AJOG editorial rejects the ethic that autonomy is a fundamental human right

Read it for yourself:  Planned Homebirth: the professional responsibility response

This article represents a serious attack on home birth and on patient centered care in the United States.  The attack is based on poor research and runs roughshod over established rights to bodily integrity.

This article was “Presented at European Congress of Perinatal Medicine, Paris, France, June 13, 2012.”  So not only does the article attack home birth, it also represents an attempt to “export” to the rest of the world a position that the obstetric profession, not mothers, should have the final decision on birth, at a time when that isn’t even legally defensible here in the United States.

The primary author, a Fellow of ACOG, faculty member at Cornell University Department of Obstetrics and Gynecology, should be aware of American jurisprudence supporting patient autonomy and right to informed consent.  We can also assume that he is aware that systems of midwife attended homebirth are well established and integrated into the health delivery systems of many European countries.  And yet, it is the decision of the 2010 European Court of Human Rights case that seems to have prompted this “critical evaluation”.  This was a case where obstetrician, Agnes Gereb, was imprisoned for attending home births in Hungary.  Her story is told in the movie “Freedom for Birth”, produced by One World Birth.

The authors’ conclusion is the height of hubris: “We urge obstetricians, other concerned physicians, midwives and other obstetric providers, and their professional associations to eschew rights-based reductionism in the ethics of planned home birth and replace rights-based reductionism with an ethics based on professional responsibility.”  In other words, reject the ethic that autonomy is a fundamental human right.

Who decides what is reasonable?

Fiduciary responsibility is, by definition, putting the needs of the patient first.  If fiduciary responsibility was the same as professional responsibility, this would not be an either/or proposition.  The author defines professional responsibility as a model of decision making where “the patient has the right to select from medically reasonable alternatives”.  Who gets to decide what is reasonable?  Why, the obstetrician, of course.  And if the patient opts for an alternative the obstetrician has not deemed reasonable, then the obstetrician is justified in placing the “rights of the fetus” ahead of the rights of the first patient (the mother), although what is actually being asserted is the obstetrician’s own agenda over the rights of his/her patient.

Buried in this article, and lost in the conclusion, is one very true statement: “The first professional responsibility of obstetricians is to ensure that hospital delivery is safe, respectful, and compassionate.” The author goes on to describe what that needs to look like, and in an easily overlooked fashion concedes that hospitals aren’t always safe places either.  In fact, both infant and maternal mortality are on the rise in the United States, at a time when hospitals have a near monopoly on birth.  This failing falls squarely at the feet of ACOG and the collective actions of its Fellows, which calls to mind this quote:

“ACOG no longer has the moral authority to set standards in maternity care…. It has made too many self-aggrandizing and self-protective recommendations (e.g. against home birth, videotaping birth, and VBAC) that limit the freedom of American women and families.” (M. Wagner, Born In The USA, 2006, University of California Press, p. 32)

Overlooking this reality completely, the author also overlooks the most reliable research on the safety of home birth, while noting that ACOG “accepts the findings of Wax et al”, a thoroughly discredited piece of published research that does not stand as prima fascia evidence against the safety of home birth.  Even Amy Tuteur (no friend to home birth) says this AJOG article is “poorly researched, relies on bad studies and is woefully paternalistic”.

One contradiction stands out as the authors call for “safe, respectful, and compassionate” hospital delivery.  No hospital birth can be truly respectful if the birth is happening in the hospital because the physician disrespects the woman’s right to an alternative and has rigged the system to eliminate access to all legal alternatives.

Illinois Friends of Midwives also responds to this article, calling it “paternalistic and misogynistic."
Wendy Gordon, LM, CPM, MPH, Midwives Alliance Division of Research, published an in-depth response on Science and Sensibility.

Another resource in any discussion on the safety of birth, and home birth in particular, can be found on Citizens for Midwifery website.

Yours in safe and respectful maternity care,
Willa Powell & the CfM Team

-----

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Book Review: Pushing for Midwives

Book Review: Pushing for Midwives: Homebirth Mothers and the Reproductive Rights Movement
by Christa Craven
Paperback: 232 pages
Publisher: Temple University Press; 1 edition (October 28, 2010)
ISBN-13: 978-1439902202

Reviewed by Molly Remer, Talk Birth

Mainstream feminist groups have been slow to recognize the right to reproduce along with the right to be free from reproducing. A focus of the second-wave women’s movement was shaking off motherhood as what solely defined womanhood. So perhaps there has been a reluctance to watch over the process that makes women mothers. –Jennifer Block quoted in Pushing for Midwives

Framed as a health policy concern, Pushing for Midwives assesses the homebirth movement and midwifery activism in the context of the reproductive rights movement. The focus of the book is on legislation in Virginia, but is still of relevance and interest to activists from other states. Craven also tackles complicated topics that are often ignored in homebirth and midwifery texts, addressing issues of race, privilege, and socioeconomic status and the impact on access to care. She also takes a solid look at issues of political and religious diversity within the homebirth activist community.

