Why Do Hospitals Stop Offering Midwifery Services?

“Research published [in 2007] concluded that hospitals’ articulated reasons for closing or placing limits on their related midwifery services are not necessarily what is motivating such moves.

Looking at two cases in which hospital-affiliated midwifery services had good outcomes, the researcher in this report conducted 52 detailed interviews with midwives, nurses, administrators, childbirth educators, policymakers and physicians and reviewed archived data such as e-mail, policy statements and memos.

In one of the cases, the hospital had claimed that too many of the women served were high-risk, so midwifery was not safe. In the other case, an increase in malpractice insurance was given as the reason for closure. No documentation backed up either of these claims; and the interviews and data analysis showed that the midwifery practice in fact represented competition for the hospital, doctors or both. In other words, the hospitals and doctors got less business if women had access to midwives, yet the public messages related to safety and liability.

The author of the study also pointed out that the US medical education system pays subsidies for medical residents, creating a disincentive to using midwives. Finally, she noted that since most state laws require that midwives be overseen by doctors, they are dependent on their competition, putting them at a disadvantage.

This small study reflects the reality that health care, as we know it in the US, is not necessarily about providing the best care for citizens, but about protecting the interests of the system. The logic of cost-saving and efficiency is also lost in this system.”

— Social Science & Medicine 65(3): 610–21

I read this today in my Midwifery Today E-News. I was not really surprised, but still, it’s kind of disgusting to me.

I think I’d definately like to see more research done into this topic. And of course, I think this is a generality that applies to the overall system, and is not going to apply to every hospital everywhere in the country. However, I think it underlines the need for real information to get into the hands of the women who make the choices about where to give birth…hence my decision to become a doula.

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