Alexandra Goldburt recently spoke at the Region 64 Libertarian Supper Club in Central Los Angeles on the topic of freedom of choice for birthing mothers, and how the medical establishment in cooperation with the state acts to suppress the ability of a mother to choose her preferred manner of birth. Her talk was taped and anyone interested in viewing the taped recording should contact Alexandra or Terry McIntyre, both of whom can be reached via Facebook. What follows are a few random thoughts of mine in reaction to the talk and bibliographical notes supplied by Alexandra for her talk. I am sure that my brief remarks do not do justice to her talk.
The libertarian movement in general pays relatively little attention to medical freedom for birthing mothers, in comparison to other medical freedom issues. This lack of attention is at best annoying, and at worst reflects a sort of careless indifference towards an issue of practical freedom of great importance to mothers but of little interest to the mostly older men who produce much of the output of the libertarian movement. Perhaps even more significant than gender differences may be the tendency of most people, and even many libertarians and anarchists, to place a high degree of confidence and trust in the Western medical establishment, with its foundation in the scientific method. This faith in the scientific establishment is often coupled with mindless acceptance of the government regulatory paradigm as necessary for the protection of hapless consumers. Patients often assume that they are getting the best possible care from the medical establishment, and that any restrictions on alternative treatments are necessary to keep out medical quacks and snake-oil sellers.
The emperor has no clothes! There's nothing like pregnancy and childbirth to make this fallacy of state-regulated health care more plainly apparent. After hearing Alexandra's comparisons between her experiences giving birth in the old Soviet Union, in the United States using a hospital doctor, and using a midwife at home, I was fairly persuaded that hospital practice in the U.S. is beginning to resemble the old Soviet Union, and that medical care in childbirth is much too heavily influenced by the needs of malpractice insurers, health insurers, and licensed doctors. Much better customer service focused on the actual health and emotional needs of the mother and infant may be available from licensed or unlicensed midwives, or via "freebirth," but few pregnant mothers explore options other than hospital birth. Consequently, an enormous number of births nowadays are by Cesarean section, which brings its own set of problems.
Frontal attacks on the medical establishment may not be a good political tactic. At least not until it becomes plainer to more people that the standard of care and customer service provided by the regulated establishment is much worse than it could be, as a result of coercive intervention in the free market by political actors. Until then, we would do well to vigorously promote and defend ethical and effective alternative health care providers, of which midwives and free birth promoters are but two important examples. The right of a mother to choose her own medical care during childbirth (as at other times) from all of her available options is surely a fundamental natural right. Force cannot be permitted to restrict medical options, only to protect against fraud and malpractice or other abusive or unfair practices.