The findings revealed that assisted homebirths did not appear to be contributing to the lower-than-average health outcomes and, in fact, that the homebirths documented all had successful outcomes. But even more importantly to Cheyney, discussions with doctors and midwives uncovered a deep gulf between the two groups of birthing providers, with doctors expressing the firm belief that only hospital births are safe, while midwives felt marginalized, mocked and put on the defensive when in contact with physicians.

“We’ve been getting insight into their world view, and it’s been quite illuminating,” Cheyney said.

Cheyney, who is a practicing midwife in addition to being an assistant professor of medical anthropology and reproductive biology, said she was surprised that physicians, when presented with scientifically conducted research that indicates homebirths do not increase infant mortality rates, still refuse to believe that births outside of the hospital are safe.

“Medicine is a social construct, and it’s heavily politicized,” she said.

That’s from an article reporting on some recent research on relationships between physicians at hospitals and midwives who have to transfer their home-birthing patients to their care; it is interesting throughout, and well worth a read. Such experiences are, for what it’s worth, quite common among homebirthing women that my wife knows, and it goes without saying that the situation is greatly worsened in states – like, I think, Maryland, where we’ll be moving next year – in which homebirthing is illegal; midwives are unlicensed and operate outside the law, and when something goes wrong they and their patients are that much less likely to turn to hospital care. This is a hugely serious problem as homebirthing grows in popularity, but it’s unlikely to be addressed if the medical establishment – notwithstanding the fact that giving birth at home is demonstrably safe in many cases, and that the infant mortality rate in the hospital-centric U.S. is the highest in the developed world – continues to treat hospitals as a necessary condition for safe and civilized childbearing.

This is, by the way, a perfect example of the sort of thing that makes me skeptical of the push for government-sponsored comparative effectiveness research. I take the point that the decisions of private actors like insurance companies can be subject to interest group pressures, too, but as Megan McArdle recently put it government power and influence have got a pretty unique capacity to  perpetuate bad paradigms. Jack was born in a hospital, and despite a complete absence of medical intervention the hospital bill alone – picked up by insurance, natch – ran to an excess of $10,000 $24,000; for the next child, we’re going to a midwife-run birth center in San Francisco (they’ve got good relationships with the local hospitals, so no worries) where the whole package, pre- and post-partum care included, will cost somewhere around three thousand. Angela will be happy, Jack can tag along, and within a few hours we’ll be back at home, resting in our bed and at no risk of developing staph infections. According to the American Medical Association, though, we’ll be putting mother and baby alike at risk with this decision. How much do you want to bet that Orzag & Co. end up with a take on the issue that’s much closer to theirs than to ours?

P.S. The documentary from which this post’s title was pilfered is worth watching.

     Filed under: health care, politics