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


  1. Re new midwives: I surely will! :) I'm meeting up with both of them on Friday, I'm so excited.

  2. Hi!

    I just started a doula/public health blog and my first (real) post links to a story you posted a couple months back. I've been reading your blog for a while - at the risk of sounding all shmoopy, I LOVE it! I'm beginning an MPH and am very curious about your research.

    Anyway, I just wanted to say hello and thanks for a great blog :-) I can tell I'll be posting more links to you in the future...


  3. Thank you!
    Please share pics of your time abroad!

  4. This is making the rounds and it says it all.

  5. Ahhhh France in the summer- jealous to say the least.
    Enjoy your well earned break!

  6. I, too, have blogged about this recently. :o)


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