Written in a densely academic style evocative of a dissertation, Pushing for Midwives, became tedious and dry in places and took a long time to finish reading. The very narrow focus on Virginia, while still applicable to other states, became tiresome by the final chapters.

I particularly enjoyed Craven’s exploration of the history of consumer activism in midwifery as well as the consideration of homebirth in the larger context of women’s health activism. I appreciated her exploration of the feminist movement and how it has historically neglected issues of birth advocacy and reform, while also looking the current relationship between feminism and midwifery activism, particularly how birth advocates choose to self-identify. Women’s health activists and midwifery advocates will likely find a lot of food for thought in the pages of Pushing for Midwives.

–
Disclosures: I received a complimentary copy of this book for review purposes.
Amazon affiliate links included in book title and image.

Guest Post: How to Avoid a Medical Induction Seminar

Are you interested in natural effective techniques to avoid a medical induction?

Are you tired of seeing birthing mothers face a cascade of intervention that could be avoided?

Are you frustrated with seeing fear take over what could be an empowering birth?

Are you saddened by the amount of medicalisation in the birth process?

 

We are hosting a one-time complimentary teleseminar on Thursday September 13 at 830am (Sydney Australia time). That’s Perth 630am, Alice Springs/Darwin/Cairns 8am, Auckland NZ 1030am, In other parts of the world this means: Wednesday September 12, LA & Vancouver 330pm, NY & Montreal 630pm & London 1130pm.

Listen LIVE from your land line or Skype on the day if you can as there will be specials, or else receive a recording later and listen to it when you’re free – it’s that easy!

SAVE YOUR SPOT NOW BY CLICKING HERE => http://acubirth.com.au/opt-in-sept-2012

On this call, Naomi and Rebecca from Acubirth and the Red Tent Health Centre will reveal:

          • The biggest mistake that can hinder the start of birth

          • The best acupressure point to encourage bub to engage and ripen that cervix

          • What the ancient secrets are and how they can empower your women

          • How Chinese medicine can deliver more choice and effective outcomes for birth

          • The importance of touch and how crucial it is in the lead up to birth

          • How to calm nerves and deal naturally with anxiety

          • Inspiring pregnancy and birthing stories where situations have been incredibly turned around using acupressure

You definitely want to save your spot for this one-time event. It’s so easy to attend from anywhere, in the comfort of your own home or wherever you are on the move. If you can, be near a computer connected to the internet, as we’ll be referring to juicy info on line.

Naomi and Rebecca both run Acubirth for Midwives as well as the Red Tent Health Centre in Sydney, Australia. Acubirth is a specialised education website for midwives to find out how natural eastern remedies can improve birthing outcomes for their clients, as well as how it can support their own health and wellbeing. All courses are accredited by the Australian College of Midwives.

On this exciting call you will not only get an insight into how supportive Chinese medicine can be for your women but you will come away with tools you can use right away. On the day we’ll be telling you how you can learn even more about acupressure for midwifery, in a way that’s accredited by the Australian College of Midwives (and we’re in the process of getting specialty credit from the American College of Nurse Midwives also).

SAVE YOUR SPOT NOW BY CLICKING HERE => http://acubirth.com.au/opt-in-sept-2012

We look forward to meeting with you on the 13th.

Warmly

Naomi Abeshouse and Rebecca Mar Young

Your Eastern Birthing Mentors

Acubirth and Red Tent Health Centre

ACUBIRTH FOR MIDWIVES
~ Empowering mothers with eastern remedies ~
www.AcuBirth.com.au

Join our Acubirth for Midwives facebook group: Acubirth-for-Midwives
Follow Acubirth on Twitter @AcuBirthSydney: https://twitter.com/#!/AcuBirthSydney

I am a Midwife Campaign

MANA has a great educational campaign going on right now called I am a Midwife. The campaign involves a series of short videos released once a week about a variety of topics. More than just a general education campaign, each video includes a variety of different women--midwives, mothers, public health activists, maternity care activists, authors---speaking out on important topics in maternity care. Each woman also identifies, "I am a Midwife." This week's video is about health disparities in maternity care, which is a very important and too-often ignored topic. It raises the concern that African American women and their babies are more likely to die than their Caucasian counterparts even when other variables are equalized (i.e. same socioeconomic status, same education, etc.) and moves into wider discussions about racism and the treatment of minority group members. It then focuses on the value and role of midwifery care in addressing these concerns.


As MANA states in relationship to this campaign: "For midwives, sharing is daring. We dare to challenge the status quo. We dare to speak up for women's innate wisdom in pregnancy and birth. We dare to assert that there is a better way for our babies to be born. And we dare to insist that birth belongs to families."

Absolutely! The I am a Midwife public education campaign is extremely powerful. I have to confess that when it originally launched, I didn't personally make time to watch the videos right away, somehow assuming that they were "generic" videos with a "rah, midwives!" type of message. Don't make the same mistake I did. These are quality videos with important messages, powerful voices, and essential education and information. You will definitely learn something from watching them!

--
Molly
CfM Blogger

Answer Ina May's Call: This Mother's Day, Support A Woman's Birth Choices

“{I am calling] for greater involvement of women in the formulation of maternity care policy and in the education of young women and men about birth. Women who are fully informed about the capacities of women’s bodies should lead the way, and all women 
who care about social justice and human rights should be involved.”
– Ina May Gaskin, Birth Matters: A Midwife’s Manifesta




Happy Mother's Day!

Here at Citizens for Midwifery, we have been heeding Ina May’s call for more than 16 years, providing women with evidence-based information about pregnancy and birth, and supporting state and national efforts to secure access to midwifery care for all women.

And we need your help! We can’t do it alone!

US Birth statistics and maternity care present many challenges:

One in three US babies are born by cesarean section, a rate more than twice that recommended by the WHO, a rate that results in harm to mothers and babies.

Racial disparities in birth outcomes remain a tremendous problem. For example, African American infants are 2.4 more times likely to die in their first year than white infants, and African American women are more likely to have cesarean sections, and nearly twice as likely to experience preterm labor or give birth to a low birthweight baby. Midwives providing individualized care have been successful in reducing these disparities.

In countries with lower c-section rates and better maternal and infant outcomes than ours, midwives provide primary care for all healthy pregnancies and births.

Access to midwives and the Midwives Model of Care in the US is limited. CPMs are licensed or legally recognized in just 27 states, and CNMs are restricted in the care they may give by practice agreements and supervision requirements in 23 states.

In the US in 2009, only 8.1 % of births in all settings were attended by midwives.

Citizens for Midwifery is working to meet those challenges, with information and action.

• Through our website and educational materials, we provide women and birth advocates with high quality, consumer-focused information.  Our website reaches many women every day (over 66,000 every year!), who download materials or find midwives and advocates in their area.

• Citizens for Midwifery represents consumers as essential stakeholders and elevates the importance of the consumer voice in key national forums on the future of midwifery care.  As part of the MAMA Campaign, CfM continues to work actively to achieve federal recognition for CPMs, so that more and more women of all income levels will eventually have access to the Midwives Model of Care.

• CfM has been at the forefront, using the internet and social networking to reach more women and families than ever before with solid information that is helpful when making maternity care choices and for advocating for the Midwives Model of Care. We have one of the most active Facebook pages reaching consumers, with over 5,000 people on our page and lively exchanges occurring on a regular basis.

Now we need YOUR financial support so we can do more and even better! Times and technology are changing, and we need your help to update our infrastructure so we can reach more women even more effectively.

Your donation today will help us to:

• Update our online infrastructure to more effectively communicate with women and activists.
• Launch targeted educational campaigns and materials to meet the diverse needs of women and birth advocates.
• Maintain a consistent consumer presence representing women at critical moments and decision points in the evolution of US midwifery.

With your support we can reach more expectant women and advocates and do more to advance the Midwives Model of Care than ever before!

Please make a donation today!
        
Visit the CfM Fundraising page at www.cfmidwifery.org/Donate. And please share this letter with your friends and family on Facebook, Twitter and email listserves.  Mothers and babies, now and in the future, will love you for it!

Thank you!


Nasima Pfaffl

President

P.S. Your donation, of ANY amount at www.cfmidwifery.org/Donate, will help us answer Ina May Gaskin’s call to equip women with the information and tools to improve maternity care in their communities.

Book Review: Into These Hands

Into These Hands: Wisdom from Midwives
Geradine Simkins
Paperback, 300 pages
Published by Spirituality & Health Publisher, 2011
ISBN: 9780981870854
Wisdom from Midwives

Reviewed by Molly Remer, Talk Birth

Into These Hands is an amazing anthology of midwives’ retrospectives about their careers and midwifery journey. You won’t find birth stories here–this is book about women’s lives and journeys to midwifery. A book of midwife stories–how women are birthed as midwives, rather than about births they attended–Into These Hands is great reading for aspiring midwives or for currently practicing midwives who wish to feel a sense of solidarity with their sisters. There are many paths, many lessons, many voices and each midwife clearly loves women and has a passion for birth.

From the press release:

We are eager for you to meet some modern-day wise women, healers, revolutionaries, and reformers. Into These Hands, Wisdom from Midwives© is a comprehensive anthology of the life stories of 25 remarkable women who have dedicated their lives and careers to the path of social change through midwifery. These exemplary midwives are all over 50 years of age with 25-40 years in the field. Collectively, they have over 800 years of experience and have assisted in over 35,000 births.

The midwives whose voices are included in the anthology come from diverse backgrounds, training, experiences, and range of practice settings. Quite a few of the stories are from “bridge club” members–women who began as direct entry midwives and later became CNMs. These midwives have a foot in both worlds and insight into the politics of the profession. In general, Into These Hands is a good look at the politics of midwifery both past and present. Almost all of the midwives in the book have homebirth roots or orientation.

Since there are lots of voices represented, the tone or style of some stories is more compelling than others. Some within-story chronology jumps were a little confusing and there were a couple of stories in which I had to do some re-reading for clarity.

Into These Hands is likely to be of particular interest to midwifery activists, aspiring midwives, or current/retired midwives and may hold less appeal for general birth enthusiasts, doulas, or childbirth educators. The stories are rich, insightful, thought-provoking, and diverse and they brought tears to my eyes several times. This book is a treasury of women’s wisdom and a powerful legacy for the generations of women to follow.

(An indicator of how much I like a book is how many page corners I turn down in order to come back to re-read those sections and write blog posts based on them/share quotes/etc. This is Into These Hands last night as I was finishing it...;-D)

–

Disclosure: I was provided with a complimentary copy of the book for review purposes.

Book Review: More Than a Midwife

More Than a Midwife: Stories of Grace, Glory, and Motherhood [Paperback]

by Mary Sommers
MavenMark Books (HenschelHAUS Publishing) (October 1, 2011), 148 pages
ISBN-13:978-1595981066

Reviewed by Molly Remer, Talk Birth

More Than a Midwife is a thoroughly delightful little volume by experienced and resourceful midwife, Mary Sommers. One of the things that makes the book particularly distinctive is the impressive diversity of Mary’s work experience. The book includes stories from her work as a midwife in urban Chicago as well as in Africa and Mexico. As always, glimpsing the dire situations facing birthing women cross-culturally is a sobering reminder of the immense challenges international midwives face with few physical resources—they accomplish an amazing level of care with only their heads, hands, and hearts.

Each story shared in the book is selected with care and has an important message to share. The stories are about unique women and their unique births and what Mary (and the reader) can learn from them. From empowering and exhilarating, to difficult and heartbreaking, particularly notable are the stories that remind us all to treat every woman with dignity and respect, regardless of her life’s circumstances or choices. Mary is clearly a midwife who loves women and birth and practices with sensitivity, respect, and positive regard.

More Than a Midwife is a slim paperback. It is nice size to hold easily and the stories are short and easy to read in small chunks of free time. It is occasionally erratic in the organization/flow of a story and in a few of them I had to re-read segments to understand chronology. However, this was a negligible issue in the context of this thoroughly enjoyable small book.

Mary Sommers has written a true gem of a book. I feel honored to have read More Than a Midwife and I highly recommend it to anyone interested in birth, homebirth, midwifery, or women’s health. Most excellent!

–

Disclosure: I was provided with a complimentary copy of the book for review purposes.

GRN: CPM Symposium Offers Live Streaming

Hello Friends,

Citizens for Midwifery is a proud sponsor of the CPM Symposium co-sponsored by NACPM and AME this coming weekend. We are very excited to both participate and support this gathering because it promises to be a unique and fresh approach to assessing the current landscape, identifying opportunity and challenges and creating realistic next steps in order to advance the profession of midwifery. We're particularly excited to see that they are offering Live Streaming, making conference content affordable and accessible to those who cannot make the Symposium in person. Live streaming participants will be able to contribute and interact with the conversation happening inside the Symposium!

We wanted to let you know that they are giving away one free Live Streaming pass. All you have to do is share the information about the conference on one of your social networks and leave a comment to enter to win. Learn more and enter here!

If you are attending the conference please make sure to introduce yourself and say hello to Susan Hodges, Jeanette McCulloch and Nasima Pfaffl who will be participating as Citizens for Midwifery representatives.

Warmly,

Hillary Boucher & the CfM team

P.S. If you can't make the conference or attend the Live Streaming event you can still follow along on Twitter! Follow the hashtag #CPMsymp12 to join the conversation!