The AMA has adopted three new resolutions concerning home birth and midwifery care. Resolutions 204 and 239 attack home birth midwives, with 239 coming as a direct response to recent legislation in Massachusetts. Resolution 205 condemns home birth, regardless of who provides it, and makes clear that the hope and intent of the AMA is to outlaw the practice:

“RESOLVED, That our AMA develop model legislation in support of the concept that the safest setting for labor, delivery, and the immediate post-partum period is in the hospital…”

The Big Push For Midwives has put out a press release in response to the AMA resolutions.

“It’s unclear what penalties the AMA will seek to impose on women who choose to give birth at home, either for religious, cultural or financial reasons—or just because they didn’t make it to the hospital in time,” said Susan Jenkins, Legal Counsel for The Big Push for Midwives 2008 campaign. “What we do know, however, is that any state that enacts such a law will immediately find itself in court, since a law dictating where a woman must give birth would be a clear violation of fundamental rights to privacy and other freedoms currently protected by the U.S. Constitution.”

The Big Push press release also notes: “The resolution did not offer any science-based information for the AMA’s anti-midwife or anti-home birth position.”

Indeed, the AMA is following ACOG’s lead in ignoring and discounting the growing body of scientific evidence for the safety of planned home birth with a trained midwife for women with low-risk pregnancies and the excellent outcomes achieved by Certified Professional Midwives. They are also out of step with their colleagues in other countries where midwives providing home birth are a seemlessly integrated part of the health care system. RCOG – the Royal College of Obstetricians and Gynecologists, which is the British equivalent of ACOG – supports the increased provision of the home birth option for women, in
a joint statement with the College of Midwives which begins:

“The Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynaecologists (RCOG) support home birth for women with uncomplicated pregnancies. There is no reason why home birth should not be offered to women at low risk of complications and it may confer considerable benefits for them and their families. There is ample evidence showing that labouring at home increases a woman’s likelihood of a birth that is both satisfying and safe, with implications for her health and that of her baby.”

Using the same body of scientific information, why do the British doctors come to the conclusion that home birth with a midwife is a safe choice with “considerable benefits” while the American doctors decide it should be outlawed? A possible answer comes from the Big Push Press Release:

“Maternity care is a multi-billion dollar industry in the United States,” said Steff Hedenkamp, Communications Coordinator for The Big Push for Midwives. “So it’s no surprise to see the AMA join the American College of Obstetricians and Gynecologists in its ongoing fight to corner the market and ensure that the only midwives able to practice legally are hospital-based midwives forced to practice under physician control. I will say, though, that I’m shocked to learn that the AMA is taking this turf battle to the next level by setting th stage for outlawing home birth itself—a direct attack on those families who choose home birth, who could be subject to criminal prosecution if the AMA has its way.”

Pennsylvania Certified Professional Midwife (CPM_ Diane Goslin, who was fined $11,000 by the State Medical board last year for unlicensed practice, has won her appeal. The court has reversed the Medical Board’s decision and ruled that midwifery is not the practice of medicine and that the medical board’s jurisdiction is only over certified nurse midwives (PA does not currently recognize the CPM credential). Hundreds of Amish families rallied in support of Goslin’s at her trial last year. See this site for more details as they become available.

From Columbus, this WOSU radio story highlights the growing popularity of water birth.

Seems like most of the news stories from the UK picked up by Google alerts are dealing with midwife shortages and preventable tragedies in understaffed maternity units. So it was very refreshing to read this story about the increase in home births.

This is a guest post from a “Post Modern Midwife.” 

21st century midwives who provide out of hospital maternity services are trained, educated primary care providers who often have relationships with physicians and other care providers to offer full scope care. A post modern midwife accesses technology as appropriate and consults in an independent fashion as necessary to provide evidence based care with great outcomes.

As the Big Push garners more and more visibility on a national mainstream level, and OFSB becomes more visible on a state level, there will be more citizens who see our publicity and legislative efforts and have visions of what I call “Little House on the Prairie birthin’”. We need to make clear that midwifery is not tribal woo woo, nor the practice of medicine, but its own independent field grounded in evidence-based practice.

Women with major health problems such as heart disease and type I diabetes which can cause serious complications in pregnancy and labor are not good candidates for out-of-hospital birth and will either self screen out or a midwife would screen them as too high risk for an out-of-hospital birth.

As well, every prenatal visit with a midwife is in fact a screening visit, looking for potential problems that could risk a women out of home birth. Because of this very intense screening process and preventative model of care, families with major problems or risk factors are not tossing the dice on a birth outside of a hospital.

