Monday, June 30, 2008

Monday, June 23, 2008

The AMA on Home Birth (updated)

Those of you in the birth world have probably heard about the AMA's recent position statement on home birth. I've come across a multitude of responses to the AMA, and I'll try to repost as many as possible here. Ricki Lake was interviewed by the AP about the resolution, which mentioned her specifically. (The AMA has since removed the reference to Ricki Lake.)

Responses to the AMA have come from all over: midwifery and childbirth-related organizations, physicians, midwives, journalists, and, of course, bloggers. If you come across other responses worth mentioning, please include a link in the comments section.
  • Our Bodies, Ourselves (aka the Boston Women's Health Collective) responds
  • Ricki Lake, Jennifer Block, and Abby Epstein wrote a response to the AMA in the Huffington Post: Docs to Women: Pay No Attention to Ricki Lake's Home Birth.
  • In Responses to AMA/ACOG Strong-Arming Women, author Jennifer Block includes responses from family-physician-turned-obstetrician Andrew Kotaska (who is one of my obstetrician heroes--you can read more about him in Pushed) and the UK-based National Childbirth Trust and the Independent Midwives' Association. An excerpt from Kotaska's response:
    • "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)....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."
  • This release from Ohio Families For Safe Birth contains comments from several physicians who support women's right to choose home birth.
  • A lengthy response to the ACOG and AMA statements on home birth from OB/GYN Stuart J. Fischbein. Also mentions VBAC policies--worth the read!
  • Author Tina Cassidy writes about Making Home Birth Illegal?
  • The Big Push For Midwives calls it Father Knows Best Meets Big Brother Is Watching.
  • Navelgazing Midwife argues that "it is the hospital system itself that writes the homebirth script." I don't entirely agree with her argument that home birth's existence is only a function of the current hospital birth climate, but it is definitely a strong factor.
  • Family physician Denise Punger discusses why she will not join the AMA. In the post, she writes:
    • "When ACOG came out with their statement Permission to Mother was not published yet, but now I can say I have a book that describes in a stepwise, logical progression from medically managed birth to my breech homebirth (where no doubt I was in the safest place for my circumstances). Permission to Mother is my response to this financially & selfishly motivated statement which does not look out for the best interest of women and their families."
  • Midwife Pamela Hines-Powell responds briefly and includes other responses to the AMA.
  • Hathor the Cowgoddess has devoted several recent comics to the topic.
Some of the many blogger responses to the AMA statement:
Below is an email Ricki Lake sent out on June 18 about the AMA resolution:
June18, 2008
Dear BOBB Friends and Supporters:

We wanted to make sure you are all aware of the news story that has exploded over the last 24 hours regarding the recent AMA Resolution against homebirth and Ricki's response to being named in it.

In February of this year, one month after the premiere of BOBB, the American College of Obstetricians and Gynecologists (ACOG) reiterated its long-standing opposition to home births. In an obtuse reference to The Business of Being Born, ACOG stated, "Childbirth decisions should not be dictated or influenced by what's fashionable, trendy, or the latest cause célèbre." If that wasn't enough, ACOG, this past weekend, 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...". The reasoning for this resolution begins, "Whereas, There has been much attention in the media by celebrities having home deliveries, with recent Today Show headings such as "Ricki Lake takes on baby birthing industry: Actress and former talk show host shares her at-home delivery in new film...". (Resolution 205, click here to read).

Since when did Ricki become an evidence-based data point? What are they so afraid of?

Just last week, Medical News Today reports that "about 8.2% of infants born in the US in 2005 had low birth weights, the highest percentage since 1968." US infant mortality rates continue to rank us below 30 other countries, 22% of pregnancies are induced, and most worrisome of all, in the last 4 years, the maternal mortality rate has risen above 10 per 100,000 for the first time since 1977. To us, these seem like the troubling trends, not home birth.

News outlets including the AP quickly picked up this story yesterday as it hit TMZ, E! USA Today, Daily News, FOX.

Ricki will be featured on Good Morning America this Saturday discussing the controversy. (If you Google "Ricki Lake, AMA" you will see the bloggers are all over this!)

Filmmakers Abby Epstein and Ricki Lake teamed up with journalist and Pushed author Jennifer Block to pen the response (following at the end of this email) for the Huffington Post (click here to read).

Late yesterday, the AMA changed the final wording on resolution 205 to omit the mention of Ricki. (Hmmm...) The AMA says that the American College of Obstetricians and Gynecologists (ACOG) drafted the initial statement so any issues should be taken up directly with them.

Stay tuned for more news to come...

