Soaring health care costs effect every American. Third party payors, small businesses, labor unions and families without health insurance are all struggling with the spiraling costs of health care in our country. Today, as the move toward "Health Care Reform" gains momentum, we face a dilemma: how to reduce health care costs while improving the access to and quality of health care services. In the area of maternity care, research has shown that midwives offer quality care at significantly less cost.

MIDWIFERY FEES ARE LOWER.

In 1992, midwifery fees averaged $1900 for comprehensive maternity care, while physician charges averaged $2500 (and did not include another $2,500 to $3,000 in hospital charges.)

MIDWIVES USE FEWER EXPENSIVE TECHNOLOGIES TO PROVIDE SAFE CARE.

Studies have consistently shown that midwives use less medications, electronic fetal monitoring and episiotomy than do physicians. Additionally, midwifery clients experience fewer cesarean sections. Consequently, all charges, including length of hospital stay, are significantly reduced.

MIDWIFERY CARE IS PREVENTATIVE CARE.

Midwives spend more time to provide education, information and social support to their clients. All of these factors have been cited as significant contributors to reducing adverse outcomes, especially prematurity and low birthweight, for which our entire society pays a high price.

MIDWIFERY CARE REDUCES MALPRACTICE CLAIMS.

In a 1988 survey only 9.6% of nurse-midwives said they had been named in a suit. A1990 survey revealed that fully 77% of obstetricians had been sued at least once. Therefore malpractice insurance premiums for midwives have averaged one-sixth the cost of policies for physicians. [This translates to lower fees charged by midwives]

INCREASED USE OF MIDWIVES WOULD REDUCE THE COSTS OF TRAINING MATERNITY CARE PROVIDERS.

In many other countries, where midwives are the primary maternity care providers, it would be considered an expensive misuse of limited health care resources for physicians to routinely care for healthy pregnant women. In our country, a shift to training more midwives and fewer obstetricians would save an enormous amount of money. The Office of Technology Assessment compared the cost of training a physician in 1985 with the cost of training a certified nurse-midwife with a Master's degree $86,100 vs. $16,800. [The cost of training a Licensed Midwife in Washington State during the same time was $8,200]

MIDWIVES PROVIDING BIRTH CARE OUTSIDE OF HOSPITALS ARE COST EFFECTIVE.

Out-of-Hospital births for healthy women, either at home or in a licensed birth center, offer dramatic savings in health dollars. Consider that in 1991 there were 78,346 births in Washington State; approximately 75% were considered "low risk". If a modest 15% of these low risk births had been attended by a midwife, out-of-hospital, Washington citizens would have saved 28.8 million dollars! These potential savings are shown in the following table.