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.

MAMA Campaign News and Webinar

Grassroots Network Message
MAMA Campaign: Great News! and Webinar

Dear Friends,

I'm hoping most of you have signed up for MAMA Campaign updates (go to www.mamacampaign.org). If not, here is the latest! (see below) The hard work by the MAMA Campaign has achieved a great step in the right direction, plus you can sign up for a Webinar to find out in more detail what the Campaign has been doing!

Sincerely,
Susan Hodges, "gatekeeper"


From the MAMA Campaign:

1. Congress takes an important step forward for CPMs!
2. We need your help
3. Join MAMA for a Webinar about the Campaign next Monday!

Congress takes an important step forward for CPMs!

MAMA's hard work, with your intrepid support, is paying off! The Senate Finance Committee has included language in their bill that will advance the interests of CPMs and the women they serve - thanks to the support of a key Senator secured by MAMA!
On Friday, November 13th, MAMA representatives met with a top health aide to Senator Maria Cantwell from Washington State . In direct response to MAMA advocacy, Senator Cantwell has included a provision in the Senate Finance Committee bill that will require Medicaid to reimburse licensed birth attendants (which would include state-licensed CPMs) who provide services in licensed birth centers. We were told that the Senator feels strongly about including CPMs in the health care bill and recognizes that her home state of Washington has played a leading role in demonstrating the high quality and low cost of CPM care. The Senator has heard the call from MAMA loud and clear and committed to finding a way to move the ball forward for CPMs.

Building from language crafted by the American Association of Birth Centers for legislation that will require that birth centers receive payment for facility fees, Senator Cantwell was able to add language specifying payment to the providers - licensed birth attendants - as well. Other Finance Committee members, including the Chairman, lined up with Senator Cantwell in support of her provision, demonstrating that our outreach to those offices has also borne fruit. Of great significance, she has also secured the commitment of Senator Reid, the Democratic Majority Leader at the center of crafting the final health care bill this year, to keep her language in this year's final bill. Inclusion of this language represents a significant commitment on the part of the Senator, and we are very grateful to her for this important step forward for CPMs and for expanded choice for women and families!

As a key member of the Senate Finance Committee, Senator Cantwell has a limited number of initiatives that she can champion herself, but she has offered to fully support any other Senator who will file MAMA's original provision on the floor of the Senate to require that Medicaid reimburse all CPMs in all settings.

We are proud of and grateful to all of the midwives and mothers in action in Washington State for the successful outreach to their Senator! And we are grateful to all of you who have helped to secure the wide support that the MAMA Campaign and CPMs enjoy in the Senate!

The provision included in the Senate Finance Committee bill will provide a strong legislative platform for further action to secure access to CPMs for all childbearing women, both in the current health care bill and in the years to come. It is interesting to note that a number of states have first secured just a portion of their initial legislative "ask" , and then accomplished their original goal in a subsequent year. In New Hampshire , for example, the midwives went to the legislature to mandate that all insurance carriers in the state reimburse the licensed midwives. That year, a mandate was passed that only reimbursed midwives operating out of licensed birth centers. The following year, the midwives were successful in having the mandate expanded to cover all licensed midwives offering services in all settings.

What is next for MAMA this year?
MAMA remains committed to including our original provision to mandate Medicaid reimbursement for all CPM services, regardless of site of birth, in the health care bills this year! We are in negotiation with Senate Finance Committee offices in the effort to secure a champion to file our amendment on the floor of the Senate. In addition, we have a strategy to leverage our support in both chambers to include our provision in the final bill that will be signed by the President, whatever the outcome in the Senate.

We need your help!
Please keep those letters to your Senators coming! You never know which letter will take us over the top and into the bill! Write today!

And please keep your dollars coming! You have made possible the most successful fundraising campaign for midwives ever! Now we are asking that you dig just a little deeper to fund us through the end of this legislative session. We have raised $140,000 to date! Washington State donors have been especially generous, accounting for 20% of this amount. We must raise an additional $30,000 in the next few weeks. If you have not given yet, please make a donation today. If you have given, please consider an additional gift today.

Join MAMA in a Webinar about the Campaign next Monday!

Please join the MAMA campaign steering committee for an informational webinar on the MAMA Campaign on Monday, November 23rd from 8-9 PM EST. Register at https://www2. gotomeeting. com/register/ 709957571. Come learn about our strategy, about exciting new developments in the campaign and about how you can support the Campaign's efforts to secure federal recognition of Certified Professional Midwives. The webinar will also strive to answer questions from supporters, so please submit questions ahead of the webinar by emailing info@mamacampaign. org, subject line "Webinar Question Submission." Click https://www2. gotomeeting. com/register/ 709957571 to register for the webinar.

MAMA thanks you for your support. If you have any questions, concerns or comments please contact the campaign at info@mamacampaign. org.

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Birth Center Closure in Brazil

This message from a Brazilian midwife was passed along to me by Debra Pascali-Bonaro regarding the recent closure of a birth center in Brazil:

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We are in a very difficult moment in Brazil. We had our Rio de Janeiro Birth Center ( Casa de Parto David Capistrano Filho) closed today. They found a state law saying that a health institution can not exist without doctors! We know it's a politcal thing. New persons in the goverment and a big pressure for our local doctors. We have the support of the Brazilian goverment but we know that in this cases we never know what can happen.
We are pretty sure that it's time to call for HELP of our friends outside Brazil. We need emails against this attitude.We need to show the power of our movement to make birth a physiological process in a c-section country.

We are organizing ourselfs to go to the street and say we want our Birth Center back!!!
If you want more details from this wonderfull birth center go here.

Thank's alot,
We are sure that if we work hard and well, in the end we will be stronger than now.
( sorry about possible written english mistakes)

Grassroots Network: Health Care Reform Kick Off Events

Dear Friends,

Organizing for America, a website run by the Democratic Party, is working to get more people involved with Health Care Reform efforts. The activity is to have gatherings or house parties—Kick Off events -- on June 6 (yes, in just a couple of days!). You can host an event, or you can find one already scheduled in your town just by entering your zip code (see link below).

These gatherings do not have to be big and fancy, but they can focus attention on the importance of Maternity Care in health care reform, and in particular on Midwives, especially Certified Professional Midwives, as an important part of the solution.

President Obama has stated that real reform must uphold three core principles -- it must reduce costs, guarantee choice, and ensure quality care for every American.

Federal recognition of Certified Professional Midwives, so that they are eligible for Medicaid reimbursement, would address all three goals without costing anyone any additional money, and would actually save us all a lot of money.

Below are suggestions for participating in these Kick-Off events. Whether you host one or participate in one, you can talk about maternity care, midwifery and especially the financial and health benefits of increasing access to out of hospital birth with Certified Professional Midwives.

For additional useful facts and information:

CfM’s letter to Obama “Maternity Care: A Priority for Health Care Reform”

“State of American Childbirth”

“Out-of-Hospital Midwifery Care: Much Lower Rates of Cesarean Sections for Low-Risk Women"

“CPM Issue Brief - Certified Professional Midwives in the United States”

Additional factual information here (scroll down home page for Childbirth Connection’s “Health Care Reform Priorities for High Quality, High Value Maternity Care” and the Milbank Report on Evidence-based Maternity Care).

How to Participate in the Health Care Reform Kick Off Parties

1) Go to the Organizing for America website that is run the Democratic National Committee

2) Register if you do not already have a user name and password.

3) Click on "Host or Attend a Health Care Organizing Kick off"

4) Create your event, entitled, "Midwifery and Health Care Reform – (Your Town)." We would like all of the events to have the same name so that we will be more noticeable.

5) Follow the instructions to create your event, including inviting as many people as you can think of. Here is a description that you can use for your event:

"This 2 hour event will be designed to inform consumers and health care practitioners about the value of including midwifery in the upcoming Health Care Reform bills. We will discuss how everyone can get involved. Light refreshments will be served."

You can, however, say whatever you would like and plan whatever you would like.

6) Download or at least read online the instructions on how to host a Kick Off event. It will give you a little sense of what they are looking for. Our events will be more specific to midwifery. At some point during your event, you can have attendees log on to the Organizing for America site and write their stories. If you don’t want to host an event, attend one that is already scheduled and speak up about CPMs and home birth.

7) These kick offs are designed to mobilize people around spreading the word about health care reform. We want to mobilize people around spreading the word about how midwifery can be included in health care reform. Brainstorm ideas for talking to key legislators and policy makers in your area.

8) These kick offs are also wanting to inspire folks to do Health Care Service projects on June 27, 2009. Brainstorm how your group might “show off” how wonderful midwives are and could be in your community. How about collecting baby clothes donations for the homeless or low-income families. What about offering a free day of prenatal visits, massage and yoga. Be creative, be fun, be visible.

So…. Let’s be part of the national debate. We need to be concise, consistent and VISIBLE!! Have fun and let us know what happened!!

Sincerely,

Susan Hodges, “gatekeeper”

Update from The Big Push

Thank you to everyone who emailed the Transition Team yesterday about including Certified Professional Midwives in federal healthcare reform. You totally rock!

While it's not possible to get an exact count, by all indications we not only met our goal of 5,000 emails, but exceeded it beyond even our most hopeful expectations.

Even better, our collective outreach efforts helped us extend beyond the usual networks of midwifery supporters to people outside of the traditional community of activists, to help them let the Obama administration know that access to the full range of maternity-care providers and settings is not a "fringe" issue but is important to people from all walks of life.

We have no doubt that there will be more opportunities in the near future to flex our grassroots muscle again and continue educating the new administration about the vital role that Certified Professional Midwives and out-of-hospital maternity care can play in healthcare reform. In the meantime, though, please pat yourselves on the back for a job well done!

And many thanks to Jane Peterson, Katie Prown and Susan Jenkins of The Big Push for Midwives steering committee for conceiving the idea, and to Sabrina McIntyre for using her Facebook skills to spread it far and wide. What we did together yesterday is just the tip of the iceberg!

