Karen Brody’s play Birth is coming to Cincinnati August 29-31. More information in this Cincinnati Community Press article or see the Birth & Beyond website.

The issues, problems, and controversies around modern maternity care continue to make headlines. This ABC News feature discusses the dearth of natural childbirth while looking at a mom whose unexpected early labor caused her to give birth in a Cincinnati hospital instead of the NY birth center she’d planned on. “As labor pains increased and Speier asked about breathing techniques, the doctor replied, “How do I know? I’ve only ever done two [natural childbirths].” The article goes on to talk about the risks of medicalizing normal childbirth and the rising cesarean rate, as well as the advantages of midwifery care.

“Homebirth was definitely the hardest, most intense, craziest, rollercoaster, empowering, and wonderful thing that I’ve ever done. It was worth every hour of those 30 hours!!! ”

The Sunday Photo Album is a regular feature of the Safe Birth Blog. If you would like to submit a picture, please email soracolvin@gmail.com.

Anyone interested in helping Ohio families maintain legal access to out-of-hospital midwifery care is warmly invited to join the Ohio Families for Safe Birth board in Columbus for a statewide meeting and grassroots training session. Recent trends in our state and nationwide mean that without a strong, coordinated consumer effort, midwifery is likely to become illegal in Ohio. If you or anyone you care about may be impacted by this, please come learn about the issues and how you can help.

WHEN: Saturday, July 26, 2008 from 1 - 5 PM

WHERE: Trinity Lutheran Church, 404 S. Third Street, Columbus, OH 43215. It is right off I-70 and I-71 (they are combined through downtown Columbus). Parking is available in the back.

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TOPICS TO BE COVERED INCLUDE:

Introduction to Ohio Families for Safe Birth: history, mission, meet the Board

Coalition Partners (Ohio Midwives Alliance and Ohio Physicians for Midwives)

Mini-workshop on Publicity and Outreach

Mini-workshop on Legislative Efforts (past and future)

Mini-workshop on Fundraising

RSVP to Kathy Skestos at kathleen@skestos.com if you plan to come. Depending on what part of the state you are coming from, it may be possible to arrange carpooling with someone else from your area.

The “BirthTrack System” for continuous labor monitoring has been approved by the FDA, and its manufacturer, Barnev Inc., wants you to know it is the greatest thing to happen to birth since the electronic fetal monitor.

The system goes a step beyond the fetal scalp electrode which is “already standard practice at most hospitals.” In addition to the sensor on the fetal scalp, the BirthTrack System places two more sensors on the mother’s cervix to continuously monitor dilation and fetal descent in real-time on the nearby monitor.

It’s sure to be universally popular with maternity patients and their partners. As the Barnev website says, “Limiting the number of intrusive, vaginal examinations provides the mother-to-be with the comfort and privacy she desires. The partner becomes an informed participant. The displayed data allows them to follow the labor process together minimizing anxiety and contributing to a relaxed atmosphere in the labor room.” What could be cozier than watching your real-time cervical dilation on a bedside monitor together? The partner can “participate”! Just like he does in the Sunday afternoon football game!

Barnev can’t prove that the Birth Track System will reduce Cesarean section rates - not “yet,” anyway. They think it might, though, pointing out that the “continuous, real-time data” will allow obstetricians to identify non-progressing labor sooner and facilitate “early decision-making.” Doesn’t sound terribly compatible with cesarean reduction, but Barnev can promise a lower risk of malpractice, and that’s what’s really important. One of BirthTrack’s benefits is “full documentation” of the labor process, which can be used as a “support tool during litigation.” This innovative new device, Barnev promises, “holds potential to become the Standard Method of Care in Women’s Healthcare.” Just like the electronic fetal monitor, a handy “support tool during litigation” which just happens to increase cesarean sections and instrumental deliveries without improving neonatal outcomes.

Hat tip: Rixa at The True Face of Birth

“What outcomes are we looking at? In the developed world, everybody talks about death. What will happen? What if something terrible happens? Everybody’s worried about mothers and babies dying. But in actuality, mothers and babies—unless you’re in Mozambique where it’s a 1 out of 13 chance the mother will die—in the developed world that’s not really happening. Maybe we should be really looking at what type of care is producing optimality. Which babies and mothers are healthier. Not just at the moment of birth but long term.”