The BOBB Team
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Nice is nice

We just arrived in Nice, France yesterday, where we'll be working over the summer. Eric will be directing a summer study abroad program for high school students. It's a French immersion dormitory program with 85 students in a beautiful residential French school in the heart of town. For the past 7 years, I have co-directed French study abroad programs with my husband, but this summer I am just doing the accounting in exchange for my plane ticket. I am excited for 5 1/2 weeks of summer in the French Riviera!

I brought just one baby carrier with me, my Fauxhawk, and I think I'll need either a stroller or a baby backpack. I thought she'd be able to walk farther distances, but she can only go so far on foot. And it's too hot with her directly on my back, except for short walks or late in the evening. I had a hiking backpack that I bought at a consignment store, but it started falling apart at all of the stress points in the past few weeks, and now it has no structural integrity. I was disappointed that it only lasted 9 months. Since we have a great running stroller back home, I think I'll look for an inexpensive umbrella style stroller.

The past 3 weeks have been incredibly busy: getting an offer on our house, packing and moving and then driving back to our old town (all of our flights were booked before we put our house on the market), going to family reunions in northern Wisconsin and upstate New York, and then traveling to France. Zari didn't handle the jet lag very well this year, but it was probably because she also got sick during the plane ride: fever and nausea. She's in a much better mood today after a long, but fitful, night's sleep.

Zari is pulling toilet paper off the roll and putting it into the toilet. At least she knows where it belongs...I better go!
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Wednesday, June 04, 2008

Separate and Unequal

In this excerpt from a book-in-progress, Faith Gibson describes working as a L&D nurse in a segregated maternity ward in the South. She contrasts the care that white and black mothers received. Ironically, black mothers and babies fared much better because the institutional "neglect" allowed them to have physiological births with very little disturbance or management. From the early 1900s and well into the 1970s, the standard of care for white mothers in this hospital included separation from family members, enema & shave, confinement to bed, heavy use of narcotics and Scopolamine during labor and general anesthesia during the birth, episiotomy and forceps delivery, and separation of mother and newborn.
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Tuesday, June 03, 2008

Survey on Birth Choices

I’m passing this along for Holly Witteman, a PhD student at the University of Toronto. Please participate!

ETA: Holly just contacted me, and she has closed some of the surveys because they have received so many responses. Thanks to everyone for participating! She is still looking for American women who fit any of the following criteria:

- have chosen to give birth at a birth center
- have chosen to give birth attended by a family physician
- have chosen to give birth unassisted (unassisted will close soon -- that bin is almost full.)

She is also still looking for responses in all categories from women who live in Canada.

Subject: Research study about choice of birth place (home, hospital, birth center) and birth attendants (OB, FP, MW, UC)

A group of researchers at the University of Western Ontario, the University of Waterloo and the University of Toronto in Ontario, Canada, and Dalhousie University in Nova Scotia, Canada invite you to complete a survey about where and with whom you choose to give birth.

Are you or were you planning an "elective" c-section? A hospital VBAC? A midwife-attended homebirth? An unattended childbirth? We would like to hear about your choices and ask you some questions about yourself and how you made your decisions.

You may be eligible to participate in this survey if you are currently pregnant or have had a baby in the last 12 months.

The survey will be completed online and will take about 30 minutes. We are looking for 400 women total to complete the survey. We will randomly select four (4) out of the 400 women to receive an honorarium. Each of those four women will receive a $100 gift certificate to,, or her country's Amazon.

If you are interested in taking the survey, please follow the link to learn more about the study and see if you are eligible to participate:
Holly Witteman
Ph.D. candidate
Interactive Media Lab
Human Factors
Mechanical and Industrial Engineering
Doctoral Fellow
Health Care, Technology and Place
University of Toronto
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Do the math

Hathor the Cowgoddess had me laughing over the new VIP concierge services some physicians are offering. For only $15,000 cash, in addition to the normal charge for prenatal care & delivery, you can receive extra services such as:
  • limited number of patients, so the physician can devote more time to each patient
  • no waiting
  • longer office visits
  • round-the-clock availability via e-mail or cell phone
  • private birthing classes
  • one massage per trimester
  • optional home doctor visits
  • guarantee that the physician will be at the hospital for her patients' full active labor and delivery
So, you can pay the full cost for prenatal care & birth (with or without insurance coverage), plus an additional $15,000 to get these "extra special" services. Or you can pay $1,000-4,000 total (and less if your midwife accepts insurance) to get all prenatal, birth, & postpartum care and those extra-fancy services, and more, as the standard of care from your midwife.

From the article on VIP treatment:
Most physicians who offer concierge health care recognize the absurdity in paying so much to get the same kind of treatment — the non-medical perks aside — that used to be standard. But the model of the amiable country doctor who knows your kids and treated your grandparents has been replaced by a bureaucratic insurance behemoth that rewards physicians for seeing more patients in less time.
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