Comments on: Midwifery

By: Why are there Many Caesareans? | John Goodman's Health Policy Blog | NCPA.org

Fri, 10 Dec 2010 15:17:00 +0000

[...] This is Jason Shafrin writing at the Healthcare Economist: [...]

By: Why are there Many Caesareans? | Go HealthReform

Why are there Many Caesareans? | Go HealthReform — Tue, 31 Aug 2010 17:23:50 +0000

[...] This is Jason Shafrin writing at the Healthcare Economist: [...]

By: An Economist’s View Of Midwifery | Go HealthReform

An Economist’s View Of Midwifery | Go HealthReform — Fri, 16 Jul 2010 19:33:44 +0000

[...] of my favorite healthcare bloggers, Jason Shafrin of Healthcare Economist, has written an article in favor of the midwifery model of care, and I couldn’t agree more. Jason’s article was included in the Cavalcade of Risk [...]

By: Rose

Rose — Wed, 07 Jul 2010 15:45:28 +0000

Um, Steve… if you read my comment, that’s what I talk about in the first paragraph: that somehow we need to deal with the fact that OB’s get ‘high risk’ births, if midwives get the ‘low risk’ births, thus skewing their outcomes (that’s what adverse selection).

On the other hand, I’d argue there’s also been ‘high risk’ creep – in other words, more people being classified as ‘high risk’ based on set criteria and not taking into account individual variation. Do we really need a 29-31% C section rate in this country? I highly doubt that one third of all women giving birth are in need of surgery in order to deliver. So, extrapolating from that, probably more than half of laboring women receive some sort of obstetric intervention. So, I think you’ve created some control for selection bias in an N that large.

By: steve

steve — Wed, 07 Jul 2010 03:16:06 +0000

“As for that science-based medicine posting, if one looks at the data on in that article, the first thing that jumps out is that births attended by certified nurse midwives is about have that of MDs.”

When you work on a labor floor, you see that the CNMs take care of healthy patients. The 27 weekers go to the OB/GYNs. You need to control for selection bias.

Steve

By: Rose

Rose — Tue, 06 Jul 2010 20:15:18 +0000

There’s OB/GYN’s protecting their turf, and then there’s the issue of adverse selection. If all ‘normal’ and healthy births went to midwives then liability costs for OB’s would increase because they’d be carrying more of the risky deliveries. And while I believe (and there’s data to back me up) that doctors overblow their risk of lawsuit (http://www.rwjf.org/pr/synthesis/reports_and_briefs/issue10.html), I do agree that somehow, tort law needs to be adjusted to account for that if we as a society want to encourage less procedure-laden births and discourage C-sections.

This being said by someone who wouldn’t want an OB within 10′ of her during childbirth.

As for that science-based medicine posting, if one looks at the data on in that article, the first thing that jumps out is that births attended by certified nurse midwives is about have that of MDs. There’s a matter of definition and skill level between CNM’s and lay midwives. The two are often conflated , thus undermining the good outcomes from CNM’s alone. I tend to take her postings with a salt-shaker, by the way.

I think the more useful meta-anaylses come from EU countries where C-section rates are a lot lower, use of midwives is a lot higher and both infant and maternal mortality rates are lower.

By: GingerB

GingerB — Tue, 06 Jul 2010 15:44:16 +0000

While the medical costs of a birth defect may be covered by insurance the change in lifestyle and increased responsibility of a child who can not grown to be a self-sustaining adult are costs the family must bear.

Even with SSI for a disabled child the parents and family will spent the rest of their days worrying about who will care for the child after they are gone.

Spaces in group homes are limited, as are decent jobs set-aside for disabled adults. The cost of a casearean is nothing compared to lost opportunities for the family and child.

By: Doc D

Doc D — Sun, 04 Jul 2010 22:55:40 +0000

BBC News had an article a few days ago on this, quoting a study of 550K births in the US and EU. While there was a statistically significant increased mortality risk from home birth, it should be pointed out the risk is still very low. The things that increase the risk are those that could be dealt with by availability of advanced resuscitation equipment and expertise.

On the whole home birth is very safe for healthy mothers with healthy babies. However, in that rare case when something doesn’t go right, there’s a delay.

As you might guess Midwife organizations challenge the research. Eh…

The Real Deal is to evaluate each woman carefully who wants home birth, and advise them of risk. Ultrasound is the first step.
D

By: steve

steve — Sun, 04 Jul 2010 00:34:55 +0000

Studies aside, the actual collected statistics show a significantly higher neonatal death rate for midwife attended deliveries.

http://www.sciencebasedmedicine.org/?p=2392

Steve

By: v

Fri, 02 Jul 2010 22:37:56 +0000

Also given the above, payment reform or bundling wont really alter the incentive structure in place and might in fact increase it given that once on salary the physician’s willingness to wait out long processes like birth typically would decrease in comparison to a quick 1 hour operation…Finally, these studies of midwives are ridiculous since they cannot/do not control for the patient population (which overwhelmingly determines complication rates)…For all this talk of market protection, I would guess most economists actually use midwives less often than the general population for their or their spouses’ births…