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.

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 41^st 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.

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[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.

Happier News

I love positive updates. Anyway, those of you who might read my blog/thoughts will remember that I was pretty scathing in my denunciation of a certain “Mr. Smith” who seemed to discount any likelihood that ICAN could bring something of value to a meeting devoted to controversies in maternity care. An admirable trait of Mr. Smith’s is that he isn’t afraid of controversy and he isn’t afraid to open up dialog that could be heated. And really, isn’t that the most important thing? Anyone with any sense knows that there will always be disagreement on some things, and differences of opinion on how any given crisis should be met and challenged and what the priorities for change should be. But through some very honest communication with Pam Udy, we’ve found that indeed, we do have something to offer each other and that our common ground is something we can definitely work in. I like that. A lot. And have to say, it does say something about Mr. Smith, that he was willing to reach out as he did.

So thank you Mr. Smith. Looking forward to the next conference!

(And if you know who Mr. Smith is, then you know and if you don’t, you don’t need to. Sorry :-)