| Grassroots News Message 2011-03-16 |
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LEARN MORE ABOUT CFM |
Thursday, March 17, 2011
GRN: ACOG Is Not Qualified to Evaluate the Practice of Midwives
Monday, August 31, 2009
Grassroots Network: Big Push exposes ACOG’s bogus research
Dear Friends,
The Big Push let folks know about ACOG’s attempt to collect anecdotal information about poor home birth outcomes; so many people posted good home birth outcomes, that ACOG quickly made the page password protected. The survey was poorly constructed with no way to verify any reports or avoid duplication, a good example of what ACOG considers “research”! Read the Big Push news release below, which includes a link to a copy of the survey page as it originally appeared.
Sincerely,
Susan Hodges, “gatekeeper”
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Trouble viewing this PushNews Release? Please visit the PushNewsroom here.
FOR IMMEDIATE RELEASE: Monday, August 31, 2009
Thousands of Activists Nationwide Force Physician Group to Scrub Its Website
"Just follow the money," said Steff Hedenkamp of The Big Push for Midwives Campaign. "ACOG does not want to continue losing patients to Certified Professional Midwives and out-of-hospital birth, so they’re telling members to send in more of the same old tall tales that far too many OBs love to scare women with. Well, we have news for ACOGit's not working."
The campaign to expose the physician group's plans began on Facebook and Twitter and rapidly drew thousands of women to ACOG's website, where they submitted their own data about their healthy deliveries in private homes and in freestanding birth centers throughout the country. In response, ACOG moved quickly to scrub its website and placed its request for unsourced data from members behind a password-protected firewall.
"This was almost as fun as last year's campaign pressuring the American Medical Association to back off from its ridiculous claim that Ricki Lake is responsible for the increase in out-of-hospital deliveries," said Sabrina McIntyre, mother of two. "The AMA and ACOG seem to forget that women are capable of making rational, informed decisions about our maternity care providers and birth settings. We don't appreciate fear-mongering tactics meant to try and scare us away from using safe and cost-effective, community-based alternatives to our current maternity care system."
"Analysts familiar with ACOG expect the group to use the anecdotal data collected from members to support its ongoing state and federal lobbying campaigns aimed at denying women access to out-of-hospital maternity care and Certified Professional Midwives, who are specially trained to provide it. "ACOG admits in its own documents that they've been forced to use 'hardball tactics' against women who are advocating for choices in maternity care," said Hedenkamp. "Frankly, this latest stunt of theirs to troll for 'fresh' folklore reeks of desperation.
"The Big Push for Midwives Campaign represents thousands of grassroots advocates in the United States who support expanding access to Certified Professional Midwives and out-of-hospital maternity care. The mission of The Big Push includes educating national policymakers about the reduced costs and improved outcomes associated with out-of-hospital birth and advocating for including the services of Certified Professional Midwives in health care reform. Media inquiries: Katherine Prown (414) 550-8025, katie@thebigpushfor
The Big Push for Midwives Campaign | 2300 M Street, N.W., Suite 800 | Washington, D.C. 20037-1434 | TheBigPushforMidwiv
Monday, June 9, 2008
Grassroots Network: More re ACOG and the MA midwifery bill
The MA ACOG letter contains a number of completely inaccurate statements, especially regarding the CPM credential. The North American Registry of Midwives has addressed these points specifically, as follows:
The MA ACOG letter states:
“The academic standards for certified professional midwifery (CPM) are remarkably lower than the academic standards for training and certification of physicians, as well as for nurse-midwives certified by the ACNM. Moreover, CPM training requirements fall short of internationally established standards for midwives and traditional
birth attendants.”
NARM states:
Certified Professional Midwives are neither physicians nor nurse-midwives. Their education is specific to risk assessment and management for normal births in out-of-hospital settings. They recognize and refer, but do not diagnose nor treat, pathologies best suited for physician management. The education of the CPM is sufficient for this task as evidenced by the outcomes of the CPM2000 study published in the British Medical Journal, and as evidenced by the acceptance of the CPM by many states that license direct-entry midwives. Twenty-two states license midwives with requirements similar to or equivalent to the CPM; many have been in existence for over 20 years, and all have found the training to be sufficient for the task.
The MA ACOG letter states:
“An individual without a high school degree could be licensed as a CPM if he or she passed the certifying exam, observed 20 deliveries, and participated as the primary attendant in 10.”