Saraswathi Vedam, speaking at Amherst College after being awarded an honorary doctorate. (You can read the entire talk at the Amherst College link above.)

This ABC News story comes down hard on the AMA and ACOG. It quotes an ACOG spokesperson claiming that the resolution “has nothing to do with Ricki Lake” and then points out that she was mentioned by name in the first version of the resolution. It quotes three different OB/GYNs who support the home birth choice and disagree with ACOG and the AMA’s position. And it frames the issue clearly as one of patient choice and autonomy: If the medical group wishes to let the public know how it feels about home births, why not simply issue a public service announcement? Why the call for “legislation?”

In the media spotlight after the first draft of resolution 205 came to pulbic attention, the AMA quickly removed the reference to Ricki Lake from the final version. With this continuing criticism of the resolution in the mainstream, national press, it will not be surprising if they also back down on the “legislation” language. Unfortunately, as Dr. Fischbein points out in the ABC piece, the AMA does not need legislation to have a “chilling effect” on the ability of doctors to work with home birth families and midwives: “If the AMA says home births are dangerous, fear of litigation will cause insurance carriers to refuse to support doctors who oversee midwives,” said Fischbein, who oversees four midwives in addition to his regular practice. The effect, Fischbein added, would be that he and other doctors would be forced to drop midwives who perform home births.”

The Midwives Alliance of North America (MANA) has released a President’s Editorial in response to the recent American Medical Association resolution condemning home birth.

July 11, 2008

Midwives Alliance of North America
611 Pennsylvania Avenue SE # 1700
Washington, DC
20003-4303

Contact:
Geradine Simkins
president@mana.org
888-923-MANA (6262)
info@mana.org
http://www.mana.org

Doctors Ignore Evidence,
AMA Seeks to Deny Women Choices in Childbirth

One wonders what process the American Medical Association (AMA) House of Delegates used to determine that “Resolution 205 on Home Deliveries” was a prudent and reasonable proposal to adopt. AMA Resolution 205 attempts to outlaw a woman’s choice to birth at home or in a freestanding birth center by calling for legislation to establish hospitals and hospital-based birth centers as the safest place for labor, delivery and postpartum recovery. Further, Resolution 205 seeks to establish that hospital-based midwives who work under the control of physicians are the only safe midwifery practitioners.

The Midwives Alliance of North America, which has represented the profession of midwifery since 1982 and whose members are specialists in homebirth, finds AMA’s Resolution 205 to be arrogant, patronizing and self-serving. We have three major objections to Resolution 2005. First, Resolution 205 patently ignores the vast body of scientific evidence that has documented homebirth to be a safe, cost-effective and satisfying option for women who prefer this alternative to hospital birth. Second, AMA Resolution 205 is seriously out-of-step with the ethical concept of patient autonomy in health care (encompassing both informed consent and informed refusal), which has gained widespread acceptance in the medical community. And third, Resolution 205 distracts from other critical issues in maternity care to which healthcare professionals should be giving substantial attention, including increasing access to care, improving perinatal outcomes, reducing health disparities and fostering client satisfaction. AMA Resolution 205 is anti-homebirth, anti-midwife, anti-choice and is unsupported by scientific evidence.

Why is the American Medical Association not asking the real questions instead of trying to debunk existing research evidence on the safety and efficacy of homebirth and attempting to corner the market on maternity care? For example, why are midwife-attended births far more likely to have fewer interventions, fewer postpartum infections, more successful breastfeeding rates, healthy infant weight gain and result in more satisfied, empowered mothers ready to embrace their newborns and parenting experiences? Why are so many women across the nation left emotionally traumatized by their childbirth experiences in hospitals and consequently why do rates of postpartum depression, anxiety and post-traumatic stress continue to escalate?

