Saturday, October 22, 2011

Home Birth Summit

I just came home from the Home Birth Summit. It was 2 1/2 exhausting but rewarding days of dialogue, discussion, and consensus-building. I was thrilled to be in a room with all of the key stakeholders in home birth and to have honest, open conversations about such a normally divisive issue.

At the end of the Summit, we (meaning all 80 of us delegates) came to consensus on nine key points. We're waiting back for the written report, but in the meantime here are 8 of the 9 main topics. I am totally blanking on the ninth!:
  • Role that liability and (fear of) litigation play in increasing costs, decreasing access, restricting collaboration and narrowing women's childbearing choices
  • Importance of childbearing women's autonomy and shared decision-making
  • Linked data collection and sharing
  • Need for collaboration between providers and a system to enable safe, seamless & respectful transfers of care
  • Involving consumers in physician & midwife organizations 
  • Need to address midwifery licensure in all 50 states, including dialogue on CPM core competencies, working towards licensing DEMs (most likely CPMs, perhaps expanding CM credential) in all 50 states, & eliminating CNM practice barriers
  • Addressing inequalities in maternity care (access, affordability, outcomes, etc.), especially for poor, rural, & minority women
  • Valuing both physiological birth and the timely & appropriate use of evidence-based interventions
The English professor in me was wincing at times; when you're writing these kind of statements by committee, the language tends to get stilted and overly wordy...but I just had to take a few breaths and let that pass.

I was thrilled that we accomplished so much in so little time. What we did at the Summit was huge. For example, we had the president-elect of FIGO and the immediate past president of ACOG hammering things out with the president of MANA and an epidemiology professor and a malpractice insurer and a direct-entry midwife. (Remember, of course, that all stakeholders attended on their own, not as representatives of their organizations.)

And of course, we had some fun along with all of our work. We had a running joke going about the disappearance of pubic hair in obstetrics (one of those "you had to be there" moments). We also met last night to share birth stories. I showed the video of Inga's birth and I was so honored that such a mixed group got to see and talk about it.

One of my favorite activities was when each stakeholder group created a Proud/Sorry list: 3 things they were proud of and 3 things they were sorry for. Jill of The Unnecesarean and I immediately turned to each other and said, "We are sorry for fanning the flames of divisiveness through anti-OB and anti-hospital rhetoric." That became #1 on our Sorry list.

Over the years I've been blogging, I've matured a lot in my rhetoric and understanding of birth and breastfeeding. I find myself more willing to embrace other viewpoints, less strident in my advocacy for home birth or natural birth (although I still feel passionately about it), and more eager to engage in true dialogue with those groups typically cast as the enemy. Repeat after me: Doctors are not the enemy. Hospitals are not the enemy. (If anyone or anything is--and I think almost everyone at the Summit would agree--it is our malpractice/litigation system.)

The OB group's Proud/Sorry list--which stretched far beyond three items in both categories--was particularly touching. It's too bad we don't have more opportunities for this kind of sharing and conversation. I think we'd find we have so many common goals and that the stereotypes just don't hold up.

I better stop now before I start singing Kumbaya and getting all touchy-feely on you.


  1. How exciting! I wish I'd been there - I'm so glad you were able to go! I'd love to hear more about what you all discussed!

  2. "I've matured a lot in my rhetoric and understanding of birth and breastfeeding. I find myself more willing to embrace other viewpoints, less strident in my advocacy for home birth or natural birth (although I still feel passionately about it), and more eager to engage in true dialogue with those groups typically cast as the enemy. "

    Yes. A thousand times yes. We all need to get a handle on the youthful zeal of a newly held idea and stop brandishing it like a rookie fencer.

    Honestly, I think that is the only thing that will ever move the abortion debate forward. We have to stop speaking *at* each other and start speaking *with* each other.

    I'm glad you had such a great experience there. I am not a professional birth attendant, but I sure love living vicariously via the internet!

  3. The ninth was about interdisciplinary education. It was great chatting with you at the conference!

  4. -Ali AKA anonymous apparently

  5. ....there was no consensus on Koombaya, I said that we COULD NOT sing that song much to the chagrin of one of my work group mates. The koombaya times they are a changin'. Of all the stakeholders at the table I found the doctors, (OBs and Family docs, to be the most needed.) Now the real work begins the HBCS was but a beginning.

  6. I would love to hear what some of the OB proud/sorry statements were.

  7. Glad you were a part of it Rixa. Can't wait to read all about it. Jenny Hatch

  8. I love the bit about mature rhetoric -- I remember reading some of your posts around the time of Zari's birth and being slightly turned off (though obviously not a lot as I continue to read!) by the "feel" of some of them. I can't say I remember specific words, phrases, attitudes; but I believe it IS true that your work now seems a lot more easy to relate to for someone who doesn't know where they stand on hospital vs. natural birth.. or should I even say versus?

  9. A lot easier.. sorry English professor, been a long week. :)

  10. Thank you for sharing this! I hear you on "mature rhetoric". When we take a strong stance on one side or the other, we alienate people. This causes an inability to accomplish anything. It's why I'm a middle of the road mama and childbirth educator.

    Been blogging about it recently too and here

    Keep us posted on further homebirth summit info. Thanks much!

  11. LoL, English Professor. I'm supposed to be grading right now but took a break. It's amazing how poorly students write tests w/o "spell check," for example.

    Anyway, I'm looking forward to reading more about the HB summit. And I don't think you need to apologize - different place & time in your life, ya know? My views on it all have REALLY changed over the years, as well. And of course my VBA2C (which was supposed to have been a HBA2C had I not been dumped by my CPM at 41.5 weeks) really changed my view on birth.

    xo Kimberly

  12. Sounds fantastic. I can't wait to hear more.

  13. Thanks for posting, great anecdotes. I'm interested in how your impressions evolve post-conference high, and what real-world impact you think this is going to have (maybe your next post?). Funny about the pubic hair disappearance. I was just at a sexual medicine conference and there, too, it was the frequent chuckle among the nurses/docs. "Formerly hair-bearing skin" was how they put it!

  14. Sounds like it was a great experience! thanks for sharing what your consensus was. Those are great.

  15. Everything I've heard about the Summit makes me think it was an extraordinary experience. Even the model itself is extraordinary (and tugs at the heartstrings of my philosophical, deliberative-democracy-loving nerdiness).

    Is it too Pollyana of me to think that even if the consensus statement has no immediate policy-level impact, it might still make important changes in the lives (and practices) of those who attended?

  16. Enjoyed getting to know you Rixa! I also felt it was a great conference. It exceeded my expectations in the way all the stakeholders worked together. We have more work to do, I hope to meet up with you again in the future! Tami Michele, DO, OB/GYN


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