NARM states:
Because the CPM is a midwifery credential, it does not set pre-requisites for non-midwifery education. The curriculum and training have been determined by the NARM Job Analysis according to procedures established by the National Commission for Certifying Agencies. The numbers in the above paragraph are false. In addition to the didactic education of over 750 competencies, the CPM candidate must complete 20 births as an assistant (not observer) and 20 births as the primary attendant, all under the supervision of a qualified preceptor. Additional verification of skills and knowledge is verified by a hands-on practical exam and an 8-hour written exam.
The MA ACOG letter states:
“CPMs have not adopted a set of criteria based on generally accepted medical evidence or public safety for patients who may be appropriate candidates for home birth, relying instead on the decision of the individual midwife and patient.”
NARM states:
Certification, by definition, defines the knowledge and skills necessary for attainment of the credential - indicating that the midwife has demonstrated the ability to make appropriate decisions for the practice of midwifery. The North American Registry of Midwives (NARM), which issues the credential, does have a mechanism for addressing complaints about the practice of a CPM. NARM does not, however, regulate the practice of midwifery. Regulation is a function of state licensure, and varies from state to state.
The MA ACOG letter states:
“The curriculum, clinical skills training, and experiences
of CPMs have not been approved by any authority recognized in certifying knowledge and skills associated with the practice of obstetrics, including the American Board of Obstetrics and
Gynecology, the American Midwifery Certification Board (AMCB), and the American Board of Family Medicine.”
NARM states:
Neither the American Board of Obstetrics and Gynecology nor the American Midwifery Certification Board approves the curriculum or sets clinical requirements for their own certificants, much less for the applicants for any other certification program. Each certification program sets its own prerequisites and conditions for application without approval from a completing or complementary certification board.
The MA ACOG letter states:
“The North American Registry of Midwives™ Portfolio Evaluation Process (PEP) requires midwives to be the primary care provider on 50 homebirths and have three years of experience. The average intern in obstetrics and gynecology gets this much experience
in 1 month.”
NARM states:
The Certified Professional Midwife does not function as an obstetrician/gynecologist. The clinical training for the CPM is similar in number to that of most certified nurse-midwives and is more extensive in vaginal births than the number required for family practice physicians.
MA ACOG could have easily checked their information before posting, but chose instead to post opinion and innuendo as if it were fact…
It is also interesting to note that the letter mentions no health evidence to support the ACOG position, and does not address the needs or preferences of mothers…
NARM’s “Planning for Legislation Handbook” includes lots of info, including factual information (p. 30) similar to the information above addressing the MA ACOG letter, and can be found here.
Sincerely,
Susan Hodges, “gatekeeper”
Wednesday, September 3, 2008
GRN: Big Push for Midwives News: ACOG ups effort to eliminate home birth midwives
Dear Friends,
The Big Push for Midwives Campaign continues to put out PushNews and PushAlerts. (If you haven’t heard of the Big Push for Midwives Campaign, look up Grassroots Network Messages from earlier this year, or read more at the website).
Today’s PushNews notes that the American College of Obstetricians and Gynecologists (ACOG) has moved gettting rid of home birth midwives up to the #2 spot on their list of State Legislative Issues for 2008! You can see the whole list here.
I have copied the PushNews (which includes some great quotes) below. It is not yet posted on the Big Push website. If you are interested in receiving PushNews and Push Alerts, contact Steff Hedenkamp.
Citizens for Midwifery supports the work of the Big Push for Midwives Campaign!
Sincerely,
Susan Hodges “gate keeper”
PushNews from The Big Push for Midwives Campaign
CONTACT: Steff Hedenkamp, (816) 506-4630, steff@thebigpushfor
WASHINGTON, D.C. (September 1, 2008)In the newest phase of its ongoing effort to deny women the right to choose their maternity care providers and birth settings, the American College of Obstetricians and Gynecologists (ACOG) has announced that eliminating access to midwives who specialize in out-of-hospital birth is now the second most important issue on its state legislative agenda. This move puts restricting access to trained midwives ahead of such critical issues as contraceptive equity, ensuring access to emergency contraception, and the prevention and treatment of perinatal HIV/AIDS.
“ACOG claims to be an advocate of women’s health and choice, but when it comes to the right to choose to deliver your baby in the privacy of your own home with a Certified Professional Midwife (CPM) who is specifically trained to provide the safest care possible, ACOG’s paternalistic colors bleed through,” said Susan M. Jenkins, Legal Counsel for the Big Push for Midwives Campaign. “It is astonishing that an organization that purports to be a champion of women’s healthcare would put a petty turf battle that affects less than one percent of the nation’s childbearing women ahead of pressing issues that have an impact on nearly every woman in this country. If this is not dereliction of duty, I can’t imagine what is.”
In recent years, ACOG has led a well-financed campaign to fight legislative reforms that would license and regulate CPMs and has now teamed up with the American Medical Association (AMA) to promote legislation that would prevent families from choosing to give birth at home. Despite these joint efforts, the groups have not been successful in defeating the groundswell of grassroots activism in support of full access to a comprehensive range of maternity care options that meet the needs of all families.
“Wisconsin is a good example of what ACOG and the AMA are up against,” said Jane Crawford Peterson, CPM, Advocacy Trainer for The Big Push. “Our bipartisan grassroots coalition of everyday people from across the state managed to defeat the most powerful and well-financed special interest groups in Wisconsin, all on an expenses-only budget of $3000 during a legislative session in which $47 million was spent on lobbying. When you try to deny women the fundamental and very personal right to choose where and how to give birth, they will get organized and they will let their elected officials know that restrictions on those rights cannot stand.”
Noting these successes, ACOG has recently launched its own grassroots organizing effort, calling on member physicians to recruit their patients to participate in its “Who Will Deliver My Baby?” medical liability reform campaign.
“ACOG itself admits that we’re facing a critical shortage of maternity care providers,” said Steff Hedenkamp, Communications Coordinator for the Big Push. “They certainly realize that medical liability reform is nothing more than a band aid and that increasing access to midwives and birth settings is critical to fixing our maternity care system and ensuring that rural, low-income and uninsured women don’t fall through the cracks. Midwives represent an essential growth segment of the U.S. pool of maternity care providers, but instead of putting the healthcare needs of women first, ACOG would rather devote its considerable lobbying budget to a last-ditch attempt to protect its own bottom line. This is not a happy Labor Day for our nation’s mothers and babies.”
The Big Push for Midwives (http://www.TheBigPu
Thursday, February 7, 2008
Grassroots Network: PushNews Response to ACOG
Following up on ACOG’s anti-home birth press release, The Big Push Campaign has posted a press release--"ACOG: Out of touch with Needs of Childbearing Families." It does not address every objectionable point in the ACOG press release, but it presents a strong message that is positive about home birth and challenges ACOG’s position.
I will still post more “talking points” later tonight or tomorrow. It will be interesting to see just how much press attention ACOG’s press release actually gets…
Sincerely,
Susan Hodges, “gatekeeper”
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A few quotes from the PushNews press release:
"Trade Union claims out-of-hospital birth is “trendy;”
tries to play the “bad mother” card"
“'It will certainly come as news to the Amish and other groups in this country who have long chosen home birth that they’re simply being ‘trendy’ or ‘fashionable,’” said Katie Prown, PhD, Campaign Manager of The Big Push for Midwives 2008. “The fact is, families deliver their babies at home for a variety of very valid reasons, either because they’re exercising their religious freedom, following their cultural traditions or because of financial need. These families deserve access to safe, quality and affordable maternity care, just like everyone else.”
"Besides referring to home birth as a fashionable “trend” and a “cause célèbre” that families choose out of ignorance, ACOG’s latest statement adds insult to injury by claiming that women delivering outside of the hospital are bad mothers who value the childbirth “experience” over the safety of their babies."
"The Big Push for Midwives calls on ACOG to abandon these outdated policies and work with CPMs to reduce the cesarean rate and to take meaningful steps towards reducing racial and ethnic disparities in birth outcomes in all regions of the United States. CPMs play a critical role in both cesarean prevention and in the reduction of low-birth weight and pre-term births, the two most preventable causes of neonatal mortality."
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Friday, July 4, 2008
A Response to the AMA Resolution
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The American College of Obstetricians and Gynecologists (ACOG) is now pushing for the American Medical Association (AMA) to lobby Congress for a law banning out of hospital birth.
Despite a statement by ACOG, regarding a patient's right to informed consent and informed refusal, it seems that more and more decisions and "recommendations" made by ACOG, are moving further away from that basic tenet. This is resulting in thousands of women being stripped of their basic right to choose safe maternity care based on balanced informed consent or informed refusal.
