Saturday, May 1, 2010

Post-Peak Health Care - The Revival of Midwives

The global industrial economy is contracting because its resource base is contracting. This contraction is occurring throughout the First World, including the United States of America. For ordinary people experiencing everyday life in the U.S., this means that the large, complex, centralized systems for meeting our needs are becoming increasingly unaffordable. This unaffordability is an early sign that these systems are breaking down.

Mainstream health care in the U.S. is one such breaking system. Health care spending is higher in the United States than in any other industrialized nation, yet health care outcomes in the U.S. are quickly becoming the worst of any industrialized nation. In a recent study published in the medical journal Lancet, the United States placed 49th in longevity for adult women and 45th in longevity for adult men. This is worse than all of Western Europe, as well as countries like Peru, Chile, Libya, Costa Rica, Canada and Cuba. (Sources: Adult mortality rate figures put Canada ahead of US” and “Adult mortality trends reveal massive global inequalities rise”.)

The Federal government and the media recently declared American health care to be a “crisis” needing a “solution,” but that solution turned into a mere discussion of “health insurance reform.” Out of this discussion came a law designed to force most Americans to buy health insurance. The law does not prevent insurance companies from continuing to raise their premiums to unaffordable levels, nor does it address the real problems of American health care. Health care has not been fixed in the U.S., and our system is still on its way to a massive breakdown.

Yet there are emerging, local, decentralized systems for care. These systems and approaches depend primarily on the skill of their practitioners, and do not lean heavily on expensive, technology-driven complexity of our mainstream model of medical care. Midwifery is one such system and approach. Midwifery is an ancient skill which has enjoyed thousands of years of peaceful practice, as well as periods of persecution and suppression during periods when doctor-based care was gaining ascendancy. In the U.S., the most recent period of suppression was during the early part of the 20th century, when the American Medical Association worked to marginalize and criminalize midwifery as “the practice of medicine without a license or proper training.”

But in recent decades midwifery has experienced a resurgence, as more women have become dissatisfied with the standard doctor/hospital approach to childbearing. In our present time of economic contraction midwifery has become even more relevant, as standard health care becomes ever more expensive and ever more people lose access to this care because of loss of income.

Thus I found myself recently checking out the Birthingway College of Midwifery in Portland Oregon, as part of my ongoing coverage of post-Peak health care. I had the opportunity to meet with Holly Scholles, founder and head of the College, and she graciously agreed to be interviewed by me. We had a long and interesting discussion about the history of Birthingway, the history of midwifery in the United States, the 20th century attacks on midwifery by the American Medical Association (as documented in the book Midwifery and Childbirth in America by Judith Rooks), and the present state of the practice of midwifery. Some interesting facts came out, such as the fact that outcomes with midwives practicing according to modern techniques are better than outcomes for doctor/hospital-based births; the fact that births by caesarian section have risen drastically over the last two decades, even though historically they were necessary on only five to fifteen percent of cases, and the fact that the introduction of expensive medical technologies has not necessarily improved birth outcomes overall.

Holly took me on a tour of the College, where I saw a community lactation coaching center, available free of charge to residents from low-income neighborhoods; an impressively well-stocked library full of medical journals, training media and books, and computers with access to online resources; a mock “birth center” complete with beds; and an herb garden for the growing of medicinal plants used in childbirth. The herb garden is interesting, because this interest in herbs is also shared by health care practitioners who are part of the Cuban health-care system. Forward-thinking groups such as these are actively building their knowledge of medicinal herbs, a useful thing in times in which many standard Western pharmaceuticals may no longer be available.

Birthingway is a good example of many useful elements of post-Peak adaptation, and not just in relation to health care. First, they are an example of people who know a vital, necessary skill, and who know how to apply it in an increasingly low-tech world. Secondly, they are part of the continuation and preservation of a useful body of knowledge. Third, they are an example of an emergent, grass-roots, bottom-up response to needs in both health care and education. Holly and I discussed all of these elements in our interview, and I hope to touch on these in more depth in a future post.

For further reading, feel free to check these links:

As to the interview, a podcast of it can be found at the Internet Archive, at “Post-Peak Healthcare - The Revival of Midwives.” (I have one confession: being a newbie podcaster, I failed to make sure my recorder's batteries were fully charged before the interview. So you'll only hear a part of it. Still, there's over 45 minutes of audio there. And I am planning to conduct a follow-up interview to cover things that were missed. There will also soon be a transcript of this week's interview.)

There's also a short video clip of my visit on Vimeo, or you can watch it below:

Post-Peak Health Care - The Revival of Midwives from TH in SoC on Vimeo.


KatieF said...

Thank you for this post. I look forward to learning more about what you learned at Birthways. The term 'Post-Peak Health Care' is new to me but the reality of it is not. There is a shift, however small, towards low-tech care from bee pollen to midwifery many people are seeking out less medicalised forms of care. It would be of great benefit to the women and families of this country if low-tech care were reintroduced during birth. While I advocate home birth for "normal" pregnancies, I think the best place to start the transition is to simplify practices in hospitals. That could mean more hands on help from nurses. Unfortunately hospitals are so understaffed that nurses are unable to give the care they'd like. So you see them watching monitors in hallways as if they are stock tickers rather than being with women like midwives are.

Well done!

jen said...

Hi - I really appreciated your post and agree with what you are saying about post-peak health care. I work with the Hesperian Foundation who publishes a lot of health-empowerment titles such as "A Book for Midwives," "Where there is no Doctor," and "Where Women Have no Doctor." Thanks!

Aimee said...

My first daughter was born in a typical high tech hospital setting, and my last two children were born at home with a midwife. Thank god all my children are healthy and all births had equally "good" outcomes as defined by modern medicine. But the first birth left me traumatized, insulted, and feeling like I had somehow been both ignored and injured by the people who were supposedto be caring for me. I didn't even feel I had given birth but rather that experts had extracted a child from my body despite my bumbling stupidity. I'm sure they all would have been hapier if I'd just been unconcious the whole time.
Furthermore, I was given an episiotomy without my consent in a non emergency situation.

It took me years to recover from that experience. In fact I don't feel that I did recover until I gave birth again- on my own terms this time, with the support of a fantastic team of midwives who made it very clear to me that I was the one doing all the birthing. They were with me throughout the pregnancy and birth to make sure things were proceeding normally and inform me if not, but beyond that, it was all me, baby. They helped my husband learn to be my support. They held my mother in law at bay. That created a safe and sacred space for my birth to happen.

If not for my midwives, I would still be a damaged mom who felt like she failed at giving birth - even with three healthy children. I thank them and bless them and I never had the slightest doubt that I and my babies were utterly safe in their care.

Anonymous said...

Thanks for this fabulous post! I am a midwifery student at Birthingway, and it is *so* nice to read such supportive words from people outside of the midwifery community!

Thank you for your story Aimee. It is helpful to be reminded of how long term the impact of birth can be, especially when it is traumatic (despite the "good outcome" of a healthy baby). There is so much more to "good birth outcomes" than two breathing human beings!

Peter said...

If you are interested in post peak healthcare you might like to visit my new website Post Peak Medicine: