Prohibition doesn’t work (health care edition)

Normally when I say prohibition doesn’t work, I’m referring to current drug and alcohol laws which punish people who use responsibly and do nothing to stop the people who abuse or put others at risk. This time, however, I refer to a Missouri law (courtesy of the Baltimore Sun) that makes it illegal for a certified midwife to deliver babies. According to the article:

“A state lawmaker whose wife was aided by a midwife pushed through legislation this year that would allow midwives to practice freely in the state”

In round 1 of midwives vs. the medical establishment, the midwives won – the new law was passed and subsequently signed by current MO Governor Matt Blunt. But the medical establishment, who “argue that home births without physicians are perilous ventures”, couldn’t let it rest and fought to overturn the law. In round 2, the medical establishment won, and the law is currently awaiting its turn in front of the Missouri Supreme Court.

Do you really think the medical establishment (of which I will soon be a member) are arguing against this law because they believe home birth is “perilous”? No – they argue against it (or rather, a lobbying group that claims to represent their views argues against it) because it hurts their pocket books. Every woman who gives birth at home is a woman not paying for a hospital bed, nurse, obstetrician, anesthesiologist, laboratory technician, etc. And, surprise – most of them do just fine giving birth at home. It’s not like women have been giving birth without doctors for 200,000 years…oh wait…they have. I’m not saying there aren’t risks involved when giving birth at home – things can and will go wrong from time to time during labor and delivery. Mom can be hypertensive, baby can be breech or have the umbilical cord wrapped around, blood is lost – these may range from minor to very serious. They occur in the hospital setting as well, though in that setting there is a team in place to respond immediately (something which cannot be said about a home birth). Of course I would also argue that a lot of the procedures done in a hospital setting may put the mother at more risk than a natural birth (anesthesia always carries a risk, and cesarean sections are invasive and thus probably increase the risk of infection or serious bleeding).

Still, pregnant women are adults who can decide risks for themselves. It’s obviously very important to many of these women to give birth at home – not only are they choosing a midwife over a hospital physician, but they are willing to break the law and risk arrest in order to get what they want, and in the process are effectively creating a home-delivery black market. If these “medical establishment” groups really cared about the safety of the women, they would listen to their reasons for choosing a midwife or home-delivery, and they would try and compete:

“Kerr of suburban St. Louis said she had an easy time finding a midwife through friends. She said many women choose home births with midwives to limit hospital pressure to use drugs for pain or to have a Caesarean; to have a more intimate, controlled and personal birth; or because of religious beliefs that keep them away from hospitals. “

Hospitals are noisy and offer little privacy, and there probably is pressure from certain doctors to use drugs for pain even after the woman has made it clear she intends to go without. Bottom line – let the woman decide who she wants to deliver her baby, and in what manner she wants it done. The only time the law should intervene is if someone is masquerading as a health care provider – i.e. a person pretending to be a certified midwife or physician. These women are adults capable of making adult decisions, including evaluating the risks and benefits of each alternative. We should not force our values onto them, even if we strongly believe we are correct; we should not use the force of law to get these women back into hospitals (it hasn’t worked yet, and in fact only succeeded in creating an illegal market for midwives) – instead we should try and create alternatives within the hospital or physician setting in order win back their trust and create an environment where they would enjoy giving birth.

~ Lily


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