Not all ACOG members are happy with the current situation. Dr. Fischbein, a California physician stated, "ACOG's little 'guideline' paper on vaginal birth after Cesarean (VBAC) in 2004 where the word readily was changed to immediately has had the chilling effect of doing away with VBAC options at hundreds if not more hospitals. Not due to patient safety, or the ideal of giving true informed consent but really, let's be honest, to fear of litigation. I have seen how patients have become counseled by obstetricians at facilities where VBAC has been banned. They are clearly given a skewed view of the risks of VBAC but rarely told of the risks of multiple surgeries. If a hospital cannot handle an emergency c/section for VBACs - and most emergencies are for fetal bradycardia, hemorrhage (i.e. abruption) or shoulder dystocia, not for ruptured uteri - then how can they do obstetrics at all?" Indeed.
ACOG needs to defend their position in encouraging the AMA to lobby Congress for yet another
restriction on the freedom of choice that belongs to all women and their families. Those choices include midwifery care and the right to give birth wherever best fits their needs and desires.
Today's Midwives are well trained professionals and are required to have obstetrical backup. Interestingly, in the countries that have the lowest maternal and infant mortality rates the vast majority of pregnancies and births are managed by midwives.
The U.S. spends more money on maternity care than any other country in the world. Yet, we rank somewhere below 32nd (NOT 1st) in maternal and infant safety. Our maternal mortality rate is on the rise, as well a premature birth, epidemic rates of labor induction and Cesarean Section. Knowing this, ACOG needs to turn it's attention on reversing this alarming and shameful trend by welcoming the superb care that midwives provide and then, taking a long hard look at -- what is it, that Singapore, Sweden, Japan, Hong Kong, Iceland, France, Finland, Norway, The Czech Republic, Germany, Switzerland, Spain, Israel and TWENTY-NINE other countries are doing so much better than us?
Friday, June 20, 2008
What Would an Evidence Based Statement from ACOG Say?
"This is the statement ACOG would file if facts interested them: We at ACOG recognize that, according to our most recent poll, none of our members have homebirth practices and, therefore, making a homebirth statement is unnecessary since this subject is outside the expertise of ACOG members. For the purpose of making an informed choice, consumers should not look to ACOG for a statement on this subject."
:-D
Wednesday, August 26, 2009
PushNews: Physician Group Pulls the Plug on Women’s Autonomy
 | Issues Policy Statement About What Women in Labor Will Be "Allowed" to Eat and Drink The Big Push for Midwives Campaign | 2300 M Street, N.W., Suite 800 Washington, D.C. 20037-1434 | TheBigPushforMidwives.org |
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The Unnecesarean also picked up this press release and shared some additional thoughts as well as a very amusing graphic--check it out!
--
Molly
CfM Blogger
Tuesday, March 30, 2010
Grassroots Network: NIH Consensus Development Conference on VBAC
As most of you know by now, the National Institutes of Health (NIH) convened a Consensus Development Conference on VBAC (vaginal birth after cesarean) in Bethesda, MD on March 8-10, 2010. I felt privileged to represented CfM and be one of the voices for consumers, trying to keep the focus on what is best for women and babies rather than the concerns and pressures that hospitals experience.
It was clear that many of the presenters really understood the problem of VBAC bans, especially Rita Rubin who gave a powerful presentation of women's stories. There was plenty of frustration, too, especially near the end when the panel ethicist refused to acknowledge a pregnant woman's right to refuse surgery, even when she has appropriately weighed the risks to herself and her baby.
All in all, I think the conference really moved the VBAC conversation in the context of other problems in maternity care. It remains to be seen just how much medical practice - and culture - will change as a result of the panel recommendations.
This Grassroots Message includes CfM's response to the NIH Consensus Report on VBAC. At the bottom, I've included links to the NIH conference documents, media coverage. Happy reading! Citizens for Midwifery on the 2010 NIH Consensus Development Conference on VBAC
Our overall assessment of the NIH report can be found below and links to much of the media coverage below that. A full analysis can be found here.
The NIH panel recommendations urge two courses of action that, if implemented, would go a long way toward improving the situation for women with prior cesareans. They state that their goal is to "support pregnant women with a prior transverse uterine incision to make informed decisions about TOL [trial of labor] and ERCD [elective repeat cesarean delivery]". To do that, they (1) urge evidence-based practice, and they (2) urge ACOG to reconsider "ACOG #5". CfM agrees. We would also like to see the following actions:
* All hospitals and OBs should start supporting VBACs, not just "offering" and "encouraging". CfM believes the Midwives Model of Care represents that support of physiologically normal birth.
