Understanding why the American obstetrical model doesn’t work very well for anyone & does so at an annual cost of $1.600,000,000,000

$1,600,000,000,000 is $1.6 billion, or the annual cost of obstetrical services in the US

Excerpt of a 10-29-2010 email to Dr. Ruth Haskins, California obstetrician and seated member of the state Medical Board’s Midwifery Advisory Council

Editor’s Note: I posted this because it is an excellent synopsis of why the contemporary obstetrical profession in America is stuck in a model that doesn’t actually work very well for anyone — not the doctors themselves, not for healthy childbearing women and certainly not for taxpayers who pay for 50% of all hospital births through the federal MediCaid program.

Statistics for why Americans are being hospitalized every year show that the Number One reason is “normal childbirth”  and Number Two is “normal newborn“.

The Truven Report* put the uninsured cost of having a baby at anywhere from $30,000 for an uncomplicated vaginal birth to $50,000 for a C-section. (Dec 28, 2020).

In Canada, normal vaginal birth in a hospital is $5,000 to $8,000, Cesarean is $10-12,000, and planned home birth with a midwife is  $2,500.

In Australia normal childbirth is $5,312, in Switzerland its $4,039, France is $3,541, in German it’s $2.500, and in Mexico only $600, which includes Cesarean surgery.

If you wonder why the US economy is dragging, why our businesses often get out-bid and can’t compete with other countries, consider that the average cost for childbirth services in American (again I point out that giving birth is a normal biological function and NOT a disease) is $40,000 — midpoint btw the 30K to 50K range. Now multiply $40,000 by 4 million.

The answer is why we are having healthcare and an economic one is $1.600,000,000,000, or as it appeared on my calculator, 1.6 and no less than 11 zeros! And despite all this money, the US ranks** in 128th place (T. 182) for maternal deaths, which means 127 other, often developing countries provide safer maternity care than the USA.

American Childbearing women would be safer if they went to any of these countries:

Turkey, Uruguay, Tajikistan, Saudi Arabia, Russia, Iran, Albania, Bahrain, Chile, Hungary, Kuwait, Korea-South, Kazakhstan, Canada, Bulgaria, Bosnia-Herzegovina, Estonia, Qatar, New Zealand, Portugal, Croatia,

Mothers are the safest in these 30 countries (i.e. which means the US is 97 countries behind the curve!)

France, Singapore, Slovenia, Turkmenistan, United Kingdom, Germany, Macedonia, Malta, Montenegro, Australia, Austria. Belgium, Ireland, Luxembourg, Slovakia, Lithuania, Japan, Netherlands, Switzerland, Sweden, Spain, Iceland, Denmark, Greece, Czech Republic, Finland, Israel, Italy, Norway, Poland, and Belarus.

As for safest place to be a newborn, the U.S. ranks No. 33 out of 36 countries or 3rd from last!.

By any measure, 1.6 followed by 11 zeros is a heck of a lot of money that we don’t have to invest in scientific research to keep is healthy, educate our kids, develop new technology, repair our country’s infrastructure, or in this pandemic, vaccinate the population and make sure our hospitals are fully equipped (enough ventilators, PPE, etc) and adequately staffed to prevent burnout of doctors, nurses and the many critically other essential employees.

So we are ALL losing when we accept the profoundly dysfunctional American obstetrical system with its 32% C-section rate and 128th place out of 182 or 54th from the very bottom of the barrel.

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Notes to a friendly Obstetrician:

In addition to my personal and professional commitment to mothers and midwives, I have always felt a great deal of loyalty to the obstetrical profession. Initially, this was due to my own personal experience.

As a very young bride, an Ob-Gyn I was seeing — Dr. Luis Puhlman — diagnosed me with Stein-Leventhal ovaries (now referred to as “polycystic ovaries”). Even though I don’t physically fit the typical physical profile for polycystic ovaries, a ‘bilateral wedge resection’ of my ovaries, a pathology report confirmed this diagnosis.

