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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Grassroots News: $40 Million Going Towards Early Inductive Election, Prematurity

Hello Friends,

The US Department of Health and Human Services (HHS) has launched a campaign called the “Strong Start Initiative,” which is designed to decrease the number of preterm births occurring every year. Babies born prematurely are more likely than babies born at full term to experience a vast array of medical complications both in infancy and across the lifespan. In order to reverse a 20 year trend of increasing rates of prematurity, the HHS has announced the availability of $40 million in grant money for programs that are exploring ways to reduce prematurity through improved prenatal care.

The “Strong Start Initiative” will focus on reducing early elective inductions, which are labors that are induced prior to 39 weeks and without any medical indication. The rate of early elective inductions has increased dramatically over the past decade and is associated with poorer outcomes for babies and increased obstetrical interventions, including cesarean section. Reversing this trend can improve the health of babies and reduce unnecessary medical intervention in birth.

In addition to creating conditions for healthier births and babies, the Strong Start Initiative has the potential to save considerable health care costs that are typically associated with preterm births. The HHS will partner with the March of Dimes, the American Congress of Obstetricians and Gynecologists, and other organizations to implement this campaign.

To learn more about current research on early elective inductions, see the recent Citizens for Midwifery article.
To learn more about the “Strong Start Initiative,” read the full press release.

Warmly,

Lauren Korfine & The CfM Team

Happy New Year!

When I began writing this blog for Citizens for Midwifery, one of my goals was to be collaborative in terms of networking with other maternity care activists across the country. To me, that means giving acknowledgement, praise, and congratulations to other organizations that are making a real difference and to sharing ideas, credit, and resources with each other. It makes complete sense to me to create a climate in which organizations are mutually supportive of one another, rather than in competition with one another. To that end, I'd like to highlight the year-end fundraising requests of some great organizations working on behalf of mothers, babies, motherbabies, midwifery, women's health, or birth activism. There are many worthy organizations out there working tirelessly on behalf of the women in this country and beyond our borders. I hope you will help to support any or all of them in some way so that we can greet 2012 with a strong camaraderie as our complementary efforts to improve maternity care continue to survive, thrive, and blossom into hopeful and beautiful fullness. To make a donation to Citizens for Midwifery, please visit this link and become, at minimum, a "citizen" supporter yourself!

CIMS shares some great information:

This year has been an eventful one for maternity care advocates. Ina May Gaskin, noted midwife and author of Spiritual Midwifery and Birth Matters won the Right Livelihood Award, (also known as the “Alternative Nobel Prize”) for 'outstanding vision and work on behalf of our planet and its people'. Robin Lim, an American midwife working in Indonesia, won the CNN Hero of the Year award. Ricki Lake and Abby Epstein released their new film “More Business of Being Born.”

The Coalition for Improving Maternity Services (CIMS) has had an eventful year as well. With the end of the grant funding that CIMS was fortunate to have for the past few years, CIMS is now transitioning into a leaner organization and we are sharpening our focus more than ever on improving maternity care and promoting the principles of the Mother-Friendly Childbirth Initiative (MFCI).

In March, CIMS-along with the Breastfeeding and Feminism Symposium-co-hosted our Forum “Reframing Birth and Breastfeeding-Moving Forward” in Raleigh, North Carolina. Forum attendees were privileged to hear cutting edge presentations on a wide variety of the latest topics in birth and breastfeeding from stellar speakers such as:

• Eugene Declercq, PhD, MBA, Boston University School of Public Health, “Where We Stand in Improving Maternity Care, Blue Print for Action”
• Penny Simkin, noted Author, Doula, Childbirth Educator, Birth Counselor, "What's New With Doulas? Challenges and Opportunities"
• Bettina Lauf Forbes and Danielle Rigg, Co-Founders, Best for Babes Foundation, “Changing Frames: Giving Breastfeeding a Makeover”
• Geradine Simkins, CNM, MSN, current President of Midwives Alliance of North America, "What Matters to Women, Matters to Midwives”
• Kirsti Kreutzer, Doula, Filmmaker, one of the founders of “Where’s My Midwife?” "Social Media and Activism: 'Where's My Midwife?' Calls For a Revolution"

As always, the CIMS Forum facilitated many exchanges of ideas and professional learning from leaders in their fields. (Click here to learn more about what sessions were offered or to purchase audio recordings from the Forum). CIMS was also honored to host two luncheons for CIMS’ Organizational Members, and facilitate discussions for collaborative learning and sharing ideas between many of the major birth organizations from around the country.