* ACOG should rescind "ACOG #5" immediately. In doing so, insurance companies would no longer have a basis for dropping or threatening to drop malpractice insurance or raising insurance rates on practitioners and hospitals that offer VBAC, as those individuals and institutions will merely be responding to both the evidence and the guidelines. By rescinding "ACOG #5", ACOG and its members would be taking a step toward earning back the trust and confidence of the women they serve.
* Informed consent must be based on an honest risk assessment, including information about provider outcomes, provider bias and conflicts of interest, as well as the research evidence, in order to support all women, not just VBACing women, to have healthy births.
Willa Powell
CfM President
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The NIH documents can all be reached from their press release, including the full report, the full evidence report, and recorded webcasts of the conference:
http://www.nih.gov/news/health/mar2010/od-10.htm
There has been a great deal of news coverage, including:
http://www.nytimes.com/2010/03/11/health/11birth.html
http://www.npr.org/templates/story/story.php?storyId=124542025
http://www.msmagazine.com/news/uswirestory.asp?ID=12295
Many organizations are developing press releases and responses including ICAN and Lamaze:
http://ican-online.org/print/node
Lamaze
A running blog discussion from the conference can be found at
http://thefeministbreeder.com/once-a-cesarean-rarely-a-choice
http://thefeministbreeder.com/nihvbac
and several blog postings with ongoing discussion can be found here:
http://www.theunnecesarean.com/blog/2010/3/10/nih-vbac-consensus-development-conference-gift-horse-or-troj.html
This article anticipated the NIH conference and very much supports CfM's philosophy:
http://www.nytimes.com/2010/03/07/health/07birth.html?partner=rss&emc=rss
A fairly comprehensive list of articles on this conference is available at:
http://birthaction.org/Blogs/tabid/66/EntryId/64/Articles-and-blogs-on-the-NIH-VBAC-Consensus-Panel.aspx
There's even a petition: http://www.petitiononline.com/VBAC2010/petition.html
Tuesday, June 3, 2008
Grassroots Network: ACOG and the Massachusetts Bill for a Board of Midwifery
Many of you already know of the bill wending its way through the MA legislative process: a bill developed by CNMs, CPMs, CMs and consumers, working together. The gist of the bill is that it would create a single midwifery board that would license CNMs, CMs and CPMs, with slightly different licenses that reflect differences in training, and includes prescriptive privileges for CNMs/CMs and administration of emergency and state mandated meds for CPMs.
Of course, ACOG (American College of Obstetricians and Gynecologists) is opposed, as they are opposed to any bill that would license CPMs and allow for legal midwife-attended home births.
Now you can read exactly what ACOG is saying about the bill, and how they are urging their members to actively work to stop passage of this bill. You can read their latest statement here.
I am sure you will recognize the many errors and misinformation, starting with the novel idea that CPMs are what used to be called lay midwives absolutely not true!
Whether you are involved with state legislation for CPMs or not, in MA or elsewhere, it is worthwhile to be aware of what ACOG is telling its members. You never know when you will have a chance to enlighten a physician or other person who has been misled by ACOG's statements!
Sincerely,
Susan Hodges, gatekeeper
Friday, September 11, 2009
The Big Push Press Release: Physicians Take Anti-Midwife Smear Campaign to the Airwaves
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If you have difficulty viewing this message, please visit the PushNewsroom.
 | Home Birth Mothers, Celebrities, Insulted on National TV The Big Push for Midwives Campaign | 2300 M Street, N.W., Suite 800 Washington, D.C. 20037-1434 | TheBigPushforMidwives.org |
Wednesday, February 18, 2009
Grassroots Network: More organizations support out-of-hospital birth!
Dear Friends,
The Big Push has issued a news release highlighting the fact that organizations including nurses and perinatal specialists have recently made statements supporting the use of midwives and the choice of out-of-hospital birth. In particular, the editorial by Nancy Lowe, editor of the Journal of Obstetric, Gynecologic, & Neonatal Nursing, the official journal of the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) here is an especially good statement.
Read the release below, forward it, and follow the links below to read the various statements!
