Bad Medicine: AMA Seeks To Outlaw Home Births


In an unmistakably insecure and aggressive move, the American Medical Association (AMA) adopted a resolution at its annual meeting last weekend to introduce legislation outlawing home birth – according to The Big Push for Midwives.

According to the hard-working women of The Big Push for Midwives campaign, faced with the sisyphean task of convincing the American mainstream medical establishment that midwifery is a viable option for birthing women:

"It’s unclear what penalties the AMA will seek to impose on women who choose to give birth at home, either for religious, cultural or financial reasons-or just because they didn’t make it to the hospital in time," said Susan Jenkins, Legal Counsel for The Big Push for Midwives 2008 campaign. "What we do know, however, is that any state that enacts such a law will immediately find itself in court, since a law dictating where a woman must give birth would be a clear violation of fundamental rights to privacy and other freedoms currently protected by the U.S. Constitution."

In other words, advocating for legislation of this kind has the eery ring of familiarity. Legislative attempts at "criminalizing motherhood" have at their core coercive control over pregnancy and childbirth. Regina McKnight was recently released from jail after a judge overturned her homicide conviction for giving birth to a stillborn baby.

Likewise, Colorado’s ballot initiative in support of a "personhood amendment" would have untold consequences for pregnant women who accidentally or otherwise miscarry a pregnancy. If a fertilized egg is conferred "personhood" status why would a miscarriage not be investigated as potential murder?

The legal issues surrounding "fundamental rights to privacy" also, of
course, reverberate throughout the discussions around Roe v. Wade and a
woman’s right to have an abortion in this country. Those who fight
rigorously to strip away womens’ legal right to an abortion somehow
seem to skirt the issue of what might happen to a woman if she does
choose to access an illegal abortion.

What the AMA’s resolution and these other kinds of potential and actual legislation do is to open the door to penalizing motherhood, in effect. Because most of these legislative attempts do not directly address the issue, they leave the door dangerously open to criminalizing women for making the decisions they feel are best for themselves, their fetuses and their families.

Proposing this kind of legislation would also force women to birth in government-approved settings, a scenario that seems almost unbelievable. According to the Big Push for MIdwives:

 

Until the AMA proposed ‘Resolution 205 on Home Deliveries,’ no state had considered legislation forcing women to deliver their babies in the hospital or limiting the choice of birth setting. Instead, states have regulated the types of midwives that may legally provide care. Currently, 22 states already license and regulate CPMs, who specialize in out-of-hospital maternity care and have received extensive training to qualify as experts in the types of risk assessment and preventive care necessary for safe and high-quality care for women who choose give birth at home. Certified Nurse Midwives (CNMs), who are trained primarily as hospital-based providers, are licensed in all 50 states and the District of Columbia.


The resolution did not offer any science-based information for the AMA’s anti-midwife or anti-home birth position.

Steff Hedenkamp, Communications Coordinator for The Big Push for Midwives says, "Maternity care is a multi-billion dollar industry in the United States. So it’s no surprise to see the AMA join the American College of Obstetricians and Gynecologists in its ongoing fight to corner the market and ensure that the only midwives able to practice legally are hospital-based midwives forced to practice under physician control. I will say, though, that I’m shocked to learn that the AMA is taking this turf battle to the next level by setting the stage for outlawing home birth itself-a direct attack on those families who choose home birth, who could be subject to criminal prosecution if the AMA has its way."

If you’d like to help The Big Push for Midwives fight this please visit their web site and push back against attempts to "deny American families access to safe and legal midwifery care."

Update, 2:45pm, EDT: Wanted – Ricki Lake! Apparently the AMA has issued Resolution 205 partially in response to none other than Ricki Lake and her campaign to promote midwifery and natural childbirth as a safe option for healthy women via her documentary, The Business of Being BornSafe Birth Ohio notes that, in Britain, mainstream medical associations like the Royal College of Gynecologists have come to very different conclusions about the safety of home birth as an option for healthy, laboring women. And, yet, the AMA has swung the pendulum in the opposite direction deciding homebirth should be outlawed and that Ricki Lake is dangerous to mamas everywhere. 

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  • http://homebirthdebate.blogspot.com invalid-0

    We already have midwives in the US, they are certified nurse midwives or certified midwives. In contrast, homebirth midwives (direct entry midwives or DEMs) have far less education and training than certified nurse midwives or certified midwives. Similarly American homebirth midwives have far less education and training that any midwives anywhere else in the industrialized world. They have far less education and training than midwives in Europe, Canada or Australia. American homebirth midwives would not meet the education or training requirements for ANY country in the industrialized world.

