Editorials

Benefits of midwifery go beyond money saved

Midwives in Washington state provide an excellent service to expectant mothers and have their place in the budget under consideration by state lawmakers.

Midwives provide comprehensive prenatal care for mothers with low-risk pregnancies who plan to deliver at home or at a birth center. State records show that there are 86 licensed midwives. Collectively, they give pregnant women a safe alternative to a hospital delivery, saving taxpayers a considerable amount of money.

In August 2007, officials at the state Department of Health hired a private consultant to weigh the costs and benefits of midwifery in Washington. The goal — in the study ordered by the Legislature — was to compare out-of-hospital births with traditional in-hospital births and determine whether there was a benefit to continue the state’s midwife license and disciplinary program.

The consultants found that the cost savings of delivery with a midwife — for both public and private insurance — amounted to $2.7 million in a two-year budget cycle. That’s about 10 times the cost to operate the state’s midwife program. The independent analysis found that savings to the state’s Medicaid system alone amounted to almost a half-million dollars.

The report also looked at cesarean-section births billed to the state subsidized Medicaid program, and found that 12.9 percent of deliveries with a licensed midwife attending resulted in a C-section compared with 24 percent of in-hospital births without midwifery care. C-sections are expensive and sometimes medically crucial. But they also have become the most frequent surgery in the United States and, when performed unnecessarily, are an undue cost to taxpayers.

Looking at the study findings, there can be no doubt that having the midwife program in place saves tax dollars.

The consultants also looked at the latest national research on the safety aspects of home deliveries and found that planned home births for low-risk women using midwives had a lower rate of medical interventions and a similar mortality rate with low-risk women who delivered in a hospital.

Relying on studies conducted by the state Department of Social and Health Services, the consultants also found that the risk for cesarean section is lower for women under the care of a licensed midwife as compared with women who did not receive prenatal care from a midwife. DSHS also studied Medicaid patients and found that women using a midwife were less likely to have an underweight newborn.

The consultants also found that the average cost for a home delivery for a midwife was $1,000. The cost for a vaginal delivery attended by a physician in a hospital averaged $3,171, increasing to $5,798 for a C-section.

From the recent reports at the state level, it’s safe to say from a both a cost and safety standpoint, licensed midwives in this state are providing excellent care and saving tax dollars in the process.

Midwives legislative agenda is simple and straightforward.

They support House Bill 2435 which would add $25 to their $450 license fee. In exchange, midwives would have access to the University of Washington’s Health Science Library, a source for vital clinical resources, medical journals, decision-support tools, and evidence-based reviews of procedures, drugs and medical devices. The bill had unanimous support in the House Committee on Health Care and Wellness, and merits legislative passage.

Midwives also are lobbying lawmakers to keep the promise made in the 2009-11 operating budget to cap license fees at $450. Proposals to increase the fee to $1,500 would force some midwives out of business, denying consumers the benefits of this safe and cost-effective care.

Midwives also hope to save their Midwifery Advisory Committee, which is made up of three midwives, a physician, a member of the public and a certified nurse midwife.

The committee members advise the Department of Health on regulatory and disciplinary issues specific to their practice. Gov. Chris Gregoire has recommended the committee be abolished as part of her government reorganization effort to reduce the number of boards and commissions.

Advisory committee supporters note that the committee members receive no reimbursement other than for travel costs, which they have reduced by teleconferencing. Advisory committee expenses are minimal compared with the value of having advocates help shape the program that gives pregnant women an alternative birth option — one that saves tax dollars and delivers quality care.

It’s important that lawmakers keep the midwife program whole.

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