Sincerely,
Susan Hodges, "gatekeeper"
PushNews from The Big Push for Midwives Campaign
CONTACT: Steff Hedenkamp, (816) 506-4630, steff@thebigpushformidwives.org
FOR IMMEDIATE RELEASE: Tuesday, February 17, 2009
Physician Groups Out-of-Step as the Number of Health Care Organizations In Support of Certified Professional Midwives (CPMs) and Out-of-Hospital Birth Rapidly Increases
Nurses, Perinatal Health Care Specialists Echo Consumer Reports Magazine in Calling for Integrating Midwives into U.S. Maternity-Care System
WASHINGTON, D.C. (February 17, 2009)Two major health care organizations have joined the growing number of groups calling on policy makers to increase access to Certified Professional Midwives (CPMs) and out-of-hospital maternity care. Acknowledging the large body of evidence supporting the safety of home delivery with CPMs, who are specifically trained to care for mothers and babies in out-of-hospital settings, nursing and perinatal health care organizations criticized the American Medical Association (AMA) and the American College of Obstetricians and Gynecologists (ACOG) resolutions calling for bans on CPMs and home birth. The groups also joined Consumer Reports magazine in highlighting the need for a major overhaul of the U.S. maternity care system.
"I am very proud to be an American, but I am embarrassed that our country, founded on the ideals of individual liberty and freedom, can also support 'authoritative' initiatives such as these by the ACOG and AMA, initiatives that are founded on neither science nor an understanding of the physiologic and psychosocial needs of mothers and babies," said Nancy K. Lowe in an editorial published in the Journal of Obstetric, Gynecologic, & Neonatal Nursing, the official journal of the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN). "What is most risky about home birth in the United States is that for most women who desire it there is a scarcity of qualified providers of home birth services." [Read the complete editorial here.
Consumer Reports magazine cited the desire for economic gain as one of the driving forces limiting access to CPMs and Certified Nurse-Midwives (CNMs), who are licensed in all 50 states and practice primarily in hospital settings, but who remain subject to anti-competitive regulations promoted by the AMA and ACOG. CPMs are legally authorized to provide out-of-hospital care in just half the states, while advocates working to reform the law in the remaining states face stiff resistance from physician groups seeking to establish a monopoly on the maternity care market in the U.S.
"Midwives provide a safe and cost-effective alternative to the current model, where the market is dominated by high-cost, high-tech specialists producing less-than-optimal outcomes," said Katie Prown of The Big Push for Midwives Campaign. "Babies delivered by midwives are far less likely to be pre-term or low birth-weight, which are two of the leading causes of neonatal mortality and of the enormous costs associated with long-term care. Midwives and out-of-hospital birth are an integral component of responsible health care reform, and the AMA and ACOG know this. That’s why they’re fighting so desperately to protect their turf, even if it means denying women maternity-care options in the process."
The National Perinatal Association (NPA) added to the growing list of organizations calling on the AMA and ACOG to end their vendetta against midwives and home birth and instead follow the World Health Organization’s (WHO) call to "'work in a spirit of recognition and respect for each other’s authority, responsibility, ability and unique contribution.'" [See their statements on place of birth and on midwifery here.
The Big Push for Midwives is a nationally coordinated campaign to advocate for regulation and licensure of Certified Professional Midwives (CPMs) in all 50 states, the District of Columbia and Puerto Rico, and to push back against the attempts of the American Medical Association Scope of Practice Partnership to deny American families access to legal midwifery care. Through its work with state-level advocates, the Big Push is helping to build a new model of U.S. maternity care built on expanding access to out-of-hospital maternity care and CPMs, who provide affordable, quality, community-based care that is proven to reduce costly and preventable interventions as well as the rate of low birth-weight and premature births.
Media inquiries: Steff Hedenkamp (816) 506-4630, steff@thebigpushformidwives.org.
Friday, February 15, 2008
More ACOG responses
"Finally, there’s a double standard lurking here: elective, medically unnecessary cesarean has been considered en vogue for some time. We know that major abdominal surgery carries with it major risks for both mother and baby, but when it comes to that cause célèbre, ACOG has vocally supported a woman’s 'right to choose.'"
For a little twist interjected into this recent flurry of press releases and blog posts responding to ACOG's statement, here is a parody of the statement from a HBAC (homebirth after cesarean) mother originally posted to Mothering.com.
A particularly salient point from the post was this: "Childbirth decisions should not be dictated or influenced by what’s fashionable, trendy, or the latest cause célèbre. Despite the rosy picture painted by hospital birth advocates, a highly medicalized labor and delivery can physically and emotionally scar both the mother and baby. Attempting a vaginal birth after cesarean (VBAC) at the hospital is especially dangerous because seemingly benign interventions such as epidural anesthesia or Pitocin augmentation can lead to complications with potentially catastrophic consequences for both the mother and baby, including death. Unless a woman is in a supportive birth environment that allows the birth process to unfold on its own schedule, she puts herself and her baby’s health and life at unnecessary risk."
