May 30, 2009 

Dear President Barack Obama and Mrs. Michelle Obama,

My name is Pam England. I am a nurse-midwife and author of a popular childbirth book, BIRTHING FROM WITHIN^®. I have been working with birthing families for over thirty years. Now is the time for a change in how pregnant and birthing women are treated in this country. Obstetric care is over-used and over-priced. As you reform the health-care system, I implore you to closely consider over-hauling the support and priorities of current obstetric practices, which are often over-used, unsafe, and over-priced  I am inspired to write to you after reading an article on May 17, 2009 in the Los Angeles Times: “Childbirth: Can the U.S. Improve?” by Lisa Girion. I have attached the article for your review.

It is incredibly important for the well-being of families and our country that women have reproductive rights. These include: access to affordable, universal prenatal care, and safe, compassionate birth practices, and insurance coverage for licensed midwifery care. Too many important maternal and infant health decisions are dictated by money and fear of liability, rather than by current research and evidence, often to the detriment of mothers and babies.

As the wide-spread use of medical induction and cesarean surgery escalates, more and more women are becoming increasingly frightened of labor. They are frequently anxious about having no control over what happens to them in labor, more so with every passing year. With the out-of-control medicalization of childbirth, women in the United States are literally losing the “option” to give birth normally. They are often pressured into unnecessary medical procedures and medications, which increase the risk of maternal and infant morbidity and mortality. As a result, new mothers often feel angry, abandoned, and depressed that their experience of giving birth was one of feeling helpless and afraid. Fathers, also, are not well-informed or supported through the process.

The result: The already-challenging adjustment to parenthood is compounded by a longer physical recovery, breastfeeding difficulties, and emotional trauma. Because my current work involves counseling parents who are recovering from and integrating difficult births, I see first-hand the increasing toll that over-use of cesareans and other interventions take on families.

I am reaching out to you for your help because you may be the only people who can make a difference as you begin to reform health care. Please, help us reverse the rampant and costly over-management of birth. 

Many recent studies have documented that midwifery care and home birth result in better birth outcomes for healthy women and babies, both in the U.S. and abroad. Normal, healthy birth and midwifery care is much less expensive for the individual and the taxpayer. However, because insurance does not cover midwives adequately or at all, women are forced to have excessive, expensive, and often inferior medical and  prenatal care.  Of course, in some cases, cesareans, medications, and other procedures are life-saving and needed. However, they are no longer used solely when needed; they are often used as a convenience, to speed up birth, or to avoid litigation. These costly and unnecessary interventions often lead to countless complications for mother and baby. This adds up, costing insurance companies and Medicaid billions of dollars. Women who choose midwifery care and/or home births must often pay all the costs out-of-pocket. We are all paying for traveling on this ill-advised path.

Please consider implementing long-overdue mandatory insurance coverage for licensed midwifery care (both for home birth and hospital). 

I am a huge fan of you both, and supported your campaign from the start. You are impacting the world every day in so many ways; both in big decisions and in inspiring ordinary people and kids to be better,  to take action, and to believe again. You have inspired me deeply.

Thank you for your time and consideration of this important matter.

Sincerely,

Pam England