in Barringtonm, 1985), matched a population of 421 women attended by physicians with 421 women attended by midwifes at home. The midwife sample fared far better with significantly less fetal distress, birth injuries, and infants needing resuscitation. The former head of the International Confederation of Gynecology & Obstetrics, Dr. Caldero Barcia, goes as far to state that, “iatrogenia (doctor-caused illness) is the main cause of fetal distress” (Barrington, 1985, p. 122).
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Furthermore, the routine of use of medical procedures initially developed to protect high-risk mothers and babies are often used by doctors simply as preventive measures. An episiotomy (cutting the perineum) is done in 80% of hospital births. Midwives use it less than 1% of the time. Labour is induced 40% of the time in hospitals; whereas, midwives never induce births. Cesarean sections are performed in 16.3% of hospital births while they rate for midwifery is only 307% (Hopkins, 1990).
Some doctors will argue the comparison of the rates ignores the reality that hospitals deal with most of the high-risk births. According to Dr. Malcolm Brown, a health care economist at the University of Calgary, however, the high rate of cesareans done in hospitals is because, “doctors find it convenient and they make money on them” (Ramondt, 1990).
Physicians also collect extra fees for inducing labour and for giving spinal blocks. These realities make it questionable whether or not to use these procedures are used in only high-risk situations as originally intended.
As well, giving birth at home offers parents and opportunity that hospitals cannot give. At home they are free to create an atmosphere of their own choosing for the birth. These greatly increase the chance for both parents to have a meaningful and personal experience. There is comfort and convenience in having the midwife come to them in surroundings that are familiar and emotionally safe. Eleanor Barrington (1985) states that studies suggest that a mother’s biting experience relates to the baby’s motor and cognitive development at two and six months of age (p. 122).
Feeling good about the birth experience would appear to enhance the mother/child relationship and, consequently, the child’s development. This is a consideration that midwives take seriously and is reflected in the quality of care and support that they offer throughout the entire experience.
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Finally, a home birth presided over by a midwife is, in the long run, less costly. Alberta Health Care pays physicians $284 for a delivery. This does not include costs for hospitalization, pre- or post-natal care, or any additional costs that may arise out of inducement of labour, cesareans, spinal blocks, or other services. The cost for an average hospital bed per night is $450. With the average stay for a birth being three to seven days, the cost to the taxpayer is very high. Midwives, on the other hand, charge between $400 and $1000 for a package that includes pre-natal care, labour and delivery, and post-natal care. Richard Plain of the University of Alberta argues that using a costly doctor to preside at a natural event like childbirth is like, “requiring a Ph.D. in mechanical engineering to grease your car” (Ramondt, 1990).
And so, parents should make themselves aware of the facts and statistics pertinent to the allegations made by the medical profession that home births are unsafe. When the myth of safety is dispelled with the facts, it is not difficult to see that giving birth at home with the consistent and professional care of a midwife offers many advantages over a hospital setting.
References
Barrington, E. (1985).
Midwifery is catching. Toronto: NC Press.
Hopkins, S. (1990, September 24).
Is delivering a baby a crime? . Alberta Report. pp. 46-49.
Ramondt, J. (1990, September 14).
Midwives less than expensive than doctors’. Calgary Herald. P. B6
