President's Editorial
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/article
