The AMA and ACOG have put out a statement saying they want to outlaw homebirth. You may already know about this. It scares me to think that they would try to do this. Women should have the right to choose where they want to birth. Freedom of choice!
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My favorite response I have read to the statement so far is from an Obstetrician!
Douglas H. Kirkpatrick, MD
The American College of Obstetricians and Gynecologists
PO Box 96920
Washington, DC 20090-2188
I am a practicing OB/ GYN in southern California and Fellow of ACOG and
recently was informed by midwife colleagues of your recommendation and
encouragement for the AMA to lobby Congress for a law banning out of hospital birth.
Funny, that I had to hear of this decision from outside sources and was never
approached by my college to see how I or my local colleagues felt about it. I
have grave concerns regarding my organization taking such a stand. I think we
are all agreed that ACOG has a statement regarding patients rights to
informed consent and informed refusal. Yet, it seems with every decision our
organization moves further away from that basic tenent. ACOG’s little “guideline”
paper on VBAC in 2004 where the word readily was changed to immediately has
had the chilling effect of doing away with VBAC options at hundreds if not more
hospitals. Not due to patient safety, or the ideal of giving true informed
consent but really, let’s be honest, to fear of litigation. I have seen how
patients have become counseled by obstetricians at facilities where VBAC has
been banned. They are clearly given a skewed view of the risks of VBAC but
rarely told of the risks of multiple surgeries. If you think this is untrue you
are, sadly, out of touch with real clinical medicine.
As to out of hospital birthing, please give me the courtesy of an
explanation as to the data you used and the process by which an organization which is
supposed to represent me came to this conclusion. Any statement saying that it
is as simple as patient safety and that one-size fits all hospital birth
under the “obstetric model” of practice should be applied to all patients is,
putting it nicely, not really in line with what best serves all our patients.
In many instances, hospitals are not safe, certainly not nurturing and have a
far worse track record for disasters than home birth. Even when emergency
help is nearby this is true. The focus of all of us in medicine should be on
reigning in trial lawyers and tort reform and lobbying Congress for that. The
best interest of the college members and the patients we serve would be for my
organization to spend its time and energy on something that has true benefit.
Removing choices from well-informed patients and caring doctors and midwives
is wholly un-American.
So please send me detailed information on how ACOG decided outlawing home
birth was a wise thing to do. You must have scientific data to take such a
drastic stand. Please make it available to me so that I may share it with
likeminded colleagues. I would also like to know the process by which this came to
pass. Who first raised this issue and why? What committee reviewed all the
data and did its due diligence in interviewing those of us with longstanding
experience in backing midwives who perform out of hospital births. There must be
a fine, non-confidential paper trail you can share with your members.
Specific names of committee member who voted for this would be enlightening and I am
requesting this information. I would like to know the background and
expertise regarding out of hospital birth for each member who had a hand in the
decision to go to the AMA.
We live in an odd era where once something is said or recommended by a
legitimate organization such as ACOG it has deep ramifications never intended such
as becoming fodder for trial lawyers trying to squeeze the lifeblood and
dignity out of your members. Or forcing women to travel hundreds of miles in
labor to find a supportive facility. Or even worse, to have them arrive in a
VBAC banned hospital and refuse surgery. Can this be the best we can do for our
patients? Rmember, your VBAC statement was meant to be only a recommendation
but quickly became the rule by which hospital administrators, risk managers
and anesthesia departments of smaller hospital banned this option for
thousands of women. An option, that in proper hands, was the safe and accepted
standard of care for 30 years. In fact, you still have an ACOG VBAC brochure that
recommends this option! For those of us working at smaller hospitals where
VBAC was banned due to lack of emergency help (anesthesia, OR crews, etc.)
there is a big question that has perplexed us that no administrator seems to be
willing or able to answer. That question is: “If a hospital cannot handle an
emergency c/section for VBACs, and most emergency are for fetal bradycardia,
hemorrhage (ie. abruption) or sholder dystocia not for ruptured uteri, then
how can they do obstetrics at all?” For they seem to still be able to have a
maternity ward without in house anesthesia. Will someday ACOG, in their great
wisdom but seeming disconnect from reality, make a “recommendation” that
little hospitals stop providing obstetric services? Will this better serve women
and their communities throughout America?
I am frightened and angered by what you have done in my name. Now I ask you
to defend your position in encouraging the AMA to lobby Congress for another
restriction on the freedom of choice that belongs to women and their
families. Those choices include midwifery and the right to have the most beautiful
and life changing event occur wherever best fits their desire. Midwives are
well trained and required to have obstetrical backup. They have very special
relationships with their patients and want the very best outcomes for them. They
do not need me or you to police them. We have a habit in out country over
the past 40 years of thinking we can legislate out stupidity. All that has done
is erode the individual freedoms that belong, by birthright, to each of us.
I would hope you trust your Fellows to know their specialty, their
colleagues, and what is best for the patient as an individual. These decisions do not
belong to politicians or faceless committees. You should have more faith in
your members to give balanced informed consent. Again, my recommendation to
you is to put all your considerable energy into changing our legal malpractice
system. Those of us actually practicing medicne and caring for patients know
this to be the greatest threat to the mission and responsibility we have
chosen to undertake.
I look forward to your response and possibly the beginning of a meaningful
Stuart J. Fischbein, MD FACOG
Medical Advisor, Birth Action Coalition