Imagine for a moment that the UK National Health Service, in an effort to save money and diminish overcrowding, offered the following service:

Patients who break a long bone, like an arm or leg bone, will be given a choice. They can receive the highest quality personalized care by orthopedic nurses in the comfort of their own home, complete with X-ray, re-alignment of bones that are out of place, and casting, but only if they forgo pain relief. Or, they could opt to wait many hours in the local emergency room for an overworked orthopedic surgeon, who also offers X-ray, re-alignment of bones, and casting, PLUS adequate pain relief.

The NHS is pleased to offer this service because it anticipates significant cost savings from limiting the use of hospital resources, paying nurses instead of doctors to provide care, and zero expenditure on either pain medications or anesthesiologist who might be needed to administer them.

That sounds to me like a choice that is both barbaric and unethical. NHS would be forcing orthopedic patients to choose between high quality care without pain relief and low quality care with pain relief.

Similarly, the latest effort to promote homebirth in the UK has the same barbaric and unethical choice at its heart. Women are forced to choose between high quality, personalized care in the comfort of their own home as long as they accept the agonizing pain of unmedicated childbirth or low quality, rushed care in exchange for access to adequate pain relief.

The orthopedic nurses who staff the new program assure us at NHS that there is really no need for pain relief in the wake of a broken arm or leg. People have been breaking long bones since the beginning of time and enduring it without pain relief. If people had needed pain relief in order to survive broken bones, the human species would no longer exist. The orthopedic nurses point to additional benefits: decreased sedation, the ability to get up and move immediately instead of waiting for anesthetics to wear off, faster healing (according to them) and fewer complications (according to them). Plus, we are designed to heal our broken long bones without any pain relief at all. It worked well for our ancestors; it can work just as well for us.

Sound familiar? It should since these are precisely the claims advanced by midwives in their efforts to promote homebirth.

But that begs the fundamental question:

Why should anyone have to choose between high quality care and pain relief?

There is really no reason why anyone should have to choose between the two, for orthopedic care or for childbirth care. So why is the choice being forced on women in the UK? The forced choice reflects the philosophical beliefs of UK midwives. They believe (without any scientific evidence) that unmedicated birth is better than birth with pain relief. They view an unmedicated birth as a success and a medicated birth as a failure. They prefer to care for women who decline pain relief and they use a variety of methods to force them to do without pain relief including delay, chivvying them into believing that they are accomplishing something by withstanding the pain, or simply refusing to provide effective pain relief altogether.

The promotion of homebirth in the UK reflects the unholy alliance of midwives who wish to increase their autonomy and bureaucrats who wish to save money. It uses an unethical, and, frankly, barbaric, bargain to promote homebirth. You can get seemingly better, more personalized care ONLY if you agree to endure childbirth in agony.

Both midwives and bureaucrats should be ashamed of themselves. This is deliberate infliction of a pernicious philosophy that treats women’s severe pain as irrelevant. Every woman deserves BOTH the highest quality childbirth care AND easy access to the most effective forms of pain relief.

Promotion of homebirth reflects political expediency and not the needs and desires of the majority of childbearing women. It’s politics, not healthcare.