Bureaucratic rationality #4: State Ownership of the Means of Reproduction edition

Bureaucratic rationality #4: State Ownership of the Means of Reproduction edition (posted 10 April 2006, 12pm)

Here's a pretty old post from the blog archives of Geekery Today; it was written about 18 years ago, in 2006, on the World Wide Web.

(Link thanks to Freedom Democrats 2006-04-03.)

With apologies to Max Weber and H. L. Mencken.

BLOOMINGTON, Ind., March 29 — Angela Hendrix-Petry gave birth to her daughter Chloe by candlelight in her bedroom here in the early morning of March 12, with a thunderstorm raging outside and her family and midwife huddled around her.

It was the most cozy, lovely, lush experience, Ms. Hendrix-Petry said.

According to Indiana law, though, the midwife who assisted Ms. Hendrix-Petry, Mary Helen Ayres, committed a felony punishable by up to eight years in prison. Ms. Ayres was, according to the state, practicing medicine and midwifery without a license.

Doctors, legislators and prosecutors in Indiana and in the nine other states with laws prohibiting midwifery by people other than doctors and nurses say home births supervised by midwives present grave and unacceptable medical risks. Nurse-midwives in Indiana are permitted to deliver babies at home, but most work in hospitals.

Midwives see it differently. They say the ability of women to choose to give birth at home is under assault from a medical establishment dominated by men who, for reasons of money and status, resent a centuries-old tradition that long ago anticipated the concerns of modern feminism.

Chloe Hendrix-Petry’s birth has not given rise to criminal charges, but a prosecution against another midwife, Jennifer Williams, is pending in Shelbyville, Ind. It was prompted by the death of a baby named Oliver Meredith that Ms. Williams delivered in June. But she is not charged with causing or contributing to Oliver’s death.

… According to an affidavit filed by Rick Isgrigg, an investigator with the Shelby County Sheriff’s Department, Ms. Williams conducted a dozen prenatal examinations on Oliver’s mother, Kristi Jo Meredith; monitored the fetal heart rate during labor; made a surgical incision known as an episiotomy when she detected fetal distress; performed frantic CPR on the baby when he emerged; and sutured the incision afterward. Ms. Williams charged the Merediths $1,550.

… Oliver Meredith’s parents have showed little enthusiasm for the prosecution, people on both sides of the case said. It’s not like they’re knocking down our doors to pursue the matter, Mr. Apsley acknowledged. They just want to get on with their lives.

— A. J. Mast, The New York Times (2006-04-03): Prosecution of Midwife Casts Light on Home Births

Here we have state prosecutors barging in punish a woman for providing responsible medical care to a willing patient who apparently isn’t interested in prosecuting her for anything in connection with a stillbirth which not even the state or the AMA alleges to have been her fault. Why? Because she dared to help willing mothers give birth without a permission slip from the state government or the doctors’ guild, and because it’s apparently a compelling state interest for guild rules to be enforced and all births to be properly institutionalized. If the state doesn’t protect women from freely deciding to have a cozy, lovely, lush experience giving birth at home, with the help of a midwife whom they’ve selected, after nine months of due consideration, who will?

But wait, there’s more. Here’s the Loyal Opposition, with their solution to the problem:

Peggy Welch, a Democratic state representative in Bloomington, has introduced legislation in Indiana to recognize and regulate lay midwives. She said the issue boiled down to choice and safety.

— A. J. Mast, The New York Times (2006-04-03): Prosecution of Midwife Casts Light on Home Births

… because I guess the problem here is that the government’s enforcement of Birth Guild rules doesn’t extend far enough. Without the government to tell women whom they can choose to help them give birth, or to lock up midwives who haven’t been duly approved in triplicate by the proper authorities, how in the world would we protect choice and safety?

Bureaucratic rationality, n.: The haunting fear that someone, somewhere, may have something good in their life without your authorization.