The Mother-Friendly model of care continues to set the standard for maternity care across the United States. CIMS is proud to continue to grow and promote The Birth Survey, which has amassed a huge database of women's birth experiences that are invaluable to researchers and care providers and encourages women and their families to seek out Mother-Friendly maternity care.

You can be a part of the growth and positive change in maternal infant health by partnering with CIMS as we continue to be a voice for Mother-Friendly care. If you haven’t already, won’t you join us by either becoming a member or making a tax-deductible donation to CIMS before the end of this year?

Thank you for all that you do to improve and promote Mother-Friendly care!

I also heard from the women at National Association of Mother's Centers (make sure to check out their 12 Days of Christmas video!)

What are you grateful for this year? Perhaps it's the birth of a new baby, or the purchase of a new home, the start of a new job, or maybe the giggles of your kids or grandkids.

For many mothers across the country, being grateful for the Mothers' Center is at the top of their list this year. They are thankful they have a place where they can come to share in the joys and challenges of motherhood and gain friendship, support and sisterhood during what can be one of the most isolating experiences of our lives.

If you are feeling grateful for your family this year, please consider making a donation in honor of that gratitude to the National Association of Mothers' Centers. With your help, we can continue our work helping mothers across the country.

And as a holiday treat - we've created this short video:A Mother's 12 Days of Christmas. Enjoy!

Choices in Childbirth is another amazing favorite of mine. I'm in love with their Guide to a Healthy Birth. Seriously. In love.

As you make your year-end chartiable contributions, please consider a gift to support Choices in Childbirth in our endeavor to improve maternity care by ensuring that women and families have access to the full range of birth options and helping women make informed decisions about childbirth. To ensure that your gift is tax-deductible for 2011, make a secure online contribution by December 31.

Thank you for your dedication to healthy birth.

P.S. Are you on Facebook? Join our Cause and start your own Holiday Wish Fundraising Page to benefit CiC!

Also, we love the Transforming Maternity Care initiative of Childbirth Connection!

As the year comes to an end, we want to say one last thank you to everyone who has remained passionate about transforming maternity care in 2011. As we wrote last week, our efforts are starting to pay off.

Let's keep this momentum going in 2012. We have the collective vision, and we know how to get there. Leaders and legislators are listening and women are activated because they know they deserve better.

There's still time to make a tax-deductible donation to support Childbirth Connection. Every dollar counts and every dollar will be used to transform maternity care.

CfM Board member Hillary and I both have our pictures on the cover of the newest edition of the women's health classic, Our Bodies, Ourselves:

"We want women to say: I read a book and it changed my life."

That's how our Turkish partner, Mavi Kalem, approached the challenge of creating Bedenlerimiz Biziz, the first Turkish adaptation of Our Bodies, Ourselves.

Slated for release in 2012, this new edition explores the social norms and laws, traditional practices and religious edicts that make it difficult for Turkish women and girls to exercise their health and human rights.

This holiday season, please give as generously as you can — $100, $250, or more — to Our Bodies Ourselves.

Your generous contribution sustains our legacy of educational activism on behalf women and girls in every region of the world.

For donations of $150 or more, we will send a signed copy of the new U.S. edition of Our Bodies, Ourselves, selected by Library Journal as one of the Best Books of 2011. Keep it for yourself or share it with friends, your local library, or community health clinic.

La Leche League has a long history of advocacy for mothers and babies and they are close to meeting their year-end fundraising campaign goal:

We have one last challenge match on the table! Between now and December 31st all donations will be matched dollar-for-dollar up to $5,000! Gifts can be made either online or by mail.

We already have an original challenge of all gifts being matched dollar-for-dollar up to $100,000, so any gift you make this last week of our campaign will go three times as far in helping mothers and babies.

These are just a handful of the many high quality organizations out there working on behalf of compatible purposes. We wish them all the best in 2012!

May the dawning of 2012 find you with warm hearts, treasured companionship, and lots of love. And, may women, babies, and families have access to quality maternity care and healthy birth choices throughout the world.

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Molly
CfM Blogger