Follow the money!
At first glance, it appears that this is one of the most persuasive arguments marshaled by homebirth advocates. Obstetricians supposedly oppose homebirth because it represents a loss of income. They supposedly lie about the risk that the baby will die at homebirth for no better reason than to preserve their profits. This argument appeals particularly to those who like to believe that they cannot be duped by authority figures or are in possession of secret, special knowledge that makes them more “educated” than the rest of us.
But a closer look demonstrates something else entirely. If anyone has a motivation to lie about the risk of death at homebirth, it is homebirth midwives.
Why? At the moment, homebirth with an American homebirth midwife represents approximately 1/2% of US births each year. That translates to 1/2% loss of obstetric income for OB-GYNs and no loss of gynecology income, meaning that for most OB-GYNs, homebirths represent a potential loss of income of around 1/4%. That’s hardly likely to be a motivation for scare mongering. Moreover, there is currently a shortage of OB-GYNs willing to deliver babies, so there’s no reason to believe that homebirth with a homebirth midwife represents any loss of income for doctors who practice obstetrics.
On the other hand, homebirth represents 100% of the income of homebirth midwives. They charge upwards of $3000 per patient, often in cash, often paid in advance, non-refundable and typically not covered by health insurance. It is an especially impressive amount of money considering that American homebirth midwives require no more than a high school diploma, and no further formal schooling of any kind, to be eligible for the homebirth midwifery certification of CPM (certified professional midwife). There aren’t many people with only a high school education who can command that kind of money, and for most homebirth midwives, they cannot possibly earn as much in any other way.
So you tell me who has the greater financial incentive to lie about the risk of perinatal death at homebirth, obstetricians, for whom homebirth represents no loss of income, or homebirth midwives (CPMs, LMs, DEMs and lay midwives), for whom homebirth represents 100% of income.