Midwives monitor mother and baby via intermittent fetal monitoring and other assessment means, just as a hospital does. Problems do not fall out of the sky, they develop with plenty of time for response. The Obstetrical Standard of Care is “Thirty minutes from Decision to Incision”. Out-of-hospital birth with a qualified attendant in relationship with her community health services provides the ability to adhere to this standard.

It is important for the general citizenry to understand that the way to protect families is to provide regulation and mandate minimum standards of training and experience for midwives to ensure public safety. No one is trying to convince anyone who doesn’t want to have a home birth, we are just trying to show policy makers that the best way to protect families who choose out-of-hospital birth is to ensure that their providers are in a regulatory framework.

A powerful medical lobby with strong financial backing opposes legislation which would legalize the autonomous practice of Certified Professional Midwives (CPMs) and protect birth choices for women and families. In many states where the practice of midwifery is not yet legal, midwifery bills are proposed in the state legislature every year. Midwives and parents work hard to gain support with limited resources. When their bills, year after year, fail to pass or even to reach the floor for a vote, the reason given is always the same.

“I understand the choice issue, but the only issue for the Department of Public Health is the safety of the mom and the baby,” Alabama State Health Officer Dr. Don Williamson said in a recent newspaper article. (The article on the Anniston Star website is for subscribers only, but the full text can be found here, after scrolling down past the “daily news” links.)

Safety was also the theme of ACOG’s recent anti-homebirth press release, which warned mothers of dire and catastrophic consequences that might result from birthing outside of the hospital and asserted that “choosing to deliver at home… is to place the process of giving birth over the goal of having a healthy baby.”

No evidence is given to support this claim, because none exists. In fact, the existing evidence overwhelmingly demonstrates the safety and excellent outcomes of home birth with professional midwives for normal, healthy pregnancies. This evidence — including the CPM 2000 study, a prospective study of over 5400 planned home births which was published in the highly respected, peer-reviewed British Medical Journal — is dismissed by ACOG as “limited” and not “scientifically rigorous.” 

Ironically, ACOG’s opposition to out-of-hospital birth and animosity toward midwifery itself poses a great danger to the health and well-being of home-birthing mothers and their babies. ACOG’s statement is not entirely mistaken: obstetricians do offer expertise and surgical interventions that are life-saving for the very few mothers and babies who genuinely need them. While 80-90% of planned home births are safely completed at home, some mothers need to transfer to the hospital in order to access necessary interventions. In the CPM 2000 study, only 3.4% of women experienced a hospital transfer that was considered by the midwife to be “urgent”. But in those rare, urgent cases, professional communication between midwife and obstetrician and smooth and well-orchestrated transfer of care may make a critical difference to the health and safety of both mother and baby.

For this reason, countries such as Great Britain and Canada, where home birth has been well-integrated into the health care system, put a great emphasis on coordination between the home birth midwife, emergency response services, and hospital obstetric departments as a key component of safe out-of-hospital birth. For example, in British Columbia, Canada, a midwife attending a home birth alerts the hospital when she is called to the labor so that hospital staff will be aware and prepared in case their services become necessary. Midwives are trained to use and legally carry stabilizing medications and other emergency equipment to treat the mother or baby until they reach the hospital. If an emergency transfer becomes necessary, the midwife remains the most responsible caregiver during the ambulance transport. Obstetricians and midwives interact as colleagues to achieve the best possible outcome for both mother and baby in an emergency situation.

By contrast, the recent raid of an Ohio midwife’s home described in last week’s City Beat article was the result of a complaint filed against the midwife when she transported a laboring woman to the hospital. The midwife in question has many years of experience and, as a CPM, has obtained a rigorous, national credential which is legally recognized in many other states. The transfer was necessary for the health and safety of the mother and baby; the midwife acted appropriately in bringing them to the hospital; and a good outcome was achieved because of the midwife’s timely transfer. Had the mother been without a skilled attendant monitoring her labor at home, the situaton could have been tragic.

This midwife now faces prosecution, not because of any negligence of action on her part, but because a doctor believed that the birth should not have been attempted at home to begin with. Other women who would have benefitted from her skill and expertise may now face the unwelcome choice of birthing at home unattended because their midwife is barred from practice. Communication between midwife and physician is a vital step when transfer of care is necessary, but now, midwives attending women who need hospital care may be afraid to accompany a laboring woman to the hospital lest they also come under fire.

The prosecution of unlicensed midwives, though undertaken by the State, is initiated and urged on by the same medical interests that work tirelessly to oppose legislation that would enable midwives to practice legally in Ohio and elsewhere. While there are individual physicians who work with midwives in a collegial manner, respect their abilities, and support their continued provision of a much-needed service, the profession as a body seems intent on stamping out the “competition.”