    American women should also be aware that the latest national birth statistics show that PLANNED homebirth with a homebirth midwife (DEM) has double or triple the rate of neonatal death as hospital birth. In 2003 the US standard birth certificate form was revised to include place of birth and attendant at birth. Now the CDC has made the entire dataset available for review and the statistics for homebirth are quite remarkable.

    As this chart shows, the neonatal mortality rate for DEM assisted homebirth is almost double the neonatal mortality rate for hospital birth with an MD. This is all the more remarkable when you consider that the hospital group contains women of all risk levels, with all possible pregnancy complications, and all pre-existing medical conditions. An even better comparison would be with the neonatal mortality rates for CNM assisted hospital birth. The risk profile of CNM hospital patients is slightly higher than that of DEM patients, but CNMs do not care for high risk patients. Compared to CNM assisted hospital birth, DEM assisted homebirth has TRIPLE the neonatal mortality rate.

    It is not suprising that the AMA opposes homebirth. Homebirth with a homebirth midwife is dangerous; it increases the rate of neonatal death.

    • invalid-0

      My homebirth midwife was a certified midwife. FYI. I don’t know of any direct entry midwives in my area. They are all certified.

    • invalid-0

      The problem with Dr Amy’s analysis is that what she calls “DEM’s” are actually refered to in the CDC stats as “other midwives.” That is…midwives other than Certified Nurse Midwives.

      This can cover a BROAD range of training–from midwives who simply hang out a shingle after being a doula at a few births, to women like my homebirth midwife–a Certified Professional Midwife with an Advanced Practice Nursing degree.

      Some people cling to the idea that women could just use Certified Nurse Midwives (CNM’s) for homebirth if they really wanted to…but that’s just not true. For many women there just aren’t Certified Nurse Midwives available to attend homebirth. Since the midwife who attended my previous two homebirths unfortunately was badly injured in a car crash and thus is no longer attending births, I had to look for a new midwife for my current pregnancy. I met with one CNM who had told a doula that she *did* attend homebirths, only to find her scrambling to back peddle when I actually asked her to attend my birth at home (will be my 3rd homebirth, and I live 5 minutes from the hospital with the highest level NICU and OR in the area–the one she has priviledges at). She was saying that she would really *like* to attend homebirth, but she didn’t have a back up midwife to work with her (what about the other midwife working in her office? The midwife I was talking to was the senior midwife in the practice) and one of the local hospitals had told her they would take away her priviledges if she attended homebirth…

      LICENSING non-nurse midwives will certainly help to standardize their training, and make homebirth safer for women. Failure to license them (just like failure to legalize abortions and thus have licensed providers in the 1960′s) will not make it go away–it will just make it unsafe. It allows bad midwives to continue practicing without oversight like a midwife in my state (assuming the rumors are true–which I don’t know) who is rumored to allow high risk women to birth at home and to encourage women to stay at home even when baby is showing distress. This midwife is rumored to have had 3 preventable neonatal deaths in the past 18 months. Just a few midwives like that can certainly have a HUGE impact on the statistics.

    • invalid-0

      First of all, this Amy Tuteur, "MD", is not even licensed to practice medicine anymore. She has found some way to cough up a large sum of money to post her website, titled the homebirth debate. Which is not a debate, but a site where comments are deleted when she has nothing truthful to reply back to them with. And I find it interesting that most lay midwives spend many more years on their education than do other medical professions. They learn their stuff. And I have found that many of her "statistics" are not true, outdated, or from very biased sources. You ladies are smart. . .please listen to your bodies and hearts, and do your own research on homebirth and its safety. Just dont try to "debate" it on Amy’s site. She will make you feel sad, angry, and even more determined to spread the amazing truth about homebirth!

      This comment has been edited to remove demeaning language. Please see our commenting policy and keep these discussions civil.

    • invalid-0

      Actually, in my state, Florida, Direct Entry Midwives must complete 3 years of school, not counting prerequisites, and pass the national exam. Licensing is very strict, these are not just random women with no education. They have studied at either a private school or public college and then interned as well, and passed a rigorous examination. What makes you think these women are not as educated as midwives in other countries?

    • invalid-0

      Sorry, “dr” (rolls eyes) you may be able to fool the sheep on your “website” but people aren’t buying it here.

      I wonder if it is legal to answer medical questions WITHOUT a VALID license?

      I wonder . . . . . I SMELL A FRAUD!

  • invalid-0

    There are CNMs who attend homebirths, as well. In fact, one of my midwives for my homebirth was a CNM (she preferred to let a woman’s body do it’s work rather than interfering in the process too much as is required through electronic fetal monitoring, IVs, etc in hospitals). Also, my other midwife was a regular homebirth midwife, but she was also the leader of the state midwives association… sooo she must not have been THAT inferior.

