Tuesday, July 1, 2008

ICAN and the AMA

Statement of the International Cesarean Awareness Network
Regarding the AMA/ACOG Homebirth Resolution
June 30, 2008

The International Cesarean Awareness Networks (ICAN) condemns the recent resolution passed by the American Medical Association and put forward by the American college of Obstetrics and Gynecology suggesting that homebirth is unsafe and that legislation stating such should be passed by states.

The resolution is not evidence-based and, in its apparent suggestion that homebirth ought to be outlawed, threatens long-held standards of informed consent and patient autonomy. ACOG itself maintains that maternal autonomy is almost absolute. The resolution is also a clear conflict of interest, since AMA and ACOG have much to gain in driving women away from using home-based care providers.

The resolution ignores a solid base of evidence that consistently shows homebirth is safe for low-risk women.[i] It also ignores the fact that there is no evidence to support the notion that hospital-based deliveries are superior for low-risk mothers. In fact, while the obstetric community often touts the significant drop on childbirth-related deaths in the last century, little of this improvement has any relation to obstetric care practices, but rather the advent of antibiotics, sterile practices, and safe transfusions. Approximately 95 percent of women in the U.S. give birth under the care of an obstetrician in the hospital and with this care, the U.S. has the second worst newborn death rate in the world[ii], and ranks 41st in maternal deaths among all nations [iii]

This resolution comes at a time when the physician community increasingly fails to deliver quality, evidence-based care to women and their babies. The most basic needs of laboring women – continuous labor support, food and drink, freedom to move, freedom from routine interventions, being allowed to push in an upright position, and immediate and unbroken contact with the newborn – are routinely ignored in U.S. hospitals. Additionally, major medical interventions such as induction and cesarean section are frequently used without true medical need.

For many mothers, the hospital environment fails to meet their needs, which is why some mothers choose to deliver at home under the care of a trained professional midwife. In our volunteer-based community, ICAN regularly supports mothers who were frightened or bullied into unnecessary interventions by their care providers or were never informed of the risks of interventions. Because of concerns over legal liability and convenience, physicians have prompted over 300 hospitals to ban vaginal birth after cesarean, forcing normal healthy women into cesareans they likely do not need.

Every woman has the right to evaluate the risks and benefits of various care providers and birth settings and choose what is right for her and her baby. Whether through legislation or institutional pressures, it is unacceptable for any professional trade organization to infringe on women’s autonomous decision-making process.

[i] Johnson & Daviss, BMJ 2005;330:1416 (18 June), Fullerton et al., J Midwifery Womens Health. 2007 Jul-Aug; 52(4):323-33., Wiegers et al., BMJ. 1996 Nov 23; 313(7068):1309-13., Janssen et al., CMAJ. 2002 Feb 5; 166(3):315-23., Anderson & Murphy, J Nurse Midwifery. 1995 Nov-Dec; 40(6):483-92., Ackermann-Liebrich, et al., BMJ. 1996 Nov 23; 313(7068):1313-8., Declercq, Public Health Rep. 1984 Jan-Feb; 99(1):63-73., Duran, Am J Public Health. 1992 Mar; 82(3):450-3., Olsen, Birth. 1997 Mar; 24(1):4-13, Mehl., et al., Women Health. 1980 Summer;5(2):17-29.
[ii] State of the World’s Mothers: Save the Children.
[iii] World Health Organization, the United Nations Population Fund, the U.N. Children’s Fund, the U.N. Population Division & The World Bank.

Read ICAN’s response to criticism of maternal and infant mortality rate numbers.

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