Thursday, July 10, 2008

Honesty from ACOG

Sometimes you just have to wonder if someone wasn't thinking. I'm not sure who originally found this, but its a document well worth giving some time to: "Lay" Midwives and Homebirth, from ACOG State Legislative Update Year in Review (August 2007)

Its no secret to anyone that ACOG doesn't approve of midwives or homebirth. They barely tolerate CNMs and have only recently given approval to certain credentialed Independent Birth Centers (which typically restrict access to only the most narrowly defined "low risk" client possible) because of the threat they see in increased public attention to homebirth (there's no reason to think that homebirths are actually increasing, all buzz about The Business of Being Born aside). The thing that I just
love about this document is that its so honest! So honest in its deliberate misrepresentation of midwifery (while I've been known to do my share of OB bashing, I don't believe they are mostly idiots -- they know exactly why the term "lay midwife" doesn't apply to most midwives these days) and so revealing in the motivations for why ACOG is opposed to midwifery. Let me share a few choice tidbits:

"Even the nurse-midwives no longer can be counted on to speak publicly against home birth or lesser trained midwives...Nurse-midwives – a fickle ally...Whereas nurse-midwives have been ACOG’s front-line defense against these bills, that’s no longer a sure thing. Today, you don’t see nursemidwives speaking with any consistency against home birth or the certified professional midwives (CPMs)."
(Gotta wonder what the leadership of ACNM is feeling about this right not...since it tends to look like they continue to believe their future lies with ACOG. So much for sticking up for each other.)

"Legislators respond to the home birth “choice” message...In 2005, a midwife bill (HB 36) was championed by an unusual coalition – Republicans, including the Speaker of the House, home schooling proponents, the religious right, and the state’s Amish and Mennonite communities. The bill language was deceptive in its simplicity. It said, “Nothing in Missouri law shall encroach on a mother’s right to give birth in the setting and with any caregiver of her choice.” (I can't really see how homebirth isn't a choice. And I don't see what is so odd about the above coalition, other than they aren't usually associated with "choice" in reproductive terms. Now, when the "pro-choice" advocates finally realize that birth in all its forms is just as much a "choice" issue as abortion, THAT will be a strange coalition. Oh, and I'm unsure of what's so deceptive about the Missouri bill -- I think its pretty clear.)

"The situation with hospitals declining to do VBAC deliveries has complicated our advocacy efforts on midwives. ACOG Fellows in California, Washington and other Western and Rocky Mountain states report that women are seeking out alternatives, including home birth with midwives, in their desire for a VBAC." (Well, no kidding. After all, it is a free-market and if you don't provide the service....someone else will. When they provide a service that is exceptionally better than anything you ever offered, you are going to have trouble catching up.)

"Physician back-up for midwives and out-of-hospital deliveries is a growing concern in some states." (lack of back-up IS a problem, one which the homebirth community would love to see a solution to. Oh, wait...) "In Wisconsin, the professional medical ethics of physicians who choose to back-up CPM-trained midwives were in dispute over home birth legislation that got approved in 2006 over the objections of the Wisconsin ACOG Section, the state AAP Chapter, and the State Medical Board." (...the problem is that physicians ARE backing-up CPMs! How unethical.)

With regard to Licensure Bills in various states: "ACOG is playing defense on most of these bills. It’s the rare situation where we can defeat these bills on the merits. For example, in Missouri, ‘lay’ midwife bills get introduced year after year. These bills have been stopped – up to now – mainly by deft political maneuvering and hardball tactics employed by the State Medical Society, not by any persuasive testimony about comparative safety or quality of care." (This might be my favorite. There it is -- they can't defeat these bill based on any evidence that homebirth is less safe or poorer quality care. They have to use hardball tactics.)

There's lots more but you'll need to just go read it for yourself -- the usual "European studies of homebirth aren't relevant to the U.S.", "people just can't understand all the different types of midwives", "midwives are uneducated" drivel, laid out in clearly understood language. Send it to those people you know who think that ACOG really is speaking out for the best interests of women and babies, and not for their own best interests.

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