_______________________________________________
Steff Hedenkamp | Communications Coordinator | TheBigPushForMidwives.org | 816.506.4630

More on Contacting Obama

From CfM Board Member Willa Powell:
--------------------
Subject: Contact President Obama TODAY!

CfM supports the The Big Push for Midwives and their "A New Birth of Freedom," campaign. To join the effort:

1) Clicking this here.
2) Cut and paste this sample message below
3) Fill in your name and send... and you are done!

Dear President Obama,

We are indeed celebrating "A New Birth of Freedom" as you assume office today!

And BIRTH is a really important element of health!

Please be sure to include Certified Professional Midwives (CPMs), who specialize in providing out-of-hospital maternity care, in federal healthcare reform.

We have a lot of very costly problems, harmful practices and poor outcomes in US maternity care, well documented in the new report “Evidence-Based Maternity Care: What It Is and What It Can Achieve” from Childbirth Connection (see here).

We desperately need other options. Certified Professional Midwives providing excellent maternity care with few interventions and excellent outcomes are a model of cost-effective maternity care and provide a safe alternative to hospital-based care for the majority of women. However, they must be recognized by the federal government for their potential to improve maternity care to be realized.

For more on consumer concerns and suggestions, please see Citizens for Midwifery’s “Maternity Care: A Priority for Health Care Reform: Lower costs, increase effectiveness, improve outcomes for mothers and babies” here.

Sincerely,

Grassroots Network: URGENT ACTION: e-mail Obama at Change.gov TODAY!

Dear Friends,

As our new President is inaugurated today, let's celebrate "A New Birth of Freedom" with e-mails to the new administration about birth and midwives!

The Big Push for Midwives posted this request this morning -- a great idea to hopefully get attention to the need to recognize CPMs at the federal level as part of health care reform. (Simply put, recognition at the federal level, as part of medicaid/medicare legislation, is the doorway to all insurance reimbursement.)

Read the post below, then send your message -- it can be brief, will only take you a minute. JUST DO IT! And don't hesitate to forward this message to other birth/midwife-friendly lists and friends!

Sincerely,
Susan Hodges, "gatekeeper"


From Steff Hedenkamp of THE BIG PUSH FOR MIDWIVES:

Greetings!

In honor of today's Inauguration theme, "A New Birth of Freedom," we at The Big Push for Midwives are asking all of you to take a few minutes to send an email with the subject heading "A New Birth of Freedom" to our new president today. Click on the URL below and send a very simple but powerful message to the Obama administration:
"Please be sure to include Certified Professional Midwives (CPMs), who specialize in providing out-of-hospital maternity care, in federal healthcare reform."
http://change.gov/page/s/healthcare [takes you to a window for e-mailing your message]

Our goal is to submit 5,000 emails by midnight today. That number will put us ahead of every other grassroots movement that has submitted comments to the Obama administration and will ensure that our issue expanding access to out-of-hospital births attended by CPMs gets the attention it deserves.

Please send a quick email notification to this list or to The Big Push for Midwives Facebook wall after you post your comment so we can keep a running tally.

Keep in mind that we are at a crossroads. Healthcare reform is now inevitable and will be based on the reimbursement categories and rates for Medicaid and federal employees. Private insurers are widely expected to follow suit. So if CPMs are not included as recognized providers in federal healthcare reform, there is a very real possibility that home birth families will not be able to receive insurance reimbursement, regardless of whether they have private or public healthcare insurance.

Please act now.
Thank you very, very much.

Steff Hedenkamp | Communications Coordinator | The Big Push for Midwives Campaign | 816.506.4630
steff@thebigpushformidwives.org
TheBigPushForMidwives.org

Envisioning a safer, less-costly model of maternity care in the U.S.

Grassroots Network: CfM’s maternity care reform message to Obama-Biden team

Dear Friends,

Citizens for Midwifery presents our recommendations to the Obama-Biden transition team: “Maternity Care: A Priority for Health Care Reform”, now on the CfM website here.

We have posted our statement to the Your Seat at the Table section of www.change.gov, (the place for organizations to submit white papers, recommendations, etc.). The document includes practical ideas for improving access to credentialed midwives in all settings, increasing evidence-based care, increasing accountability and transparency, and eliminating the legal/economic incentives to perform more and more interventions in childbirth.

Other documents have been submitted, for example by Childbirth Connection, “Health Care Reform Priorities for High Quality, High Value Maternity Care,” and by the Midwives Alliance of North America, “Reforming Maternity Care in America: Recommendations to the Obama-Biden Transition Team on Maternity Health Care," and probably others that we do not know of. As yet, searches of Your Seat at the Table at change.gov (childbirth, maternity care, midwife, midwifery, etc.) do not turn up any documents at all, and we are working to find out what the problem is.

These are valuable documents arguing for change in maternity care! Please read these documents, forward the links, quote from them, use them with your legislators and state policy-makers!

Sincerely,
Susan Hodges, “gatekeeper”