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

by faithgibson on January 9, 2021

in Contemporary Childbirth Politics, Women's Reproductive Rights

$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.

Statistical Citation: 

*www.whattoexpect.com  > Cost of Pregnancy: Insurance, How Much Delivery & Care Costs

** Infant Mortality Rate – America’s Health Rankings –> Organization: OECD

*** Global Maternal Mortality Rate –> Index Mundi 

Note — the Mundi Index graph is posted at the bottom of this page — just scroll paste the “Notes to Friendly OB” to the Index Mundi MMR chart

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.

That me sitting on the floor and holding the mother in my lap to help her push more effectively. Janet Ferrare from the Pescadero area caught the baby.

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.

French obstetrician Le Jumeau de Kergaradec first introduced the use of the stethoscope to listen to fetal heart sounds in 1822 and is considered the pioneer of Fetal Auscultation

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^

** Global Maternal Mortality Rate –> Index Mundi

Scroll rapidly down to find MMR stats for developed countries

Country Comparison > Maternal mortality rate

Rank Country Maternal mortality rate (deaths/100,000 live births)
1 South Sudan 1,150
2 Chad 1,140
3 Sierra Leone 1,120
4 Nigeria 917
5 Central African Republic 829
6 Somalia 829
7 Mauritania 766
8 Guinea-Bissau 667
9 Guyana 667
10 Liberia 661
11 Afghanistan 638
12 Gambia, The 597
13 Guinea 576
14 Mali 562
15 Burundi 548
16 Lesotho 544
17 Cameroon 529
18 Tanzania 524
19 Niger 509
20 Haiti 480
21 Eritrea 480
22 Congo, Democratic Republic of the 473
23 Zimbabwe 458
24 Swaziland 437
25 Ethiopia 401
26 Benin 397
27 Togo 396
28 Congo, Republic of the 378
29 Uganda 375
30 Malawi 349
31 Kenya 342
32 Madagascar 335
33 Burkina Faso 320
34 Senegal 315
35 Ghana 308
36 Equatorial Guinea 301
37 Sudan 295
38 Mozambique 289
39 Comoros 273
40 Gabon 252
41 Burma 250
42 Djibouti 248
43 Rwanda 248
44 Angola 241
45 Zambia 213
46 Nicaragua 198
47 Namibia 195
48 Nepal 186
49 Laos 185
50 Bhutan 183
51 Indonesia 177
52 Bangladesh 173
53 Yemen 164
54 Cambodia 160
55 Bolivia 155
56 India 145
57 Papua New Guinea 145
58 Botswana 144
59 East Timor 142
60 Pakistan 140
61 Sao Tome and Principe 130
62 Venezuela 125
63 Philippines 121
64 Suriname 120
65 South Africa 119
66 Saint Lucia 117
67 Algeria 112
68 Solomon Islands 104
69 Saint Vincent and the Grenadines 98
70 Dominican Republic 95
71 Guatemala 95
72 Kiribati 92
73 Korea, North 89
74 Peru 88
75 Micronesia, Federated States of 88
76 Paraguay 84
77 Colombia 83
78 Jamaica 80
79 Iraq 79
80 Libya 72
81 Vanuatu 72
82 Morocco 70
83 Bahamas, The 70
84 Trinidad and Tobago 67
85 Honduras 65
86 Mauritius 61
87 Kyrgyzstan 60
88 Brazil 60
89 Ecuador 59
90 Cape Verde 58
91 Maldives 53
92 Panama 52
93 Tonga 52
94 Jordan 46
95 El Salvador 46
96 Mongolia 45
97 Vietnam 43
98 Tunisia 43
99 Samoa 43
100 Argentina 39
101 Egypt 37
102 Thailand 37
103 Cuba 36
104 Belize 36
105 Sri Lanka 36
106 Fiji 34
107 Mexico 33
108 Brunei 31
109 Syria 31
110 Uzbekistan 29
111 China 29
112 Malaysia 29
113 Lebanon 29
114 Barbados 27
115 Gaza Strip 27
116 Costa Rica 27
117 West Bank 27
118 Armenia 26
119 Azerbaijan 26
120 Grenada 25
121 Georgia 25
122 Puerto Rico 21
123 Romania 19
124 Oman 19
125 Latvia 19
126 Moldova 19
127 Ukraine 19
128 United States 19
129 Turkey 17
130 Uruguay 17
131 Tajikistan 17
132 Saudi Arabia 17
133 Russia 17
134 Iran 16
135 Albania 15
136 Bahrain 14
137 Chile 13
138 Hungary 12
139 Kuwait 12
140 Serbia 12
141 Korea, South 11
142 Kazakhstan 10
143 Canada 10
144 Bulgaria 10
145 Bosnia and Herzegovina 10
146 Estonia 9
147 Qatar 9
148 New Zealand 9
149 Portugal 8
150 Croatia 8
151 France 8
152 Singapore 8
153 Slovenia 7
154 Turkmenistan 7
155 United Kingdom 7
156 Germany 7
157 Macedonia 7
158 Malta 6
159 Montenegro 6
160 Australia 6
161 Austria 5
162 Belgium 5
163 Ireland 5
164 Luxembourg 5
165 Slovakia 5
166 Lithuania 5
167 Japan 5
168 Netherlands 5
169 Switzerland 5
170 Sweden 4
171 Spain 4
172 Iceland 4
173 Denmark 4
174 Greece 3
175 Czech Republic 3
176 Finland 3
177 Israel 3
178 United Arab Emirates 3
179 Italy 2
180 Norway 2
181 Poland 2
182 Belarus 2

Definition: The maternal mortality ratio (MMRatio) is the annual number of female deaths per 100,000 live births from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes). The MMRatio includes deaths during pregnancy, childbirth, or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, for a specified year.

Source: CIA World Factbook – Unless otherwise noted, information in this page is accurate as of January 1, 2020

See also: Maternal mortality rate map

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