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> 1. Childbirth is handled by midwives (Jordemothers) instead of doctors. Doctors are brought only when medication or any treatment is necessary. This is perfe

> 1. Childbirth is handled by midwives (Jordemothers) instead of doctors. Doctors are brought only when medication or any treatment is necessary. This is perfectly rational in the context of publicly-funded healthcare; for many mothers (younger and in optimal health) pregnancy has little complications. On the other hand, we really benefited from high-intensity pre-natal care with frequent ultrasounds, as we were able to increase our kid's chances of survival with lung development-accelerating steroids. What I mean is that it's a wonderful cost-saving tactic which doesn't imply better care. In Brazil we have MDs handling sore throats in overloaded ERs, and it might be more cost-effective to have teams of RNs in a more distributed proactive fashion. I still can't think of a case where, individually, I would prefer a RN rather than a MD handling my sore throat. Billionaires might even have MDs clipping their toenails to care for fungi.

mikepurvis 5y ago
Surely frequent contact with a lower-cost specialist who is trained to monitor for situations requiring escalation very much implies better care? Maybe I'm misreading your tone, but it sounds like you're dismissing midwifery as being only about cost savings. I don't think that's true at all (parent of three; we did a midwife for the younger two), but even if that was a major motivation, it's like saying SpaceX is only about cost savings. The cost savings are a game changer in terms of access/frequency/etc.
gregmac 5y ago
I'm not sure why you're talking as if these are mutually exclusive? I'm in Canada, where midwives are publicly funded, but still not that common (there's a waitlist and not everyone gets in). The midwives have hospital privileges, and are basically the "primary care provider" (instead of an obstetrician or family doctor). They still do ultrasounds, and if there was a concern, they can turn over care to a MD. We actually did the birth in the hospital, and were just alone in the room with 2 midwives the entire time (no nurses / doctors involved). Our midwife did warn us that if a complication became up - especially at the end - that the room could get very busy very fast if they had to call in people, but thankfully that didn't happen. We have a friend that had their kids at home. The midwives notify the hospital and ambulance service this is happening. They actually had to go to the hospital for one kid who had a complication, and my understanding is the ambulance was there very quickly and things were turned over to the medical team for birth, then after everything was ok, care turned back to he midwife a few hours later.
reacharavindh 5y ago
> What I mean is that it's a wonderful cost-saving tactic which doesn't imply better care. I don't agree. It is not mutually exclusive to have a midwives dealing with childbirths and Doctors providing excellent care when needed. The midwives perform the scheduled ultrasound and if there was any inkling of complication, they would have immediately involved a Doctor into the process(I was told so, but my son didn't need any). This way the Doctors are engaged only when necessary thereby increasing chances of better care and not wasting their time handling sore throats or clipping rich people's toe nails.

mikepurvis 5y ago

Surely frequent contact with a lower-cost specialist who is trained to monitor for situations requiring escalation very much implies better care? Maybe I'm misreading your tone, but it sounds like you're dismissing midwifery as being only about cost savings. I don't think that's true at all (parent of three; we did a midwife for the younger two), but even if that was a major motivation, it's like saying SpaceX is only about cost savings. The cost savings are a game changer in terms of access/frequency/etc.

gregmac 5y ago

I'm not sure why you're talking as if these are mutually exclusive? I'm in Canada, where midwives are publicly funded, but still not that common (there's a waitlist and not everyone gets in). The midwives have hospital privileges, and are basically the "primary care provider" (instead of an obstetrician or family doctor). They still do ultrasounds, and if there was a concern, they can turn over care to a MD. We actually did the birth in the hospital, and were just alone in the room with 2 midwives the entire time (no nurses / doctors involved). Our midwife did warn us that if a complication became up - especially at the end - that the room could get very busy very fast if they had to call in people, but thankfully that didn't happen. We have a friend that had their kids at home. The midwives notify the hospital and ambulance service this is happening. They actually had to go to the hospital for one kid who had a complication, and my understanding is the ambulance was there very quickly and things were turned over to the medical team for birth, then after everything was ok, care turned back to he midwife a few hours later.

reacharavindh 5y ago

> What I mean is that it's a wonderful cost-saving tactic which doesn't imply better care. I don't agree. It is not mutually exclusive to have a midwives dealing with childbirths and Doctors providing excellent care when needed. The midwives perform the scheduled ultrasound and if there was any inkling of complication, they would have immediately involved a Doctor into the process(I was told so, but my son didn't need any). This way the Doctors are engaged only when necessary thereby increasing chances of better care and not wasting their time handling sore throats or clipping rich people's toe nails.