Friday, June 20, 2008

It's a Civil Rights Issue

I read a lot of blogs: family blogs, friends' blogs, knitting blogs, AP blogs, and birthing blogs. Lately the birthing blog realm has been in a flurry about the AMA's new statement.

And I quote from item #205:

That our American Medical Association support the recent American College of Obstetricians and Gynecologists (ACOG) statement 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 American Academy of Pediatrics (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” (New HOD Policy); and be it further

RESOLVED, That our AMA 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.”


Interestingly, my sister-in-law, sent me a news article about Ricki Lake's response (response here).

What's going on here? First, for those of you not interested in the birthing world, I'll give some background:

This year has seen some pro-midwife action: The Business of Being Born by Ricki Lake, and The Big Push.

In response, ACOG released an anti-homebirth statement and I just posted AMA's statement.

However, the World Health Organizaion (WHO) has published this about place of birth (my added emphasis in italics):
The call for a return to the natural process in many parts of the developed world opened up delivery rooms to fathers and to other family members, but the location stayed the same: the hospital. Some hospitals have made an effort by installing a home-like birth room and this was found to increase maternal satisfaction and reduce the rate of perineal trauma, as well as reducing the desire for a different setting for the next birth, but randomised trials found no effect on the use of epidural analgesia, forceps delivery and caesarean section (Klein et al 1984, Chapman et al 1986). These trials were primarily concerned with a more attractive labour ward setting without a fundamental change in care; apparently this is not enough to improve the quality of care and the obstetric outcome.
Other studies found that a woman with a low risk delivery giving birth to her first child in a teaching hospital could be attended by as many as 16 people during 6 hours of labour and still be left alone for most of the time (Hodnett and Osborn 1989b). Routine, though unfamiliar, procedures, the presence of strangers and being left alone during labour and/or delivery caused stress, and stress can interfere with the course of birth by prolonging it and setting off what has been described as a "cascade of intervention".
....

So where then should a woman give birth? It is safe to say that a woman should give birth in a place she feels is safe, and at the most peripheral level at which appropriate care is feasible and safe (FIGO 1992). For a low-risk pregnant woman this can be at home, at a small maternity clinic or birth centre in town or perhaps at the maternity unit of a larger hospital. However, it must be a place where all the attention and care are focused on her needs and safety, as close to home and her own culture as possible.

My opinion: First, in almost all cases, homebirth is the safest option. It prevents intervention which prevents complications which prevents both mother and child deaths. I don't think that the AMA and ACOG seriously have women's health and safety in mind (and definitely not civil rights). I don't know why AMA and ACOG feel threatened and feel like they have to defend the hospital. If they want hospitals to be the #1 choice for birth, then they ought to be trying to understand why women choose against it (is it because of atmosphere? procedures? the attitudes of the staff?) and help the doctors and physicians in their organizations cater to the laboring woman instead of planning to use legislation to overrule a woman's right to be in her own home. You can't force people to respect you by taking away their civil rights. It's ridiculous to say, "I'm sorry- but you have no right to be in your own home." If they're worried about losing "customers" then why don't they try improving their product instead of forcing people to use their services? Maybe I'm crazy, but I always thought that a doctor is supposed to help people.
I like how one person put it, "What’s next- plumbers making a law that says that I can’t unclog my own toilet, I have to call them to do it? It’s certainly risky- Lord knows what could come out of there! Someone could lose an eye!"

I'm not against doctors, but I do believe they should be used on an as-needed basis. I'll call one if I need one. Birth doesn't require a professional, so I won't be calling one.

Heather's birthing checklist:
  • A laboring woman.


Yup. That's about it for necessities.

3 comments:

  1. Arg! Why do they keep trying to do this?! I read the quote to my husband and he said "that is just plain unconstitutional." I agree! Soon they will be telling us that breastfeeding is only safe behind closed doors and if we want to come outside we need to bottlefeed! Or perhaps they might even say that public breastfeeding is traumatic for others to see. This is getting beyond ridiculous. Why is it that anything that is natural has to be declared to be unsafe, unsavory or unfair?

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  2. Hi Heather,

    I think I'm the most pro-UC of any never-would-UC person I've ever heard of. I think UC and homebirth people are especially supported by the "cascade of intervention" that you mention.

    So often when people say they "would have died in birth" if they hadn't been in a hospital, in almost every instance, the birth began with an intervention, so it's impossible to guess how things could have been different.

    However, I have to quibble with just one part of your post, and that is where you say that birth doesn't require a professional. I think birth does require a professional, AND/BUT I think that a woman can become a professional in birth by preparing, studying, attending births, working with midwifes and doulas, etc.

    I think you risk sounding as if you think no education/preparation/forethought is required when you dismiss "professionals" completely.

    Instead, women should be empowered to become their own "professionals," to redefine what it means to be an "expert" on what is a normal function, not a pathology.

    Otherwise, great post!

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  3. I love your birth checklist!!! Awesome. I didn't even buy a birthing kit - all I got was a shower curtain liner and a pkg of Depends. LOL

    *I* am the expert on my own body, and I am very satisfied with that. Be on the lookout for another UC story any day now!

    ReplyDelete

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