Better Birth

Abstract

Although the recent focus on maternal mortality has highlighted the problem of poor health outcomes for childbearing women and their babies, especially in communities of color, adverse outcomes are only one of many indications that mainstream maternity care often fails pregnant people and their families. Other signs that maternity care reform is desperately needed include the high financial cost of childbirth, especially for uninsured people; the extent to which non evidence based practices continue to be the norm in many hospitals and physician practices; the growing number of women who report feeling traumatized by childbirth, even showing symptoms of post traumatic stress disorder; and the general dissatisfaction registered by pregnant people who experience giving birth as disempowering and alienating.

These pregnant people sometimes choose to opt out of mainstream maternity care in order to protect their autonomy and make informed decisions about their care in future pregnancies. Against this sobering backdrop, this Article argues that midwifery represents a potential solution to the problems in the current maternity care system. Sometimes referred to as the oldest profession in the world, midwifery provides an important alternative to the high cost, high intervention, high complication model of birth that currently dominates the U.S. health care system.

This Article provides a critical analysis of restrictive regulations that exclude midwives or prevent them from practicing to the full extent of their training. It offers a brief history of the relationship between midwives and physicians since colonial days, showing how interprofessional cooperation and respect waned as physicians became increasingly professionalized and sought to advance obstetrics as an independent specialty with preeminent expertise in childbirth. These efforts established the conditions that have led to modern day hostility towards midwives by the medical profession.

Because physicians oversee a majority of the relevant state licensing boards—and their professional organizations have strong political influence on state legislatures—doctors in many states have resisted competition from midwives by regulating them to the margins of maternity care. The Article highlights recent research showing that greater integration of midwives into mainstream maternity care is associated with better maternal and infant health outcomes and argues that current restrictive regulation is both unlawful and impedes progress on improving outcomes at a time when the United States is facing a maternal health crisis.

Keywords: Health Policy; Maternity Care; Antitrust; Professional Regulation; Reproduction; Midwifery; Childbirth

JEL Classification: I18