What are We Paying For in Birth?
Whether birth is covered under an insurance plan, or whether a woman or couple are paying “out-of-pocket”, birth is still costing them – and us – money. Question: Are we getting the value fr
om the money it costs to have a baby today? Another Question: Are parents in many places being limited in their choices regarding 1) where to birth, 2) how to birth, and 3) with whom to birth… by what is covered under their government health plan or insurance?
When it comes to modern childbirth, it’s important to think about how much money is involved and how it is being spent. There are so many pressing social and health problems that need resources such as money. So, when you read this, we hope you’ll dream and envision how best money can be spent when it comes to birth.
If you or someone you know is preparing to have a baby, it’s wise to ask the question: “Are you (or Am I, or Are we) limiting the dreams and hopes for bringing a child into the world by money decisions. Think about this: It costs tens of thousands of dollars for the average wedding, yet half of all those marriages will end in divorce, often within just a few years. A baby is a lifetime and that child a lifetime responsibility. The decisions we make about what is and is not important about that birth and this baby will last a lifetime. It’s not only about the kind of birth your baby would like to have, but also the kind of life you want for yourself and your baby, especially in the first 9+ months after birth.
FACT: All human babies, even those born full-term and looking perfectly healthy and robust, are actually born many months premature in terms of physical development. We should behave as if the second 9+ months (the ones after the baby is born) are as important as the womb-time. Science has shown us that we humans are really more like kangaroos (who need to be “gestated” outside the womb, as well as inside, for many months) than we are like baby horses, needing to be “worn” on a parent’s body and fed from that body for many months. That is how long it takes for a human infant to develop physically to the point where most other large mammals are at birth – where they can stand on their own legs and follow their food source!
When it comes to money and birth, just imagine what it would mean if every mother was paid to be with her baby for the first nine months after birth, and paid an extra bonus every month she continues to breastfeed that baby! With that in mind, let’s see what the economics of modern birth look like using the United States as an example.
Hospital Birth
One of hallmarks of birth in the U.S., which differs from birth in most other countries, is that it is a huge, profit-driven industry. There are nearly four million births each year in the U.S., costing over $ 100 billion per year, when you include the cost of caring for our nation’s prematurely born babies. Today, 1 out of every 8 births in the U.S. is premature (born more than 3 weeks before the “estimated due date.”
99% of all births take place in hospitals, and the rate of planned home births is now less than one quarter of 1% , the U.S. lacking a model for normal birth. As a result, the U.S. today spends more money on birth than any other nation in the world. Yet we have one of the worst/highest rates of infant and perinatal mortality. “It is safer to have a birth in Cuba than in the U.S.”
The typical “drive-through” American-style hospital birth today consists of a 24-hour stay in a hospital following a vaginal birth and just three days following cesarean surgery. Vaginal birth costs an average of $6,000-$8,000 for the hospital, including the cost of all the medical interventions and drugs, plus the cost of the obstetrician, which adds another $4,000-$5,000. Cesarean surgery often triples that cost. However, Americans who have insurance coverage that pays for birth don’t realize what they are paying for.
The total cost of a midwife-attended birth at home is just $3,000-5,000. This includes a full course of prenatal visits done by the midwife, with each visit lasting half an hour or more (instead of the typical six minutes per OB visit). Midwife-attended birth has been proven to be as safe as physician care, and home birth with a midwife as safe as a hospital birth. Yet few insurance companies in the U.S. will pay for it or for birth in a birth center.
Each year in the U.S. more than 500,000 healthy full-term newborn babies are placed in a hospital intensive care nursery for “observation” or for “just in case” treatment. Typically this entails a 3-day ICU stay, which includes many painful tests and procedures done on the newborn baby and drugs given intravenously at a minimum cost of $2,000 per day. In addition, U.S. intensive care nurseries routinely separate babies who are in ICU’s from their mothers, rather than caring for them as a pair, where each newborn baby is in bed with, or next to, its mother, as is done in some European hospitals with excellent results.