It is ironic that the AMA should have a quarrel with a known safe birth option such as homebirth at the same time when the epidemic rise in coerced or elective cesarean sections puts healthy mothers and infants at greater risk than normal vaginal birth and causes excess strain on the limited resources of our healthcare system. The rate of cesarean sections in the United States is unacceptable-one in three pregnancies end in major abdominal surgery-and the decline in availability of vaginal birth after cesarean (VBAC) is deplorable. It is unethical to expect that women and infants should continue to bear the brunt of increasing medical malpractice risks by over-treating them with obstetric technologies such as c-sections while denying them safe evidence-based options such as VBAC. It is past time that the AMA in collusion against homebirth with the American College of Obstetricians and Gynecologists (ACOG) realizes that women and their partners are choosing to labor and deliver at home and in freestanding birth centers to avoid ethically unsupported obstetric interventions.

Modern medical ethics have evolved to embrace autonomy-patient choices and patient rights-over medical recommendations based on paternalism or physician preference. In almost all areas of modern medicine, except obstetrics, the locus of control rests firmly with the client or patient and not with the medical provider. It is a commonly held principle that it is not appropriate to force medical treatment upon clients or patients against their will, including medications, blood transfusions, chemotherapy or even life-saving surgeries. Informed consent has appropriately become the gold standard in healthcare decision-making. Why then do the AMA and ACOG believe that they can promote legislative efforts to deny women choices in maternity care providers and childbirth settings? In the 21st century this concept is outdated and absurd.

The AMA and its members might consider using their considerable energy, intelligence and resources to focus on promoting the health and well-being of mothers and babies and devote less time to limiting women’s access to midwifery services. All maternity care providers should band together to reduce the unacceptably high rates of maternal and infant mortality and morbidity in the United States, increase access to maternity care for all women, reduce unnecessary cesarean sections, encourage vaginal birth and VBACs for healthy women, reduce health disparities of women and infants in minority populations, and promote increased breastfeeding. These challenging but attainable goals would improve the health of mothers and babies far more impressively than reducing the rates of homebirth.

The Midwives Alliance joins the other individuals and organizations, including individual AMA and ACOG members, who have grave concerns about the AMA taking the stand articulated in Resolution 205, and calls for the AMA to abandon this resolution. Midwives everywhere honor and respect the numerous friendly physicians with whom we already partner and look to the day when midwives and obstetricians will consistently work collaboratively to support women’s choices in childbirth and provide the best possible and most appropriate range of services for every situation.

References

1.. K.C. Johnson, B.A. Daviss, Outcomes of Planned Home Births with Certified Professional Midwives: Large Prospective Study in North America, British Medical Journal 2005; 330: 1416 (18 June).

2.. Royal College of Obstetricians and Gynaecologists and Royal College of Midwives Joint Statement No. 2, April 2007. See http://www.rcog.org.uk/index.asp?PageID=2023

3.. Wiegers TA, Keirse MJ, Van der Zee J, Berghs GA. Outcome of planned home birth and planned hospital births in low risk pregnancies: prospective study in midwifery practices in the Netherlands. BMJ 1996; 313:1309-13.

4.. Olsen O. Meta-analysis of the safety of the home birth. Birth 1997; 24:4-13.

5.. Ogden J, Shaw A, Zander L. Deciding on a home birth: help and hindrances. Br J Midwifery 1997;5:212-15.

6.. Canadian Institute for Health Research Giving Birth in Canada: Regional Trends From 2001-2002 to 2005-2006. http://secure.cihi.ca/cihiweb/en/downloads/Childbirth_AiB_FINAL_E.pdf

7. CMAJ Maternal mortality and severe morbidity associated with low-risk planned Cesarean delivery versus planned vaginal delivery at term. http://www.cmaj.ca/cgi/reprint/176/4/455.pdf 8. Listening to Mothers II Report (2006.) Childbirth Connections, http://www.childbirthconnection.org/

Comfest 2008 was a great success! We collected nearly 50 signatures from individual supporters and made great connections with other grassroots organizations who will likely sign on to our coalition. We will be following up soon with everyone we spoke to as we get the ball rolling on our legislative campaign. Thanks to the CHOICE midwives for letting us use their booth space, and to the volunteers who handed out information and encouraged folks to sign up!