Please Help Advocate for Midwifery, Home and Birth Center Birth!

As many of you are aware, midwifery and out-of hospital birth are enjoyed by only a small minority of American women. Although research shows that giving birth in home and birth center settings is safe, there have been some recent developments that threaten the birthing choices available to women and families desiring midwifery and out-of-hospital care.

The American Medical Association and Home Birth

The American Medical Association (AMA) recently issued Resolution #239 to develop laws regarding oversight and control of midwifery licensure and scope of practice. This especially threatens Certified Professional Midwives (CPMs), but has the potential to threaten all types of midwives, including Certified Nurse Midwives (CNMs).

The AMA also issued Resolution #205, which supports crafting laws limiting births to hospital, hospital-based birth centers or accredited free-standing birth centers (like Madison Birth Center). This Resolution is critical of home birth and aims to restrict the rights of women and families about the choices available to them.

Although we agree that there are safety parameters required in every birth setting, we at the Madison Birth Center oppose the concept of physician groups deciding (and legislating) either the scope of practice of midwives or the choice about where families give birth. We suppport the ethical concept of autonomy and informed choice for families about where and with whom they give birth.

The AMA is joining with the American College of Obstetricians and Gynecologists (ACOG), who issued their own statement against home birth in 2006. ACOG recently affirmed their long-held position in a Feb 2008 Press Release.

Here's a response to AMA by the Association of Certified Nurse Midwives (ACNM): http://www.midwife.org/siteFiles/policy/ACNM_Letter_to_AMA.pdf

Here’s a response to the AMA by the Midwives of North America (MANA): mana.org/pdfs/MANAPresidentResponseAMA.pdf

Here's an LA Times article by Jennifer Block, author of "Pushed: The Painful Truth About Childbirth and Modern Maternity Care": Big Medicine's blowback on home births

Here’s a link to an on-line petition in support of legal home birth: www.ipetitions.com/petition/birthathome?e


Did you know?

There has been no recent improvement in the infant mortality rate, and "the percentage of underweight babies born in the U.S. has increased to its highest rate in 40 years”

The United States has the second worst neonatal mortality rate among developed countries. ALL the countries with better neonatal mortality rates than ours use midwives as the main providers of maternity care.

As described in an article by the Childbirth Connection entitled, "Why Does the National U.S. Cesarean Rate Keep Going Up?":

“Recent studies reaffirm earlier World Health Organization recommendations [that] ...the best outcomes for mothers and babies appear to occur with cesarean section rates of 5% to 10%. Rates above 15% seem to do more harm than good.”

The current Cesarean rate is 31.1%. This rate has increased by 50% over the past decade, reaching a record level.

Over 20 countries have lower maternal mortality levels than the United States. The 2007 "Mother's Index" compiled by Save The Children ranked U.S. mothers with a higher lifetime risk of maternal mortality than mothers in 27 other developed countries.

A large study of planned home births with Certified Professional Midwives (CPMs) in the United States showed similar safety rates compared with low risk hospital births. These births were accomplished with a much lower rate of medical interventions and for much less cost than comparable hospital births. Our own Wisconsin CPMs and their clients were part of this study.

The Royal College of Obstetricians and Gynecologists (the British sister group to ACOG) supports home birth! In the UK, out-of-hospital births are routinely offered, and at least 80% of women have midwives attending their births.

According to Dr. Marsden Wagner, former Director of Women's and Children's Health for the World Health Organization:

"Overwhelming scientific evidence shows that the home is a perfectly safe place to give birth if you are one of the more than 80 percent of women who have had no serious medical complications during pregnancy...have a trained birth attendant for your homebirth, be it non-nurse midwife, nurse midwife or doctor...[and are] within thirty minutes of the nearest hospital. The single most important advantage of homebirth is that the birthing woman is in control."

About 99% of American births take place in the hospital. Why are we at the bottom of the developed countries in neonatal and maternal mortality? Clearly, we need to do something different!


Childbirth Reform Efforts

The International MotherBaby Childbirth Organization has developed the International MotherBaby Childbirth Initiative, whose basic principles include:

• The mother and baby constitute an integral unit ("MotherBaby") during pregnancy, birth and infancy and should be treated as such, as the care of one significantly impacts the care of the other.
  
  
• The needs of the Mother-Baby unit should take precedence over the needs of caregivers, institutions and the medical industry.
  
  
• Midwives, who are the primary care providers for millions of birthing women in most countries, have developed a model of care based on the normal physiology, sociology and psychology of pregnancy, labor, birth and the postpartum period...midwifery knowledge, skills and behavior are essential for optimal MotherBaby care.
  
  
• Women can safely give birth outside of hospitals in clinics, birth centers and homes when skilled care and effective referral are available.
  

The National Quality Forum recognizes that "morbidity and mortality associated with pregnancy and childbirth is substantial and, evidence suggests, is largely preventable through the delivery of high quality perinatal care and adherence to evidence-based guidelines."

In response, it is developing National Voluntary Consensus Standards for Perinatal Care which will address issues such as:

• Rate of elective delivery prior to 39 weeks gestation
  
  
• Cesarean rate for low-risk, first birth women
  
  
• Incidence of episiotomy (surgical cut into a woman's perineum to enlarge the opening of the vagina)
  
  
• Breastfeeding at hospital discharge

It seems apparent that our maternity care system has lost its way. We believe that the Midwifery Model of Care presents a well-supported alternative to the current medical model. [Here is a comparison of these two models of care]

We can't do this work alone. For all you do to help ensure that women have access to places and ways to instinctively and safely give birth, we offer our heart-felt thanks!

Thanks also to Ten Moons Rising, a non-profit organization in Minneapolis committed to raising awareness about Prenatal & Birth Psychology. Their recent wonderful newsletter inspired this one in both substance and style.