Over the next 7 years, I became the proud mother of three children.I am now a grand dame of two grandsons. It also provided me with a quality of experience as a childbearing woman and new mother that prepared me to become a good midwife. This debt of gratitude to the obstetrical profession requires the full measure of my fidelity.

One aspect of that fidelity, as well as an essential aspect of being a midwife or speaking on behalf of midwifery organizations, is protecting the reputation of obstetrics.

No matter how justifiably bitter we feel about ACOG politics, we must never publicly say or do anything that would make childbearing families distrust the obstetrical profession or fear hospital-based obstetrical care in ways that might cause a pregnant woman to refuse, avoid or delay critically-needed obstetrical interventions.

Midwives and obstetricians are on the same side when it comes to keeping women healthy and their unborn and newborn babies safe.

However, I define loyalty to the obstetrical profession in a way that ACOG and most obstetricians would not be happy with. Obstetrics can be and should be a noble profession.

The potential to prevent suffering and do great good is so extraordinary that we, as members of society, cannot in good conscience let it be wasted.

We also cannot depend on obstetricians to be the source of desperately needed political and societal changes in the national policies relative to women’s reproductive health and the model of maternity care for an essentially healthy population of healthy women.

I have a great deal of natural sympathy for contemporary members of the obstetrical profession. Compared to the OBs i worked with in the 1960s, modern obstetricians have been metaphorically neutered — that is, had their professional power siphoned off to ACOG’s economic focus (i.e. making money and not getting sued) and corporate medicine’s galloping consumption of profits above all else.

Average obstetricians are scared to step out of line, lest they lose their hospital privileges or the esteem of their colleagues, and are literally prevented by obstetrical department policy from actually practicing obstetrics in the broader historical sense.

In the 1960s, general practitioners did 90% of all deliveries but called an obstetrician for breeches, twins, big babies, vaginal birth after cesarean, and women with significant medical problems such as heart disease. Nowadays, the only ones left to practice obstetrics as a full range of childbirth-related services are midwives, as OBs no long attend vaginal births for breeches, twins, big babies, VBACs, etc. That is a real shame on both sides of the perineum.

Having watched the story up close and personal for 50 years, it is my sad duty to report that individual obstetricians and obstetricians as a class are and will remain functionally unable to be effective change agents.

The social construct is exactly the same as it is for members of the military and the priesthood. Having experience with the military, I know that each soldier takes a vow of allegiance and loyalty that requires him or her as an individual to subsume their personal ideas and points of view to the ‘greater cause’.

Just as Catholic priests will not be at the head of the line trying to reform the Catholic Church, neither is it reasonable to expect ACOG fellows, individuals, or small groups to change the ACOG’s mentality and current self-aggrandizing beliefs and reform its problematic policies and poor practices.

The social ethos of medicine is based on vows of allegiance and loyalty which means we all (including myself as an L&D nurse) do what is socially appropriate, even when the act is quite obviously harmful to the mother and represents a breach of trust, to say nothing of common sense.

For example, L&D nurses at the hospitals that don’t ‘do’ VBACs are personally responsible for getting women ready for a non-consensual and medically unnecessary CS. If the system is to change, it will not be because L&D nurses told the doctors they wouldn’t cooperate with them any more in such cases, no matter how wrong they personally believe these policies or decisions to be.

What, in a social and political sense, makes non-nurse mfry different than professional of medicine and nursing is that we, as a class, never pledged allegiance to the politically-based and AMA invented form of allopathic medicine that in the US is the foundation for our entire healthcare system.

We can and are speaking up, growing in number and and getting louder and more insistent. We can’t do otherwise. Eventually professional midwifery will be as much a part of mainstream medicine in the US as it is in Sweden or the UK or is now in places like the Kaiser Hospital in Redwood City, California.

Warm Regards,
faith ^O^

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