Friday, December 7, 2012
AJOG editorial rejects the ethic that autonomy is a fundamental human right
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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Friday, March 20, 2009
Grassroots Network: Useful press releases about new CDC stats
Several organizations have posted informative press releases with different points regarding the new CDC birth statistics, especially the issue of increasing cesarean rates:
From CIMS: “Need for Transparency Increases as Cesarean Section Rates Rise” (scroll down to see this press release listed near the bottom of the page). Points out the variations among hospitals and providers, and the need for information and transparency to enable pregnant women to make informed decisions about their care, and highlights the work of The Birth Survey projects.
From ICAN: “Cesarean Rate Jumps to Record High; 1 in 3 Pregnant Women Face Surgical Delivery More Women Forced into Surgery; Few Mothers Recognize They Can Reduce Their Risk of Surgery” Notes that a big contribution to the rise in the cesarean rate is the underuse of VBACs, including the facts that VBACs have been banned at more than 800 hospitals, and are not available at another 600 plus hospitals.
From Lamaze: “Evidence Increases for Risks in Cesarean Surgery as National Rate Continues to Rise” Emphasizes the accumulated evidence of risks associated with cesarean sections, for both mother and baby.
As Lamaze concludes (and Citizens for Midwifery agrees): “Two of the most important decisions a woman can make are where she gives birth and who she chooses as her care provider.” Regarding cesarean sections, a healthy pregnant woman can significantly decrease the chance that she will “end up” with a cesarean section by choosing midwifery care, especially in an out-of-hospital setting. (See “Out-of-Hospital Midwifery Care: Much Lower Rates of Cesarean Sections for Low-Risk Women”). In the face of these facts, it is incomprehensible and unreasonable that the American Medical Association and the American College of Obstetricians and Gynecologists continue to make policy statements in opposition to midwife-attended home birth, particularly when they have no evidence to back up their positions. (For more information about ACOG’s anti-home birth stance, see: “ACOG 2008 Press Release on Home Birth- CfM Rebuttal and Talking Points” and for more about AMA and ACOG organizations see “BACKGROUND INFORMATION ABOUT THE AMA AND ACOG”)
Do take a look at these press releases! It is likely that news media of various kinds will publish articles about the latest national statistics. We can all write letters to the editor and respond on blogs, making use of the information in these press releases and additional information in this message, and emphasizing the need for midwives, in and out of the hospital, to improve maternity care and birth outcomes in the US.
Sincerely,
Susan Hodges “gatekeeper”
Thursday, February 7, 2008
Grassroots Network: ACOG Homebirth Statement
Well, some combination of press about Ricki Lakes film The Business of Being Born, the Big Push for Midwives press conference (across the street from AMA headquarters in Chicago), and active legislative efforts in a number of states, actually got the attention of ACOG! Yesterday they posted a press release opposing home births.
The main points are not really different from their Position statement (which is not publicly available on their website), but with added negative and misleading beliefs and downright lies. And of course, this press release is definitely meant for public consumption!
The press is quite likely to pick up this ACOG press release. You are encouraged to write letters to the editor, write on blogs, etc. To help, I am compiling a list of effective talking points, which I hope to post by tonight or first thing tomorrow morning.
Meanwhile, several responding press releases are being prepared by various organizations.
Sincerely,
Susan Hodges, gatekeeper
Friday, June 13, 2008
ACOG's Midwifery Year in Review
The tone of the report seems to be that this issue is all about politics and not about any real issue of safety/concerns. Given the experiences of the tireless advocates at the Capitol, the admission of using "hardball" tactics is interesting, because that's certainly how it FELT, but it was denied by opponents of the legislation.
The year in review discussion does not discuss evidence or anything about real outcomes -- it discusses turf and beliefs and also about how the legislative efforts across the country
“complicates” ACOG's work.
Friday, June 20, 2008
Homebirth Petition
| "Resolutions were recently introduced by the AMA to support ACOG's position against home birth and to 'develop model legislation in support of the concept that the safest setting for labor, delivery, and the immediate post-partum period is in the hospital, or a birthing center within a hospital complex, that meets standards jointly outlined by the AAP and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers.'"