  • invalid-0

    Anyone who’d like to see the opposite viewpoint to what Amy is writing should watch The Business of Being Born:
    http://video.google.com /googleplayer.swf?docId =8597620254789409121
    The filmaker exposes the way births are conducted in hospitals and follows a few pregnant women as they go through the birthing process. Good movie.

  • invalid-0

    Too may times I see this-homebirth is unsafe and the midwives untrained, line of reasoning. The HUGE problem with this attempt to ban is that no one should be able to tell me what I am allowed to do or not do with my own body. And many of us who advocate for homebirth really want there to be more emphasis on the training and licensing of midwives in all states. That is the way to ensure safe homebirth, not banning it. This move is so obviously about money that throwing the “safety” issue into the mix is insulting. Stop taking my rights to decide what is best for me and my family and telling me it is for my own good.

  • invalid-0

    I think it is important to note that many home birth midwives, regardless of their training, require their clients to see nurse midwives throughout the course of the pregnancy. They also offer many of the traditional prenatal tests that OBGYNs offer to screen for anomalies that would require a medical intervention not available in a home birth setting. In addition to the home birth plan there is typically a hospital emergency back up plan in place where the woman is preregistered at the nearest hospital should a complication arise. All midwives (CNMs, CPMs, DEMs, etc) are trained in preventative care. While they may not be qualified to handle ALL medical emergencies that could possibly arise during labor and delivery, they are trained anticipate it and either diffuse the trouble or defer to the appropriately trained medical personnel. This does not disqualify them for the job of attending these births. Any decent OBGYN will willingly call on a neonatal surgeon should the need arise, what these home birth midwives are doing is no different. I am sure that I speak for all mothers, whether they choose a home or hospital birth, when I say that it is an arrogant and greedy position the AMA is taking. I hope that the members of the AMA who still operate under the laws of integrity will put a stop to this resolution which is clearly motivated by unbridled greed for money and power.
    Signed,
    Mother of 4 (1 hospital birth, 2 home births with a DEM, 1 home birth with a CNM, 0 problems)

  • invalid-0

    I’m labor and delivery nurse that supports midwives (all midwives) and homebirths. My post is in reply to the MD’s post. I like playing with numbers too, I put in the same unrealistic criteria the MD up in, babies passed away 0-27 days after birth, WHITE, 37 plus weeks, bigger then 2500 grams, and mothers 20-45 years of age and got this:

    CNM MD DEM
    Deaths 64 1200 6

    Births 178,692 1,973,682 13,215

    Death Rate Per 1,000 0.36 0.61 0.45

    Change race to include all races and include ages 15-45 and you get this:

    CNM MD DEM
    Deaths 94 1,759 6

    Births 251,966 2,726,642 14,890

    Death Rate Per 1,000 0.37 0.65 0.40

    I don’t see how she got 1.1. Play with the system and the numbers yourself… see what you get. CMN do have the safest rate, but only slightly over DEMs. Maybe instead of getting rid of all DEMs, we should find out the ones driving up those numbers. There are AMAZING DEMs like Ina May Gaskin. Her numbers include 35 week plus, twins, VBACs, and breeches. Let’s put those numbers into the CDC’s system and see what we get:

    CNM MD DEM
    Deaths 151 3.217 14

    Births 291,599 3,233,353 17,243

    Death Rate Per 1,000 0.52 0.99 0.81

    Ina May’s is 0.39 per 1,000. These numbers are based off of her statistics in the back of either of her books, Ina May’s Guide to Childbirth or Spiritual Midwifery.

    She beats everyone’s numbers. Should we outlaw her as well? I would trust her “second class” skills.
    My point? I think a few bad eggs are ruining good numbers for DEMs.

    I would also like the mention that I don’t know what I think of the reliability of some of the CDC’s numbers. Play around with more numbers; it said that 831 out of 1000 infants born under 20 weeks died. That means that 169 infants under 20 weeks lived? I don’t think so. That would be unheard of. Some food for thought.

  • invalid-0

    for unnecessarily demeaning language. As a result, we deleted the first sentence of the comment.

    As per our commenting policy, RH Reality Check embraces and encourages a civil and productive discourse on reproductive and sexual health and rights but will delete comments that have been brought to our attention by readers or otherwise that demean, threaten or decrease the civility of the discussion.

    Amie Newman

    Managing Editor, RH Reality Check

  • invalid-0

    Renae,

    I just did the numbers on the CDC site myself with the same criteria (White women, ages 20-45, 37+ weeks gestation, birth weight >2500gm, deaths in first 28 days of life). This is what I got:

    In Hospital, Certified Nurse Midwife(CNM): 140 deaths, 376,042 births, death rate 0.37 per 1000.

