This is a news report initially published in Colombian newspaper La República. I translated the report from Spanish to English, because it was part of my application to the M.A. in International Affairs at The New School in New York.

1. EE.UU. The expensive health care system generated a large number of
women opting for births attended by persons dedicated to this service.
Midwives, by choice or for savings ?
By: María Ximena Plaza
mplaza@larepublica.com.co
Bogotá
2007
Few minutes before giving birth, Jennifer* was walking around her apartment,
until she leaned against a wall and, while standing up, she delivered a beautiful
girl, who still remained in the bag that protected her in the womb.
Dawn Rogula, a midwife that travels around Florida, United States, cut the
umbilical cord and felt she had accomplished her job: to guarantee the chosen
method of labor by the mother, a personalized attention that, according to the
midwife, you cannot find in any hospital.
In the United States some women prefer bringing their baby to the world with
the assistance of a midwife. According to a report carried out by the National
Center for Health Statistics and the Center for Disease Control and Prevention,
between 1979 and 2002, births attended by women dedicated to this service
increased from less than one per cent to 8,1 per cent in 2002, although in 2004
it descended to 7,9 percent.
Eugene Declercq, professor in the Public Health Department at Boston
University, pointed out that midwives assist women, who don’t have any access
to health care. He said that the health care system is “private and fragmented”
and that most insurance depends on the job you have.
If a woman is not working or isn’t related to a small enterprise offering the
benefits of insurance, she will have problems to enter to the health care system.

2. The specialist affirmed that some employers provide a health care package too
expensive, given that they don’t offer any kind of compensation.
Some insurance packages require for women to indicate during renewal if they
are going to use maternity benefits and if so, they must make an additional
payment. If they are expecting a baby without any notification, the pregnancy
has no coverage, said Declerq, though he clarified that the Government offers
supplementary plans such as Medicaid.
According to a study carried out by the Agency for Healthcare Research and
Quality, a natural birth in a hospital may cost more than six dollars and one that
includes a c- section with complications may have a value of more than 16
thousand dollars.
Meanwhile a delivery in a Birth Center, where a large amount of midwives work,
can cost around 1.600 dollars, according to figures from Childbirth Connection.
Childbirth Connection Director, Carol Sakala, assured that a large part of the
population seeks doctors, but in the birth centers “there is no conflict between
what’s the best care for mothers and their babies and the cost of this service.”
Medical Procedures
The fear of overcoming medical procedures like a c - section has influenced
women’s choice of a midwife, as this practice does necessarily imply a surgical
intervention , said Rogula.
C-sections increased five percent in 2005, reaching 30,2 percent of all the births
in the nation, a high level, according to preliminary figures of the Center for
Disease Control and Prevention for this year.
The World Health Organization established that no region in the world is
allowed to have a c - section rate superior than 10 to 15 per cent. Therefore the

3. United States has tried to decrease it by leading the “Healthy Persons 2010”
campaign, however great advances in this matter have not yet been reported.
Sakala argued that hospitals benefit enormously of the recovery days after the
surgery, more over when it is a planned procedure, in which they can control
the staff of nurses.
“Moms want to receive an attention that doesn’t depend on others interests,
instead according to their own concerns”, she said.
Although, Declrecq pointed out that midwives dedicate more time during and
after the pregnancy, therefore there are more expenses.
He also insisted that the c- section issue is a marginal matter and not a priority
for around four million moms in the United States.Declrecq prefers to attribute
this situation to highly medicated births.
Politics
The cost of medical service is the biggest concern for Americans, according to a
poll carried out by NBC and the Wall Street Journal.
According to Childbirth Connection Director “the system is out of control in
terms of expenses”.
Last week, in an attempt to change this situation, the White House proposed a
deduction of taxes for those who buy private medical insurance, one of the most
important initiatives for this year.
“It’s by far the fair and hoping option, though if you want the Government to be
in charge of everything, this would be a mistake”, U. S President, George W.
Bush, said.

4. The tax decrease would be 15 thousand dollars for one family and 7.500 dollars
for individuals who acquire a private insurance. On the other hand, the
insurance sponsored by employers would receive a higher burden.
* The source asked her name to be changed.