Pregnant with Debt: How Midwives Deliver Solutions to U.S. Health Care Costs

by Vivian Liang

What is the most common and costly reason for hospitalization in the United States? Maternal and newborn care. Cesarean sections are the most common operating room procedure in the United States and are performed at a rate of 33 percent, which is excessive compared to the World Health Organization’s recommended 15 percent.

The U.S. surpasses all other countries in maternal-newborn care costs. Cases vary in complexity, but a typical vaginal delivery costs $9,000, while a basic cesarean section can cost upwards of $15,000. According to the New York Times, in most other developed countries maternity care is either free or inexpensive. While many U.S. insurance plans cover a portion of the costs, women still have to pay a significant chunk out of pocket. Some women must pay entirely out of pocket if their insurance doesn’t cover these expenses. Caring for a child is already expensive enough, and prohibitive maternity costs create additional stress. The only hope of relief is through programs like Medical Assistance (also known as Medicaid).

Even though the U.S. spends the most on maternal care, it does not achieve the best outcomes. Of the 34 organizations which belong to the Organization for Economic Cooperation and Development, the U.S. ranks 32nd in maternal and infant health outcomes. Furthermore, appreciable racial and ethnic disparities persist in access to quality maternal care. According to the CDC, the group with the highest maternal and infant mortality rates is non-Hispanic blacks, with a rate 2.2 times higher than whites. In addition, inconsistencies in reporting race on birth certificates may underestimate the true infant mortality rates by race. The reality of the situation is more painful than the pain of labor, and it gives rise to the “perinatal paradox,” where spending more on birthing care doesn’t produce better outcomes.

The good news is that there is a viable solution to America’s “perinatal paradox.” Midwives have been an under-utilized resource in America, and the experience is not all about delivering babies in a bathtub (although it is an option). Midwives, meaning “with woman,” are independent, certified health care providers who focus on a full range of women’s health needs, including gynecological care, family planning and maternity care (before, during, and after childbirth). They partner with women from all walks of life to help them make informed choices about their maternity. Midwives work in hospitals, medical offices, clinics, birth centers and homes.

Having a baby at a birth center is extremely cost-effective. At The Midwife Center for Birth and Women’s Health, located in the Pittsburgh Strip District, the cost to deliver a baby is around $2,500 on average, and most insurance plans cover midwife services. In general, birth centers accept clients who are low risk for complications during birth. This way, the mother can save on the cost of expensive surgeons and anesthesiologists. Furthermore, the midwives are very attentive to the mother and work with her by walking her around the room, so that she can try out different positions to induce labor. This method encourages a natural labor, so costly interventions can be avoided. If there are complications, the woman is sent to the hospital (UPMC Mercy is the primary referral hospital for The Midwife Center for Birth and Women’s Health). Women who give birth at a birth center can expect to be discharged after 24 hours. For a hospital birth, the mother typically is required to stay for three days after giving birth, further driving up the service charges for maternal care. If 10 percent of current hospital births were held in a birth center, the U.S. would save $2.7 billion alone on service fees.

Even though Obamacare is expected to bridge the current coverage gap, it still may not be enough. Standard maternity care in America does not include benefits that would help new moms, such as breast-feeding education and basic training for newborn child-rearing. These are services that are integral to ensuring new mothers have everything they need to take care of their child, and that other developed countries include for free in their maternity care packages. It’s time to consider midwifery as an affordable alternative to hospital births. It allows women to take charge of their birth experience, helps reduce strain on the U.S. health care system and creates a bridge across the socioeconomic disparities in women’s health. The unconventional alternative, in this case, may be the right one.