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Disparity in Maternal Care: Medical Dictionary and Medicaid Should Expand to Include Home Birth

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Despite our wealth and advancement in medicine, maternity care in the United States, especially when it comes to labor and delivery, is far from perfect.  The situation worsens if you are African American and/or poor.

Medline Plus online medical dictionary defines “maternity” as, “a hospital facility designed for the care of women before and during childbirth and for the care of newborn babies”.

This definition fails to take into account the often safer, cheaper option of home birth under midwives’ care and needs revised, particularly considering the gross failures of our current maternity system to protect women of color.

Miriam Zoila Pérez writes in Colorlines reports:

A report recently released by the New York City Department of Health examining maternal mortality in the city between 2001 and 2005 found striking disparities for women like Eady: black, non-Hispanic women were more than seven times more likely to die from pregnancy-related causes than white, non-Hispanic women. Such disparities recur nationally. In a March 2010 report entitled “Deadly Deliveries,” Amnesty International explained, “African-American women are nearly four times more likely to die of pregnancy-related complications than white women. These rates and disparities have not improved in more than 20 years.” The report found that in 2004 and 2005, more than 68,000 women nearly died giving birth.

What is the solution?  Perez suggests given the current political situation and budget, greater access should be given to home births for minority or impoverished women on Medicaid as it is safer and cheaper than hospital births.

Perez describes how we have moved from a maternal care system based on midwifery to one where it is not even considered in the definition described above:

We’ve arrived at this standard for childbirth care through a purposeful and calculated campaign on behalf of the medical establishment. Up until the early 20th century, childbirth always took place in the home, attended by midwives. In a span of about 30 years, doctors were able to convince women (and their husbands) that the hospital was the best place to give birth. The profession of midwifery was almost entirely eliminated in the U.S. through this campaign. Not only did doctors convince women to give birth with them in hospital, they also convinced the general public that birth at home was dangerous and risky—an idea that still prevails today, vigorously promoted by both the American Congress of Obstetricians and Gynecologists (ACOG) and the American Medical Association (AMA)…

Meanwhile, hospital birth took a different path for women of color and low-income women than it did for white women with access to resources.

Before Medicaid was established in the 1960s, women of color and low-income women had little access to hospital birth because they couldn’t afford to pay for it. In the rural South, midwifery thrived until the ’70s and ’80s…Once Medicaid was enacted and provided reimbursement for obstetricians and hospital birth, it signaled the end of the midwifery era, as doctors made the final push to bring all of birth into their domain in the hospital now that they were guaranteed payment for the services.

Financial gain has long been a motivating factor at the root of the modern maternity care system— and it helps maintain the status quo today. Childbirth remains the number one cause of hospitalization for women in the U.S. A hospital birth will cost anywhere from $8,500 for an uncomplicated vaginal delivery to upwards of $20,000 for a c-section with complications. Taxpayers shoulder a significant portion of this burden, through the rising costs of programs like Medicaid, which cover the costs of millions of births each year.

Since many minority women rely on Medicaid, as well as other families of low socio-economic status, this government supported socialized medicine needs to change.  Unless Medicaid starts to pay for home births, these women are trapped into a system of hospital maternity care where they are at a great risk of mortal complications.

Birthing for a typical pregnancy should be about the mother’s choice, not financial or government supported medical services.  I still remember a story my midwives shared about a grandmother of a client offering to pay for her granddaughter’s hospital birth, not understanding her home birth choice. As it was during the grandmother’s time, she assumed her granddaughter was choosing the only option she could afford. Little did she know that the home birth was actually more expensive, as the granddaughter had to pay out of pocket for the experience, whereas had she been on Medicaid, of which she qualified, her hospital birth would have not cost a dime.

Representative Chellie Pingree (D-Maine) has introduced legislation that would mandate states offer Medicaid coverage to Certified Professional Midwives (CPM).  Rep. Pingree states,

This is not a partisan issue.  I believe it’s important that women are able to have the birth experience they want, regardless of where they live and how much money they make. Women with Medicaid coverage [should] have the same access to high quality, safe, and cost-effective services.

I couldn’t agree more!

Via: Alternet

Photo:  Attribution Some rights reserved by Farrish


  1. Last year, as part of the Affordable Care Act (the new health care reform law), Congress added birth centers facility costs and the professional services of all types of midwives (Licensed Midwives/CPMs as well as CNMs) who work in birth centers to the list of health care services that state Medicaid plans and Medicaid managed care plans MUST offer for all pregnant women on Medicaid. It makes so much sense to expand that coverage of out-of-hospital births to also include births in the woman’s home, particularly since many midwives who own birth centers also offer home birth services. Numerous studies have demonstrated that women of low socio-economic status or who belong to minority groups have excellent outcomes with midwives and in birth centers. And the cost-savings are amazing, including savings from far fewer c-sections or NICU admissions about the out-of-hospital-birth population.


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