In the U.S. today, in most hospitals, families are billed for a 1-day newborn nursery charge, averaging $300, whether or not their baby ever goes to the nursery. The cost of this routine separation of mother and baby is nearly $1 billion a year. This money is needed to see that every pregnant woman receives good food and housing. Insurance may cover much of these unnecessary hospital costs, but the American public actually pays the bill.
The cost, in dollars, to circumcise the penis of newborn baby boys in the U.S. is more than $300 million per year. The cost in human suffering is immense. Recent evidence proves there is no scientific basis for doing any circumcision. Furthermore, the U.S. is the only country in the world that continues the practice circumcision routinely on newborn baby boys. The number of baby boys in the U.S. who are circumcised has dropped from over 90% to 60% or less, as a result of an active grass-roots campaign by parents and some physicians, nurses, attorneys and rabbis and will eventually be eliminated entirely.
Midwifery Attended Birth at Home or in a Birthing Center
Midwifery training and midwifery care costs far less than obstetric training and care yet produces equal or better results, according to the most recent studies around the world. Providing a “doula” (a trained professional proving support throughout labor) to every woman giving birth in a hospital also reduces costs dramatically because one-to-one skilled labor support reduces the use of artificial stimulants to speed up labor, reduces dramatically the requests of women for drugs (narcotics and epidurals) for pain, and also reduces dramatically the numbers of babies brought into the world by forceps, vacuum extraction or cesarean surgery.
Midwifery care makes it possible to provide home visits during pregnancy and the postpartum, as well as home birth, all of which have been shown to improve safety and the quality of mother-baby health in measurable ways.
Although labor-intensive, this approach is cost-effective over the long-term. It reduces unnecessary hospitalizations, overuse of emergency rooms, and over-dependence on physicians because mothers who have been cared for (at least in part) in their own homes or neighborhood are more self-confident in making judgments and decisions about their own and their child’s health.
Birth centers run and staffed exclusively by midwives have been proven safe and appropriate choices for healthy women who cannot or do not wish to birth at home. They too reduce costs measurably and improve outcomes. We need to remove the obstacles to midwives, doulas and birth centers that currently exist and create a system that supports and encourages use of them, one that is not controlled by the medical or insurance industry.
We can save $40-50 billion per year and set a standard for natural, healthy birth
This is money needed to reduce poverty and reduce the number of babies born prematurely in America.
Any country needs a reasonable rate of healthy women giving birth in the setting where they feel most comfortable, because that is the place where you are most likely to see how women behave when they are not inhibited and where you are most likely to see truly “normal” birth. Birth attendants, doctors and midwives must see normal, natural, spontaneous birth in order to know what the range of normal is and what is abnormal. The place where most women feel most comfortable and at ease is usually the place where they live. Without a model for normal, natural birth, birth becomes abnormal and the cost in dollars and human terms is too high.
Imagine if only complicated births (and births where there was a high chance that problems would arise during labor) took place in the hospital and the rest took place in homes and birth centers. Then the vast majority of births would occur outside of a hospital. (Remember that a hospital is a place of infection and disease and carries risks).
Imagine if the national cesarean rate were 10% instead of over 30%, as it is today in the U.S. and many other countries as well. According to the World Health Organization any country should be able to have a cesarean rate of no more than 10%.
Imagine if there were 10,000 practicing obstetricians and perinatologists (specialists in problems in birth) and 80,000 practicing midwives, instead of the current figure of 35,000 OBs and just 8,000 midwives.
Imagine if every mother was cared for by a midwife, or a pair of midwives, who worked together and followed her from early in pregnancy until the baby were a year old.
Imagine if obstetricians were available to any women who needed them. Most women would never need to see an obstetrician because most women would come to birth in a high state of health and most birth would be natural. Drugs and surgery in birth would also be rare.
It is possible to have a maternity system like we have just described. One country already has it, and also has fine statistics in health and safety for mothers and babies. That country is Holland. In The Netherlands (Holland), every woman first sees a midwife. The midwife is the one who refers the woman to a physician, but only if she has serious problems that might need a physician. The midwife consults with a physician whenever she thinks there may be a problem but continues giving the primary care to the mother-baby.
