I recently watched a video advocating for increased use of midwives during births. There is little doubt that using a midwife reduces costs. In addition, many studies have shown that home births with midwives have comparable health outcomes to those in the hospital setting. In fact, even births using non-nurse midwives have health outcomes similar or better to when a doctor is involved.
What was surprising about the video was the following observation: 33.7% of Massachusetts births in 2007 were caesarean sections.
Why are there many caesareans? Dr. Gene Declerq claims the reason is the cascade of intervention. Dr. Declerq defines this term using the following scenario: “…they come in and they’re relative low risk, but to be cautious, they put a fetal monitor on them…because things do not appear to be going as quickly as they would like, they induce them or stimulate the labor. And then because the contractions–as a result of the induction–become very strong, they have to do an epidural to try to relieve the pain from those now stronger than natural contractions…that may slow labor a little further and then they have to keep adding intervention upon intervention to the point where at the end, somebody says ‘we’re going to do a Caesarean. Thank god we’re able to do the Caesarean’ whereas if they hadn’t start that series of interventions in the first place, we may have never gotten to that point.”
An economist would simply claim that physicians do Caesareans because they are revenue enhancers.
Why aren’t midwives more popular? Couldn’t midwives be the first option and only if there are problems would the patient be transferred to the hospital? One reason is that obstetricians want to protect their turf. Having midwives perform more births will not only take a large chunk of the birth market share, it may also drive down price.
Economists may to often run to the conclusion that financial incentives are the sole driving factor motivating human behavior. In this case, however, one cannot help but arrive at the conclusion that hospitals and physicians have made giving birth a high-cost, high utilization process to increase their revenue.