"Please help send a message to the AMA and ACOG, and to our state and federal legislators, to tell them that we object to these resolutions and we view legislation that would restrict a woman's right to choose a home birth as a being contrary to scientific evidence and a violation of women's basic human rights." |
Friday, December 18, 2009
Response to Boston Radio Program About CPMs
Midwives and midwifery clients and advocates have been working for many years to achieve meaningful regulation for midwives in Massachusetts. The current bill this radio show refers to would create a Board of Registration of Midwifery, which will license and regulate the practice of Certified Nurse Midwives (CNMs), Certified Midwives (CMs), and Certified Professional Midwives (CPMs). The point of having such legislation is both to create a reasonable system of accountability AND to increase access to midwives in all settings.
There is no one type of provider or one birth setting that is best for all pregnant women, because we are all unique individuals. There are always some risks in childbirth, no matter where or with whom you give birth. For most women, pregnancy is a normal process that proceeds on its own unless interfered with, but this process can also be affected by the mother’s beliefs and feelings, and by how she is treated by the people who are with her and their beliefs about birth. Furthermore, a great deal of standard hospital and obstetric practices and interventions applied to women in labor are not based on any evidence at all. Therefore, it is only reasonable that women should have a range of proven options available to them. Passing legislation that enables credentialed midwives to practice legally and with accountability makes sense. No one is going to force any woman to have a home birth, or to have a midwife, but for those of us who would prefer to be attended by a midwife in hospital, birth center or home, such legislation would certainly increase our options.
ACOG is a professional organization accountable only to its members. It does not have evidence to support its anti-home birth stance, it is based purely on belief! See their statement at http://www.acog.org/from_home/publications/press_releases/nr02-06-08-2.cfm . It states: “ACOG believes that the safest setting for labor, delivery, and the immediate postpartum period is in the hospital, or a birthing center …” without citing a single reference to support this “belief”. So much for scientific medicine. In fact, a large collection of studies over many years and in a number of countries has consistently shown that for a woman having a normal pregnancy a planned homebirth with a trained midwife is as safe as the hospital, with far fewer interventions and less morbidity for mothers and babies. (for just one example, see http://www.cfmidwifery.org/pdf/CPM2000.pdf and see more fact sheets and resources on the CfM website).
Obstetricians and hospitals are not accountable for their outcomes. For example, while the cesarean rates have been increasing every year (now over 30%!!) in the absence of any medical justification for such high rates, no one in state or federal government offices has even been asking: Are we having better outcomes for mothers and babies with these rates of cesarean sections? In fact, research has shown that when cesarean rates rise above 10 to 15%, more babies and mothers die than are saved by the surgery. Similarly, no one has been asking about outcomes related to the huge increases in induction, use of drugs to intensify labor, and use of epidurals. In contrast, even the relatively rare instances of a midwife transferring a laboring woman to a hospital for medical care usually are scrutinized critically.
Informed consent in hospital-based maternity care in general is a joke – women are not adequately informed about the pros and cons (including the % risk) for specific interventions and for NOT doing the intervention. Hospitals and obstetricians rarely if ever inform women that there are economic incentives behind each and every “suggested” practice and intervention, ie, conflicts of interest. In contrast, most states that regulate out-of-hospital midwives require extensive disclosure documents that the client must read and sign.
A woman can find out far more information about a used car than she can find out about her obstetrician. In most states, she may be able with some difficulty to find out rates for some interventions (cesarean section, induction) and outcomes (perinatal death, maternal death) for a local hospital, but not for individual obstetricians. For rates of episiotomies and cesarean sections, research has shown enormous variation among individual providers, even within the same hospital, demonstrating the lack of evidence for the high rates of these practices. A midwife is trained to observe and monitor, but not to intervene unless there is clear justification, because her focus is on supporting the normal birth, not getting in the way. For most women choosing a midwife, especially outside the hospital, she can be pretty sure she will not be subjected to any unnecessary interventions.
Nearly 25 years ago, when intervention rates were far lower than today, I was pregnant with my first baby. My husband (a scientist, and from a medical family) and I did extensive research regarding our options and birth practices. Even then, there was plenty of evidence that unless you had a real medical reason to be in a hospital to give birth, you would be better off at home with a midwife. As a result, at 7 ½ months we switched to a home birth midwife (who happened to be one of very few CNMs with a home birth practice at that time). It was one of the best decisions I’ve ever made. Not only did I get outstanding care and support, but my midwife competently, safely and non-intrusively addressed a minor “variation on normal”; had I been in the hospital, standard practice would almost certainly have caused a life-threatening hemorrhage. Glad I was at home with a midwife!
Susan Hodges
Disclosure: I am a founding member of and current president of Citizens for Midwifery, a national non-profit organization providing information about midwives and the Midwives Model of Care.
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