Panel 4:
Collaboration, Competition, Money and Monopoly:
The legal status of doctors, midwives, and hospitals in pregnancy and obstetric care
Panelists:
Barbara Hewson spoke about independent midwives in the UK and their difficulty in obtaining malpractice insurance (also called professional indemnity insurance, or PII). Recent EU regulations concerning healthcare mandate that all health care providers carry PII, which might mean the extinction of independent midwives across Europe unless they are able to find a creative solution to the insurance mandate.
She also mentioned Mary Cronk, an experienced (and now retired) British midwife known for her pithy advice. Cronk was fond of saying that doctors and midwives are the servants of the women they look after, not the masters. Hewson also referred to
Cronk's strategies for when you're told "you're not allowed to do that."
Marlies Eggermont, a midwife and lawyer in Belgium, referred to the Ternovszky case and examined whether Germany, France, the Netherlands, the UK, and Belgium are in compliance with
Article 8 of the European Convention on Human Rights. She concluded that these five countries have legislation in place consistent with Article 8, but that real choices are often absent. Insurance is often an issue, either availability or cost. She also noted flaws with physicians' risk communication and detection.
Becky Reed highlighted the history and closure of the Albany Midwifery Practice, which I summarized in
Panel 2.
Amali Lokugamage, a UK OB/GYN, spoke about her journey to home birth as an obstetrician. She noted the monopoly of the medical model in understanding pregnancy and childbirth. Her own experience of pregnancy opened new ways of knowing and understanding the world around her, as her left-brained self discovered right-brained thought processes for the first time. She wrote a book about her own journey to choosing a home birth ("a peak experience in my life"), called
The Heart in the Womb. She also mentioned that the grading of evidence in RCOG and ACOG documents gives patient more power in negotiating their care.
Elke Heckel also spoke about the difficulties for independent midwives to find PII.
Debra Pascali-Bonaro spoke about the important role of doulas in maternity care.
Jill Arnold told her own story: pregnant with a suspected big baby, her care providers urged her to have an elective cesarean. She began researching the medical literature, disocvered that those recommendations were not supported by evidence, and refused the procedure. She named the elephant in the room in her story: that an authority figure was encouraging her to make decisions that had no medical basis.
In the ensuing discussion--which, like all of the post-panel discussions, was quite lively--I remember that Betty-Anne Daviss made a comment about both
horizontal (provider to provider) and
vertical violence (provider to woman) in maternity care. We also heard about the importance of pursuing mediation before pressing charges or going to hearings.
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Rixa, thank you so much for your wonderful summaries. I just spent my evening reading them and taking my own notes! I'm doing some work over the summer with IMBCI and will likely be preparing a blog post for them on the Initiative, human rights in childbirth, and Debra & Robbie's attendance at the conference. I'd love to reference your coverage!
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