worthy of forwarding to local news editors!
there's a PDF version at mana.org
steve

President’s Editorial


July 11, 2008


[[]]


Midwives Alliance of North America

611 Pennsylvania Avenue SE # 1700

Washington, DC

20003-4303


Contact:

Geradine Simkins

president@mana.org <mailto:president@mana.org>

888-923-MANA (6262)

info@mana.org <mailto:info@mana.org>

www.mana.org <www.mana.org/>

















Doctors Ignore Evidence,


AMA Seeks to Deny Women Choices in Childbirth



One wonders what process the American Medical Association (AMA)
House of Delegates used to determine that “Resolution 205 on
Home Deliveries” was a prudent and reasonable proposal to
adopt. AMA Resolution 205 attempts to outlaw a woman’s choice
to birth at home or in a freestanding birth center by calling for
legislation to establish hospitals and hospital-based birth
centers as the safest place for labor, delivery and postpartum
recovery. Further, Resolution 205 seeks to establish that
hospital-based midwives who work under the control of physicians
are the only safe midwifery practitioners.



The Midwives Alliance of North America, which has represented the
profession of midwifery since 1982 and whose members are
specialists in homebirth, finds AMA’s Resolution 205 to be
arrogant, patronizing and self-serving. We have three major
objections to Resolution 2005. First, Resolution 205 patently
ignores the vast body of scientific evidence that has documented
homebirth to be a safe, cost-effective and satisfying option for
women who prefer this alternative to hospital birth. Second, AMA
Resolution 205 is seriously out-of-step with the ethical concept
of patient autonomy in health care (encompassing both informed
consent and informed refusal), which has gained widespread
acceptance in the medical community. And third, Resolution 205
distracts from other critical issues in maternity care to which
healthcare professionals should be giving substantial attention,
including increasing access to care, improving perinatal
outcomes, reducing health disparities and fostering client
satisfaction. AMA Resolution 205 is anti-homebirth, anti-midwife,
anti-choice and is unsupported by scientific evidence.



Why is the American Medical Association not asking the real
questions instead of trying to debunk existing research evidence
on the safety and efficacy of homebirth and attempting to corner
the market on maternity care? For example, why are
midwife-attended births far more likely to have fewer
interventions, fewer postpartum infections, more successful
breastfeeding rates, healthy infant weight gain and result in
more satisfied, empowered mothers ready to embrace their newborns
and parenting experiences? Why are so many women across the
nation left emotionally traumatized by their childbirth
experiences in hospitals and consequently why do rates of
postpartum depression, anxiety and post-traumatic stress continue
to escalate?



It is ironic that the AMA should have a quarrel with a known safe
birth option such as homebirth at the same time when the epidemic
rise in coerced or elective cesarean sections puts healthy
mothers and infants at greater risk than normal vaginal birth and
causes excess strain on the limited resources of our healthcare
system. The rate of cesarean sections in the United States is
unacceptable—one in three pregnancies end in major abdominal
surgery—and the decline in availability of vaginal birth
after cesarean (VBAC) is deplorable. It is unethical to expect
that women and infants should continue to bear the brunt of
increasing medical malpractice risks by over-treating them with
obstetric technologies such as c-sections while denying them safe
evidence-based options such as VBAC. It is past time that the AMA
in collusion against homebirth with the American College of
Obstetricians and Gynecologists (ACOG) realizes that women and
their partners are choosing to labor and deliver at home and in
freestanding birth centers to avoid ethically unsupported
obstetric interventions.



Modern medical ethics have evolved to embrace
autonomy—patient choices and patient rights—over medical
recommendations based on paternalism or physician preference. In
almost all areas of modern medicine, except obstetrics, the locus
of control rests firmly with the client or patient and not with
the medical provider. It is a commonly held principle that it is
not appropriate to force medical treatment upon clients or
patients against their will, including medications, blood
transfusions, chemotherapy or even life-saving surgeries.
Informed consent has appropriately become the gold standard in
healthcare decision-making. Why then do the AMA and ACOG believe
that they can promote legislative efforts to deny women choices
in maternity care providers and childbirth settings? In the 21st
century this concept is outdated and absurd.



The AMA and its members might consider using their considerable
energy, intelligence and resources to focus on promoting the
health and well-being of mothers and babies and devote less time
to limiting women’s access to midwifery services. All
maternity care providers should band together to reduce the
unacceptably high rates of maternal and infant mortality and
morbidity in the United States, increase access to maternity care
for all women, reduce unnecessary cesarean sections, encourage
vaginal birth and VBACs for healthy women, reduce health
disparities of women and infants in minority populations, and
promote increased breastfeeding. These challenging but attainable
goals would improve the health of mothers and babies far more
impressively than reducing the rates of homebirth.



The Midwives Alliance joins the other individuals and
organizations, including individual AMA and ACOG members, who
have grave concerns about the AMA taking the stand articulated in
Resolution 205, and calls for the AMA to abandon this resolution.
Midwives everywhere honor and respect the numerous friendly
physicians with whom we already partner and look to the day when
midwives and obstetricians will consistently work collaboratively
to support women’s choices in childbirth and provide the best
possible and most appropriate range of services for every
situation.



References


1. K.C. Johnson, B.A. Daviss, Outcomes of Planned Home Births
with Certified Professional Midwives: Large Prospective Study in
North America, British Medical Journal 2005; 330: 1416 (18 June).
1. Royal College of Obstetricians and Gynaecologists and Royal
College of Midwives Joint Statement No. 2, April 2007. See
www.rcog.org.uk/index.asp
<www.rcog.org.uk/index.asp
1. Wiegers TA, Keirse MJ, Van der Zee J, Berghs GA. Outcome of
planned home birth and planned hospital births in low risk
pregnancies: prospective study in midwifery practices in the
Netherlands. BMJ 1996; 313:1309–13.
1. Olsen O. Meta-analysis of the safety of the home birth.
Birth 1997; 24:4–13.
1. Ogden J, Shaw A, Zander L. Deciding on a home birth: help
and hindrances. Br J Midwifery 1997;5:212–15.
1. Canadian Institute for Health Research Giving Birth in
Canada: Regional Trends From 2001-2002 to 2005-2006.
secure.cihi.ca/cihiweb/en...iB_FINAL_E
.pdf
<secure.cihi.ca/cihiweb/en...AiB_FINAL_
E.pdf>
7. CMAJ Maternal mortality and severe morbidity associated
with low-risk planned Cesarean delivery versus planned vaginal
delivery at term. www.cmaj.ca/cgi/reprint/176/4/455.pdf
<www.cmaj.ca/cgi/reprint/176/4/455.pdf>
8. Listening to Mothers II Report (2006.) Childbirth
Connections, www.childbirthconnection.org/article
<www.childbirthconnection.org/article>