Quote from platon20
Fine then make it $500, or $1000, or $10,000 per delivery. Thats not hte point and I really dont care what CNMs make for each delivery.
The point is that WHATEVER CNMs make, whether its $1 per delivery or $10,000 per delivery is going to be MUCH MUCH cheaper than what it costs for a CNM-delivery at a birth center or major hospital.
I may have overreacted in my response, but you should know that your arguments would have more credibility (at least for me) if you had a more realistic view of the costs of health care. And your arguments would also have a little more credibility if the overall tone did not come across as quite so argumentative and closed-minded. I'm giving you the benefit of the doubt and assuming that your questions have in fact been to gain information or perspective, and not just to bash hospital CNMs.
Obviously, hospital deliveries cost more than home births. No one is arguing with you on that one. The difference in costs is probably not as great as I think you think it is. Obviously it varies based on where you live, but where I used to live, an unmedicated vaginal hospital birth costs about twice what your average home birth midwife charges. Birth center (free-standing birth center) births are much more comparable in cost to home births than hospital births.
Where I am now, there ARE no legal assisted home births. So even if I bought into your message that CNMs should quit doing hospital births because it is a ripoff and start doing home births en mass, that is just not going to happen. The laws have to be changed first. And until they are, I am going to keep doing hospital births, keep trying to change the laws, keep trying to make hospital birth better for women, keep feeding my family, and keep my *&% out of jail. I'm not going to do anyone any good in jail (unlike Paris
What I am trying to help you understand is the gulf that exists between the ideal - which is what you are presenting - and the reality of the world today - which is what I am trying to explain to you. MY point is that you can argue and complain about the current state of things until you are blue in the face, but nothing is going to change until people stop complaining without offering feasible solutions and start MAKING the changes.
Changing the culture of birth is not going to happen overnight. One step to making this change COULD and SHOULD be to have CNMs become more prevalent in the hospital setting, as a transition step to having midwifery (not just CNM) care as a whole - encompassing and promoting the woman's CHOICE to deliver at home - become more widely accepted in our culture. Then, when women start seeing that home birth is, in fact, a safe alternative for low risk women, and when insurance companies see that midwives do in fact save them money in the hospital setting and could save them even more money outside the hospital, home birth may become a more feasible choice for more women. This is going to take time, if it happens at all. Giving up and leaving the hospital is probably the worst thing that CNMs could do, though.
You wanted to know why CNMs keep working in the hospital. Everything I've said - that is why.