Call the Midwife

Over at The Federalist , Joy Pullmann summarizes the case in favor of expanding opportunities for midwives to offer their unique style of woman-oriented health care: “First, it’s low-cost. Second, it creates more flexible health-care arrangements for both providers and clients that greatly increase satisfaction and positive health outcomes. Third, it has the potential to ‘disrupt' the woman’s health-care industry and thus improve women’s health-care as a whole, with potential also to improve basic health care for everyone. Fourth, the ethos of midwifery is genuinely empowering and life-affirming, to women both individually and holistically, in the context of their whole families.”

After unpacking those four points, Pullmann observes, “My state has a strong industrial health lobby. They have fought hard to marginalize midwives and add enough regulations to their practices so as to convert them into just another arm of the health-industrial complex instead of a vibrant competitor.”

My state too . Alabama allows home birth (how could anyone prevent it?), but does not allow home births attended by obstetricians or midwives. Two midwives have been prosecuted for practicing midwifery without a licence, so, even though there's no law against midwifery, it is illegal.

I admit that I have a personal investment in the issue. My wife used midwives for a number of our kids, and she worked as a midwife in Idaho. Even making allowance for my bias, it seems clear that in a state as rural and poor as Alabama, outlawing midwifery makes no sense. It is more a sign of the power of the medical lobby than of the state's interest in women's health.

Pullmann nails it: “The major impediment to the innovative potential of midwifery is the medical establishment, which has obvious incentives to keep out low-cost, high-satisfaction competitors.”