2 replies to Bureaucratic rationality #4: State Ownership of the Means of Reproduction edition

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Stefan /# 2am • 11 Apr 2006

Isn’t the typical response of government bureaubots to this type of case that reckless, unregulated behavior of individuals results in additional negative externalities to society? For example, laws requiring safety belts are argued for because of the increased taxpayer cost from treating the injured in state-funded medical facilities. You could of course argue that medical facilities shouldn’t be a part of the state at all, which is what I would do, but do you have a different thought?

Follow Up

Rad Geek /# 4am • 15 Apr 2006

Stefan,

Well, my experience is that the immediate response is usually just to stare, aghast, at the prospect of an unregulated market, without any further pseudoeconomic arguments tacked on. The idea is that we are supposed to be so horrified that rank amateurs might be helping women deliver their babies that it’s obvious that the tender ministrations of AMA doctors have to be mandated by law.

Once the pseudoeconomic argument is raised, you might point out that if you’re really worried about externalities to taxpayers, forcing women to give birth in state-funded hospitals all the time seems like a rather odd solution. But even setting that aside, there’s a whole tangle of problems with the argument.

Empirically, there’s no evidence that home births or midwife assisted births have worse health outcomes on average, for either mother or child, than hospital births. (In fact when the AMA first began its systematic push to put childbirth into the hands of MD Ob-Gyns, late in the 19th century, it caused a huge spike in mortality rates, and even today home births tend to have lower mortality rates than hospital births.)
More broadly, childbirth is not a disease or a medical emergency, and it’s simply ridiculous to treat it as such. It requires no special medical care unless complications arise, and if those do arise, midwives without medical training are generally going to have a moral and professional obligation to get the woman to a hospital for care anyway.
Politically, the government has no legitimate role in funding or controlling medical providers, so at the most this is an argument against tax-funded healthcare, not against home births.
Morally, we also need to insist that whatever risks they may be choosing to face, women do bloody well have a right to choose how they want to give birth, and that the presumptions behind government micromanagement of birthing options, control over or banning of midwives, etc. are both arrogant and directly sexist.

Follow Up

2 replies to Bureaucratic rationality #4: State Ownership of the Means of Reproduction edition Follow replies to this article

Stefan /# 2am • 11 Apr 2006

Isn’t the typical response of government bureaubots to this type of case that reckless, unregulated behavior of individuals results in additional negative externalities to society? For example, laws requiring safety belts are argued for because of the increased taxpayer cost from treating the injured in state-funded medical facilities. You could of course argue that medical facilities shouldn’t be a part of the state at all, which is what I would do, but do you have a different thought?

Follow Up
Rad Geek /# 4am • 15 Apr 2006
Stefan,

Well, my experience is that the immediate response is usually just to stare, aghast, at the prospect of an unregulated market, without any further pseudoeconomic arguments tacked on. The idea is that we are supposed to be so horrified that rank amateurs might be helping women deliver their babies that it’s obvious that the tender ministrations of AMA doctors have to be mandated by law.

Once the pseudoeconomic argument is raised, you might point out that if you’re really worried about externalities to taxpayers, forcing women to give birth in state-funded hospitals all the time seems like a rather odd solution. But even setting that aside, there’s a whole tangle of problems with the argument.
1. Empirically, there’s no evidence that home births or midwife assisted births have worse health outcomes on average, for either mother or child, than hospital births. (In fact when the AMA first began its systematic push to put childbirth into the hands of MD Ob-Gyns, late in the 19th century, it caused a huge spike in mortality rates, and even today home births tend to have lower mortality rates than hospital births.)
2. More broadly, childbirth is not a disease or a medical emergency, and it’s simply ridiculous to treat it as such. It requires no special medical care unless complications arise, and if those do arise, midwives without medical training are generally going to have a moral and professional obligation to get the woman to a hospital for care anyway.
3. Politically, the government has no legitimate role in funding or controlling medical providers, so at the most this is an argument against tax-funded healthcare, not against home births.
4. Morally, we also need to insist that whatever risks they may be choosing to face, women do bloody well have a right to choose how they want to give birth, and that the presumptions behind government micromanagement of birthing options, control over or banning of midwives, etc. are both arrogant and directly sexist.
Follow Up

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