My first response to ACOG’s press release for their newest “Committee Opinion” on homebirth was, like many of you, what’s new? Remember the last opinion statement in 2008, the one that accused women of caring more about their birth experience than the safe arrival of their child, and attacked homebirth as a trendy cause celebre? (Because, before hospitals, women birthed their babies where?). This one appears to be slightly less aggravating although they’re still squeezing as much as they can out of the flawed and infamous Wax analysis published last year.

The press release begins with ACOG’s ostensible commitment to informed choice, at least it pertains to other types of care providers:

“As physicians, we have an obligation to provide families with information about the risks, benefits, limitations and advantages concerning the different maternity care providers and birth settings.”

Fair enough — sensible even. But mothers: how many of you were counseled by your physician during your prenatal visits on their cesarean and induction rates, or the risks of pitocin to start and stimulate labor? The rest of the release is more or less the same-old same-old  though it does acknowledge that the “absolute risk of planned homebirth is low.”

If the tables were reversed and midwives attended the majority of births, and had a large, powerful and politically divisive trade union, would we charge forward with an all out media attack on the obstetric industry, highlighting the dangers of hospital birth and deceptive physician practices? Probably not. As a profession, we do not desire to further the division between physicians and midwives. It’s not about attacking the competition. It’s about safeguarding women’s ability to determine where and how to bring their children into the world.

Certified Professional Midwives (CPMs) do have a trade union, so to speak, in the National Association of Certified Professional Midwives (NACPM), but it is a relatively new organization, and since not all midwives are registered as CPMs, the organization does not represent the entire body of US midwives.

As it is now, third-party journalists, researchers, activists, and physicians are increasingly illuminating the pitfalls of modern obstetrics and doing a fine job of critiquing that which needs to be critiqued in our maternity care system. But in order to really reach into the minds and hearts of American women we need more than rational analysis and deconstruction. We need to move beyond the political and the scientific debates. We need a large enough PR campaign aimed at reframing the debate in the public sphere, not a mud-slinging campaign. We need a campaign that promotes woman-centered midwifery care and out-of-hospital birth in a context that is complimentary to conventional obstetric care. There is room, and need, for both models to harmoniously coexist.



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  1. Sabrina McIntyre #
    January 24, 2011

    Thank you Erin for writing this!!

  2. January 24, 2011

    bless you sister! I sat in a triage room today with one of my mama’s who is 41&6, healthy and a bit stubborn so not in labor, and had to listen to a nurse midwife speak to the risk of her baby dying due to an undetermined afi (a 6.2 based on only 2 pockets) and one late decel down to 120. the focus of healthy mom and baby that we all share is losing its nuance and i’m desperate about it.

    • January 25, 2011

      oh shiela! do you have regs requiring you to transfer at those dates or is that your personal protocol? and we all know the tragedy of using AFIs as a rational for induction….but sometimes a “safety” reason will always be found.

  3. January 27, 2011

    Excellent read and response my dear. Check out Dr. F’s response. Not all doc’s are against us. The way as you so eloquently write is to speak the true about good care, good providers and hope that consumers are smarter than the likes of fucken ACOG.

  4. January 29, 2011

    yes indeed postdates is a hot topic here in the bay so while i believe in flexibility around it based on how the mama and babe are doing i also do a relatively conservative informed consent based on the culture here. so they decided to go for the nst/afi. the good news is that we had an AMAZING birth. my best induction to date for sure. she had a foley then a bit of pit and no other interventions. babe born at dawn in the caul. i got to help unwind her from the cord as the resident who had probably caught all of 2 babies ;) was fumbling. she was lovely though and honored our delayed cord clamping request and to not break the sac before the babe was born. i got to take the sac off her face which was my second this week. such an honor.

  5. April 22, 2011

    “We need a campaign that promotes woman-centered midwifery care and out-of-hospital birth in a context that is complimentary to conventional obstetric care. There is room, and need, for both models to harmoniously coexist.”
    Thank you so much for your model of harmonious coexistence. I call upon all readers to go out and emulate it! With that model in more places, what a beautiful world it would be!

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