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Commercializing Childbirth

If you were born in the early 1950s like I was and lived in one of California’s cities or in one of its newly flourishing suburbs, you were probably born in a hospital. Like food additives (“Better Living Through Chemistry”), baby formula (Isn’t breastfeeding just a bit, er… animalistic?), Gerber’s jarred baby food (I got roast beef and vanilla pudding – still my favorite dessert – every day for lunch), and Johnson & Johnson’s (“no tears”) golden baby shampoo and talc-based baby powder (its scent ultimately becoming synonymous with diapered babies over that decade and beyond), the commercial industrialization of childbirth had arrived with a vengeance. My mom grew up on a farm in the 30s, and for her this brave new world of uniquely American, post-war, modern babyhood seemed like a miracle. No more baking bread for the week, milking the cows, or grinding up your own baby food–hoorah! 

Seventy years later many of those new-fangled modern practices and retail “upgrades” have been thrown out with the (scented) bathwater, starting with the birth experience itself. Secretly listening in as my mom and her girlfriends discussed this experience in detail, I heard them talking about being pharmacologically knocked out for their deliveries (Scopolamine, anyone?) and staying in hospitals “flat on their backs” for at least a week, maybe longer. Birthing babies had suddenly gone from a wholly natural, typically home-based experience to an illness requiring hospitalization. It may not have seemed like it at the time, but the roots of institutionalized corporate healthcare and its evil twin, the for-profit insurance industry, were already burrowing deep into American healthcare’s firmament, to reemerge in ravenous full flower over the coming decades. 

“We don’t treat pregnancy like a disease,” said Ukiah-based certified professional midwife Lisa Rawson, of Mountain Valley Midwifery. “It’s a natural event.” Rawson’s delivered some 600 babies by her own count, mostly in the comfort of clients’ homes, and today usually delivers one or two babies a month in Mendocino and Lake counties, with maybe one birth a year across Mendo’s southern border into Cloverdale. “We have a wide scope of care,” Rawson said, “and birthing moms can move around freely as they see fit, including walking around, squatting (sometimes over a sofa), or in a birthing tub filled with body-temperature water,” which Rawson calls “Nature’s epidural.” She said that this natural, more meditative and holistic approach to childbirth ends up requiring fewer episiotomies and less need for pain meds (which, like vaccines, midwives can neither prescribe nor administer). It also almost ways costs a whole lot less: more on that later.  

Though most babies are still born in hospitals, the number of expectant mothers choosing home birth is growing in many parts of the country, including in California, where its practice is highly regulated by the state. For example, according to California’s Midwifery Practice Act (Assembly Bill 1308), enacted in 2014, licensed midwives may “assist a woman in childbirth” under normal conditions, meaning: no preexisting maternal diseases or conditions such as uncontrolled high blood pressure, no twins, and no breech births (when a baby isn’t positioned to come out head first), among other conditions, all of which Rawson says are pretty rare. Otherwise, licensed midwives can do pretty much everything non-surgically associated with childbirth. “We can administer oxygen and antibiotics, both oral and in IV form, anti-hemorrhagic medicine, and perform sutures and neonatal resuscitation,” Rawson said. She also does scheduled prenatal exams and newborn wellness exams. Altogether, Rawson told me that in Mendo comprehensive midwifery services cost around $5,000 and, blood work and other tests aside, not all health insurance plans cover them. According to a recent Kaiser Permanente online newsletter, “…for women who are interested in services provided by midwives and birthing centers, there are no coverage guarantees, despite the law’s provisions that prohibit insurers from discriminating against licensed medical providers.” Those same non-paying insurance plans typically cover the much higher costs of in-hospital deliveries. 

A study by UCSF found that in California the cost of normal hospital births ranges from $3,296 to $37,227 for an uncomplicated vaginal delivery, to an eye-popping $8,312 to nearly $71,000 for a c-section. (Who says we don’t need single payer?) Oh, and according to the California Health Care Foundation, 1 in 3 babies nationwide is delivered by c-section, a 50% increase over the past decade, and “California hospitals show significant, unwarranted variation (ranging from under 15% to above 60%) in the number of c-sections performed.” There are many opinions as to why obstetricians resort so frequently to the knife, but the one I personally find most credible is the fear of lawsuits in our increasingly litigious society. Fearful of an unanticipated turn of events that could affect the baby can raise the terrifying specter of a looming malpractice suit, so doctors opt for the “safer” c-section option, even though c-sections bring with them a high risk of infection and longer recovery times for new mothers, in addition to their astronomical cost. This dynamic, as the theory goes, has prompted less obstetric training in turning a breech baby in utero to avoid surgery, which in turn further ramps up the expensive (and often unnecessary) c-section option. And in California, where childbirth is the number-one reason for hospitalization, half of all births are paid for by Medi-Cal.    

Midwifery is regulated by the states, and California requires that licensed midwives receive training every two years, report birth stats every year, and transport high-risk births to a hospital, sometimes by either ambulance or helicopter, an extremely rare event, according to Rawson. And “it’s all regulated by the DA’s office,” she said. She also maintains a pharmacological license, though she’s limited in what she can prescribe, and meets once a year with the obstetrics team at Ukiah’s Adventist Hospital in Ukiah, the lone hospital in all of Mendocino County that still delivers babies. At that annual meeting Rawson told me they discuss how their coordination worked over the past year and any new procedures, among other issues. She added that some physicians are still not all that supportive of home births. “It’s a love/hate relationship,” Rawson said, “but whether they agree or not, [home birth] is a legal and viable option in California.” I followed up with the cheery communications manager at Ukiah’s Adventist hospital, who told me she’d get someone from the obstetrics team to call me right back with his or her perspective on working with Mendo’s midwives; but alas the hospital must have had a change of heart since I heard neither bang nor whimper from its hallowed halls.

Rawson delivered one of Boonville’s newest residents, Joaquin Lee Moore, last May. New mom Cora Hubbert lives with her partner and extended family on property “out by the airport.” Hubbert herself was born at home and said she never hesitated to make the same choice for herself. “For me it was a no-brainer,” she said. “We all felt calm and comfortable.” Hubbert said her son’s birth was the natural process she expected. “When things started kicking into high gear, I needed to stand up pretty much the whole time, bending over. I couldn’t imagine lying on my back. I gave birth in a crouched position next to the bed, no episiotomy needed.” Hubbert told me that having your baby at home is an ancient practice for women and should be treated as such instead of like an illness requiring medical intervention. “Midwives have a wisdom that’s been taken away from women…now it’s being reclaimed,” she said.  

Rawson told me she got into midwifery because she loves educating people and is encouraged by a recent increase in first-time mothers choosing home births. “You’re always working, always on call when you’re a midwife,” she said, adding that social media has been a factor in this increase.  She is passionate about replacing in-hospital birthing driven more by the richness of your health insurance than by a natural event, “where everyone can celebrate and make room for a new member of the community.”

“You’re looking at a system where insurance is starting to regulate health care (“She has better insurance so let’s treat her”), even telling doctors how they can treat,” Rawson said. “People want more integrated medicine because we’ve created a system where the patient comes last.”   

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