Here’s a safe and cost-saving idea: For many years, in Holland a woman has had to pay extra to birth in a hospital with an obstetrician if she is healthy and has no medical need for hospitalization or a physician. She has the right to birth wherever she wants and with the practitioner of her choice, but she must pay for the privilege of using services that she does not need!
You can figure out the savings possible if we simply changed the place of most births by removing births from the hospital, those that didn’t need to be there, and the care from costly physicians whose expertise is surgery, drugs and handling serious complications, to midwives, whose expertise is preventing complications and keeping birth natural. The full savings would be greater than $50 billion because there would be many fewer newborn babies who needed “special” or intensive care. With so few mothers and babies seen by doctors, and so many cared for by midwives, we would also see the rate of breastfeeding rise dramatically and most mothers would breastfeed longer. Midwives love breastfeeding and are skilled in helping help women breastfeed successfully. This alone, full breastfeeding, would result in many fewer babies needing to be seen by doctors or hospitalized for sickness in the first year after birth.
Most of these savings would then be given back directly to the people of this country. Some of it could provide every pregnant woman and postpartum mother and baby with the education and preparation for birth and parenting and the social support and healthcare they need and deserve. This care could effectively be delivered primarily through neighborhood clinics and home visits, as is already done in Australia, New Zealand, Britain and other western European countries. We already have the appropriate professionals to carry out such an integrated system: family physicians, midwives, nurse practitioners, physician assistants, social workers, health educators, etc., with specialist physicians and hospitals providing technical backup when needed, and with the emergency transport and paramedic system we have in place. This policy itself would reduce our long-term national health costs well beyond the direct savings in birthing costs. This is because so many chronic ailments in children and adults are a direct or indirect result of how we bring babies into the world and how we care for that mother-baby pair from conception to the first birthday.
As a nation, we can no longer afford the exorbitant costs of unnecessary, invasive, painful, and often traumatizing procedures done to the most sensitive and vulnerable members of society – our pregnant and birthing women and newborn babies.
We can no longer afford to neglect the real needs of childbearing women for guaranteed, fully-paid maternity leave of at least six months, with another six months of part-time paid leave, so that mothers can care for their babies.
There is so much to be done, and there is so much that we can do, right here and now, with the resources we already have available.
The economics of birth is just one dimension of a bigger picture.
The over-arching need is for us to create a system of caring that supports and protects the natural biological processes of conception, gestation and pregnancy, birth, breastfeeding, infant and baby care, and care for the postpartum woman. These natural processes are both subtle and sophisticated and, when interfered with, especially for no urgent medical reason, result in long-term problems – mental and spiritual, as well as physical.
We can use this same model – supporting the natural biological processes and using the least amount of intervention to achieve the greatest benefit with the least harm – for solving fertility issues and other issues, as we can for solving prematurity.
Where do we start? We start with an understanding of the value and importance of protecting and supporting natural processes and creative problem-solving to provide the very best of education, care and support for our childbearing women, mothers and babies.
The economics of birth is about how to prevent problems before they arise, how to treat problems that do arise with the least amount of harm, both immediate and long-term. The result is not only a savings in money but an increase in health and well-being and the quality of life, and the joy of living.
Creating the Most Natural, Healthy Birth for a Baby, a Woman and Family
Rethinking birth, how much money is it worth to parents to give their baby the healthiest start in life? Imagine you are pregnant, or thinking about it. Consider what it would mean to a woman, a baby and a family if she found a way to take a holiday from work for the last three months of pregnancy and the first 9+ months after birth… especially since how much stress a woman has in her life, how much ease and joy, directly affects how her baby develops and how likely this baby is to be born full-term and healthy.
What would men and women need to do to change the circumstances of their life to make that possible – if they live in a country or work for a company where the woman gets no paid maternity leave? How could they (or you) “down-size” life, cut living expenses, in order not to have to work for that 12 month period? What would it be worth for mothers to be allowed and supported to do the life-saving work of growing a healthy full-term baby and being a happy, at-ease mother?