Below are two responses to the AMA/ACOG’s resolution to limit women’s autonomy in how, where, and with whom they give birth. The first is from Canadian physician and researcher Andrew Kotaska, the second is from the National Childbirth Trust in England, where the government is encouraging women to consider home birth! More bloglinks and repsonses to come. If you have one you’d like to see posted, send it here.
“ACOG should join the 21st century”
I would invite ACOG to join the rest of us in the 21st century.Modern ethics does not equivocate: maternal autonomy takes precedence over medical recommendations based on beneficience, whether such recommendations are founded on sound scientific evidence or the pre-historic musings of dinosaurs. In the modern age, the locus of control has, appropriately, shifted to the patient/client in all areas of medicine, it seems, except obstetrics. We do not force patients to have life-saving operations, to receive blood transfusions, or to undergo chemotherapy against their will, even to avoid potential risks a hundred fold higher than any associated with home birth. In obstetrics, however, we routinely coerce women into intervention against their will by not “offering” VBAC, vaginal breech birth, or homebirth. Informed choice is the gold standard in decision making, and it trumps even the largest, cleanest, RCT.(randomized controlled trials).
Science supports homebirth as a reasonably safe option. Even if it didn’t, it still would be a woman’s choice. ACOG and the AMA are, by nature, conservative organizations; and they are entitled to their opinion about the safety of birth at home. As scientific evidence supporting its safety mounts, however, (to which BC’s prospective data is a compelling addition) they will be forced to accede or get left behind. The concerning part of this proposed AMA resolution is the “model legislation. ”
If ACOG and the AMA are passive-aggressively trying to coerce women into having hospital births by trying to legally prevent the option of homebirth, then their actions are a frontal assault on women’s autonomy and patient-centered care. Hopefully the public and lawmakers realize the primacy of informed choice enough to justify Deborah Simone’s words: “We don’t need to be angry or even react to these overtly hostile actions from the medical community. We just need to keep doing what we do best; the proof is always in the pudding.”
It is sad to see the obstetrical community still trying to earn itself a wooden club as well as the wooden spoon; if the resolution passes, it is sad to see the politico-medical community helping them.
NCT and the Independent Midwives’ Association (IMA) voice concern over actions of ACOG on home birth
NCT and the Independent Midwives’ Association (IMA) today voiced concern at the recent actions of the American College of Obstetricians and Gynaecologists (ACOG), that seek to undermine and threaten American women’s opportunities to give birth at home.
The NCT and IMA call on the ACOG to reconsider their position as a matter of urgency. Following the example of its international counterparts it should consider all available evidence on the benefits and risks of home birth. Women in America should have access to home birth rather than being limited simply to the medicalised model of birth available in US hospitals.
In February this year the ACOG reiterated its long-standing opposition to home births. More recently, the ACOG, introduced a resolution to the American Medical Association (AMA) at their annual meeting. The resolution commits the AMA 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…”.
NCT and IMA are members of the Maternity Care Working Party (MCWP), which advises members of the United Kingdom Parliament on maternity care and services.
Counted among the membership of the MCWP, are the Royal College of Obstetricians and Gynaecologists (RCOG), the UK equivalent of the ACOG, as well as the Royal College of Midwives. These two organisations issued a joint statement in April 2007 on home births which states:
“There is no reason why home birth should not be offered to women at low risk of complications and it may confer considerable benefits for them and their families. There is ample evidence showing that labouring at home increases a woman’s likelihood of a birth that is both satisfying and safe, with implications for her health and that of her baby.” (Royal College of Obstetricians and Gynaecologists/Royal College of Midwives Joint statement No.2, April 2007)
NCT and IMA also believe that all women should have access to a home birth and up-to-date evidence-based information that addresses their questions, so they can make the right choice for them.
Home birth should be considered a mainstream option and offered as a regular choice for pregnant women using the health service, whichever country they reside in. For a healthy woman with a straightforward, low-risk pregnancy, home birth is a safe option. It is important that midwives provide care for women at home and that they have experience in home birth, receive active support and supervision, and that their training needs are met. Women’s individual needs must be assessed and the back up of a modern hospital system, with good communication and transport links, are important, should transfer be needed.
The views of the NCT and IMA are supported by UK Government policy which seeks to reduce unnecessary interventions in childbirth and increase the numbers of women who experience a normal birth.