“ACOG State Legislative Update Year In Review (August 2007)” begins by noting “troubling trends” in state legislation and sets the tone for the bias of this opinion from the American College of Obstetricians and Gynecologists (ACOG). There are four trends ACOG finds troubling: right to home birth bills are on the rise, more midwives not recognized by medical associations are being licensed by states, midwives appear to have a public advantage and finally that ACOG considers itself on the defensive today.
The facts ACOG provides are clear and succinct in their first two cases, but are opinion laden in the latter. More home birth bills are being introduced and those that have been in debate for years now are finally passing. For example, Virginia recently passed legislation protecting women’s rights to birth at home and in 2007 Missouri granted midwives licensure. It is also true that states are granting Certified Practicing Midwife (CPM) licensure, hands-on training including non-medical skills. This is not the same training model as the medical path for midwifery recognized by ACOG and the American College of Nurse Midwives. ACOG does not debate the safety of home birth but rather goes into examining why midwifery and home birth are gaining groundswell support.
ACOG tells us that midwives have learned how to “work” the legislative system and are now using the same tactics ACOG has used themselves: lobbying and propaganda. Midwives have been so successful that they have garnered endorsement from the American Legislative Exchange Council (ALEC) for a model to license Certified Practicing Midwives. ALEC’s endorsement is powerful because it is conservative in nature and therefore, an endorsement renders the CPM licensure model credibility. ACOG’s illogical stand is, without medical training, midwives are an unsafe choice.
However, ACOG pointedly leaves out the basis for recognizing midwifery: it is not the practice of medicine. This is critical to understanding the process by which midwifery is recognized and can be protected as a viable option for birth care. Connecticut is undergoing the struggle to create a definitive line on the issue of whether or not midwifery is practicing medicine. Almost ten years ago midwife Donna Vedam found herself on trial for practicing medicine. The courts determined she was, in fact, practicing midwifery and midwifery is not medicine. Then in 2006 the state’s Medical Examining Board (MEB) found another case to try, midwives who made the right decision, transferring a mother whose birth was not an emergency but should have the medical care her evolving situation might call for available. The educated decision these midwives, Joan Mershon and Mary Ellen Albini, made in transferring the mother is argued by the MEB as practicing medicine. There is an irony as midwives finding themselves hounded for providing midwifery care are also persecuted for transferring the mother into appropriate medical care. The outcome of the birth was a fine healthy baby and mother. Both mother and father refuse to testify against the midwives.
ACOG states that midwives have the public advantage of winning support through the use of the buzz words “safety” and “choice.” Their case – that this advantage is an unfair one – is not fact based. They argue that home birth is safe in the Netherlands only because everyone lives near a hospital. There is no evidence in that statement at all. It only implies that home birth is safe only when it takes place near a hospital. Their statement is not a case and it is clear they cannot even make the effort to understand what home birth care is. It is evident that they fear what they do not understand, what is different.
Further, ACOG also argues that comparisons of home birth and hospital birth cannot be compared because the studies are not scientifically rigorous. This also ignores the basis for home birth care: birth occurs naturally and organic without active management. Therefore as each mother-baby pair is unique, they cannot be controlled.
ACOG’s final cited troubling trends is, interestingly, presented last. It should have been first as it clearly state’s the article’s bias: ACOG is on the defensive. ACOG is clearly feeling not only outmaneuvered, but also recognizing that they placed themselves in this position. For example, it is ACOG who made it difficult for hospitals to provide care for women who want birth vaginally after having had a surgical delivery (cesarean) also known as a VBAC (Wagner). Yet, their position in this paper is that women are seeking out alternatives, home birth with midwives, since their care providers cannot provide VBAC as a birth care option.
ACOG closes the article stating that their position is that legislative support for midwives is not won on merit but rather a sympathetic public and press. Additionally, ACOG says, it finds itself in a situation where showing up in large numbers when they can give testimony makes them appear to be engaging in a “turf battle” rather than a credible alliance. This is the plea that they make to find or create alliances with other organizations. Make no mistake, this is not a light objective to note as some pediatric and newborn service providers have jumped onto ACOG’s wagon.
This written public statement is clearly an opinion piece reporting facts that are driving ACOG to explore options for defeating midwifery and home birth as a legally protected option for women. It fails to cite any merits for this position and in fact the “uninformed public” they lament could also be the informed reader’s lament for the uninformed public may not understand that denying American women access to home birth is a clear violation of every American citizen’s right to privacy and right to choose what care or actions are taken upon their bodies.
What did 2008 bring us at Independent Childbirth? Many, many, natural, spontaneous unmedicated labor and birth over an intact perineum taking places in homes, birth centers and a few hospitals under the expert care and guidance of independent midwives and enlightened midwifery/ob practices.