In Ohio, nearly 1000 babies are born at home each year. Despite ACOG’s best efforts, families continue to choose home birth. If the safety of mother’s and babies was truly ACOG’s goal, they would take a position of working with midwives to ensure that no communication gaps or professional animosity prevents access to needed obstetrical expertise for those who cannot safely continue a planned home birth.  ACOG has systemically chosen to place their political agenda and business concerns above “the goal of having a healthy baby.”

The American College of Obstetricians and Gynecologists (ACOG) “reiterates its long-standing opposition to home births” in a press release that was put out yesterday.

Responses have been forthcoming from many bloggers, and from The Big Push for Midwives.

Friends of Missouri Midwives, Midwifery World, The Mommy Blawg, and Permission to Mother all have posts on ACOG’s press release today. The press release from The Big Push follows.

PushNews from The Big Push for Midwives Campaign

CONTACT: Steff Hedenkamp, (816) 506-4630, redquill@kc.rr.com

FOR IMMEDIATE RELEASE: Thursday, February 7, 2008

ACOG: Out of Touch with Needs of Childbearing Families

Trade Union claims out-of-hospital birth is “trendy”; tries to play the “bad mother” card

(February 7, 2008) The American College of Obstetricians and Gynecologists (ACOG), a trade union representing the financial and professional interests of obstetricians, has issued the latest in a series of statements condemning families who choose home birth and calling on policy makers to deny them access to Certified Professional Midwives. CPMs are trained as experts in out-of-hospital delivery and as specialists in risk assessment and preventative care.

“It will certainly come as news to the Amish and other groups in this country who have long chosen home birth that they’re simply being `trendy’ or `fashionable,’” said Katie Prown, PhD, Campaign Manager of The Big Push for Midwives 2008. “The fact is, families deliver their babies at home for a variety of very valid reasons, either because they’re exercising their religious freedom, following their cultural traditions or because of financial need. These families deserve access to safe, quality and affordable maternity care, just like everyone else.”

Besides referring to home birth as a fashionable “trend” and a “cause célèbre” that families choose out of ignorance, ACOG’s latest statement adds insult to injury by claiming that women delivering outside of the hospital are bad mothers who value the childbirth “experience” over the safety of their babies.

“ACOG has it backwards,” said Steff Hedenkamp, Communications Coordinator of The Big Push and the mother of two children born at home. “I delivered my babies with a trained, skilled professional midwife because I wanted the safest out-of-hospital care possible. If every state were to follow ACOG’s recommendations and outlaw CPMs, families who choose home birth will be left with no care providers at all. I think we can all agree that this is an irresponsible policy that puts mothers and babies at risk.”

The Big Push for Midwives calls on ACOG to abandon these outdated policies and work with CPMs to reduce the cesarean rate and to take meaningful steps towards reducing racial and ethnic disparities in birth outcomes in all regions of the United States. CPMs play a critical role in both cesarean prevention and in the reduction of low-birth weight and pre-term births, the two most preventable causes of neonatal mortality.

Moreover, their training as specialists in out-of-hospital maternity care qualifies CPMs as essential first-responders during disasters in which hospitals become inaccessible or unsafe for laboring mothers. In addition, CPMs work to ensure that all babies born outside of the hospital undergo state-mandated newborn screenings and are provided with legal and secure birth certificates.

Currently, Certified Nurse-Midwives, who work predominantly in hospital settings, are licensed and regulated in all 50 states, while Certified Professional Midwives, who work in out-of-hospital settings, are licensed and regulated in 24 states, with legislation pending in an additional 20 states.

The Big Push for Midwives is a nationally coordinated campaign to advocate for regulation and licensure of Certified Professional Midwives (CPMs) in all 50 states, the District of Columbia and Puerto Rico, and to push back against the attempts of the American Medical Association Scope of Practice Partnership to deny American families access to legal midwifery care.

The president of the Missouri Midwives Association has an editorial in the Kansas City Star on the need for CPMs to be part of each state’s emergency response / distaster management plan.

The Concord Monitor reports on the passage of a bill requiring health insurance companies to cover home birth. New Hampshire licenses direct-entry midwives and also requires Medicaid to cover midwifery services. Two years ago, they passed a bill requiring health insurance companies to cover birth center births.

“Carol Leonard, a midwife and longtime advocate for her group’s cause at the State House, said that since the Legislature began requiring insurance payment for birthing center births, the number of babies delivered at such centers increased by 600 percent.”

Look for an increase in New Hampshire home births now that families don’t have to compare the full price tag on a midwife’s at-home care to an insurance deductible at the hospital or birth center.

Free-standing birth centers are sometimes described as “the best of both worlds” — combining the advantages of both home and hospital birth. This blogger disagrees. The comment section discussion raises many interesting points. Bottom line: different women have different needs; safe and legal options should be available wherever they choose to give birth.