Zatera Ul

As I mentioned in the previous post, the House health care bill has a bizarre little bit about freestanding birth centers buried in it. I was surprised to come across it when I was skimming the bill. Now I see why it’s there: Midwives are much cheaper than obstetricians. Birth centers and homes are much cheaper places to give birth than hospitals. Costs for prenatal care and labor and delivery services are a significant part of health care expenditures in the U.S. They will try to cut their costs by pushing for state-certified midwives, birth center births, home births, and, probably, more VBACs.

I am in favor of more women having out-of-hospital births, but it’s not for everyone–it requires a higher level of responsibility in making decisions, and in actually doing the work to give birth. My concern is that this federal meddling in health care will tend to lead to an increase in out-of-hospital birth, but also an increase in regulation of out-of-hospital birth and a decrease in maternal autonomy. Home birth is actually not the central issue for me here–instead, it is autonomous birth: I believe that birth is safest when the mother is free to listen to her body and follow her instincts (and has accessible backup and emergency care). The bill is full of draconian measures to discourage autonomous health care choices, such as refusing to buy health insurance, or seeking personalized treatment outside of predetermined “best practices”.

Update: I found something by Shrinkwrapped that states the value of personal autonomy in health care decisions well (though actually he was talking about economics!):

In complex systems multiple autonomous agents will always lead to better outcomes than a more limited number. They are simply closer to the information necessary for making decisions, quicker to respond to alterations in the data, able to operate on smaller data sets, and unencumbered by the need to filter vast quantities of data in order to produce the appearance of a distilled, simple paradigm.