    In Hospital, Doctor of Medicine(MD): 2,647 deaths, 4,294,598 births, death rate 0.62 per 1000.

    Home, Direct-Entry Midwife: 27 deaths, 23,584 births, death rate 1.14 per 1000.

    I’m not sure how you are getting different numbers, you must be inputting something incorrectly.

  • invalid-0

    No matter whose statistics are right, a mother should always have the right to birth where she feels the safest and with the caregiver of her choice. I’m all for educating the mother, so that she can make an informed choice…but it should be her choice, not the AMA’s.

    I have experienced both hospital and home births and there was a huge difference in the quality of the birth experience & prenatal care for me and my babies. I wish all my babies could have experienced the gentle birth we had at our home birth. I worked hard with the help of my midwife to take excellent care of myself during my pregnancy and after the birth. I felt my midwife did a much better job of monitoring my pregnancy and addressing issues that came up than my OB did. If there would have been something we couldn’t handle at home we were prepared to transfer to the hospital.

    I wanted to have a home birth because my previous birth was really short and we almost didn’t make it to the hospital. I knew a home birth would be safer than a birth in the car on the way to the hospital. I am so glad that I was able to have a skilled midwife at my birth. I think it is just awful that the AMA is trying to restrict home birth midwives. Do they really think it will be safer if women have to have their home births without a midwife.

    I wish the Big Push big success in getting Certified Professional Midwives licensed in all 50 states. It’s all about choices.

  • invalid-0

    I think everyone is getting a bit carried away with the numbers. (If you can’t give it up, compare live births and mother mortality rates with those of other countries who use midwives/homebirth) Babies will continue to survive and not survive regardless of the mother’s care provider. That is the sad truth of nature. These numbers do nothing to explain the stories of each of these children. SIDS and fatal diseases will not be prevented by birth in the hospital. The real concern here is what is backing each side of the issue. If MDs are concerned with the health of children, they should be promoting gentle births, VBACs and breastfeeding, and work hard to lower the caesarean rates in the US. My midwife, who attends my birth at home IS a CNM. The MD who spoke above describes these people as acceptable care providers, and my CNM acknowledges homebirth as a safe option for low-risk women such as myself. I also highly recommend Ina May Gaskin’s Guide to Childbirth for anyone critical of a woman’s choice to birth where SHE feels most comfortable. A woman’s body doesn’t need a surgeon looking over her shoulder to give birth. That is what a woman’s body was designed to do. It happens naturally. It is very sad that financial matters are at the forefront of an issue that concerns new babies and mothers’ bonding and their first experiences together. There are plenty of other issues that the AMA could address, such as pregnant mothers smoking cigarettes or new mothers refusing to attempt breastfeeding, both of which have proven to be detrimental to a baby’s potential health. But then, who would make money?

  • invalid-0

    I figured out what my numbers were missing, it’s the less than 28 days…..

  • invalid-0

    As long as midwives are certified and licensed by the state and refer women with high-risk factors to OBs (as the VAST majority do), homebirth is just as safe as hospital birth, with less risk of unnecessary c-sections and episiotomies. I too would recommend Ina May’s Guide to Childbirth by Ina May Gaskin.

    I don’t know about those CDC statistics above, but are they broken down in a way to compare states with licensing and certifying boards for certified professional midwives versus those that are not?

  • invalid-0

    More problems crop up with the analysis…

    Dr. Amy excludes in-hospital births to “other midwives” from her analysis, I’d assume because she presumes that these have nothing to do with the safety of homebirth.

    But they have EVERYTHING to do with the safety of homebirth! Why? Because the majority of homebirth advocates will tell you that a key component of the safety of homebirth is the ability to smoothly transport a laboring woman to the hospital in the case of a problem.

    I highly doubt that “other midwives” are attending nearly 3000 births per year in the hospital (nearly 18% of all births with “other midwives”) where the labors actually started in the hospital–especially considering that New York is the only state that I’ve ever heard of non-CNM midwives having hospital privileges.

    So I’m assuming that these “in hospital” births are intended-homebirth transfers. It is an assumption to be sure…but I believe that it is one that is made with reasonable support. The North American homebirth study published in the British Journal of Medicine (http://bmj.bmjjournals.com/cgi/content/full/330/7505/1416) reported a 12% in-labor transfer rate for Certified Professional Midwives.

    When you include in the “in hospital” births, the neonatal mortality rate drops to 0.92 for “other midwives.”

    So again…I believe that licensing midwives…which would hopefully lead to midwives who are less hesitant to transfer…would lead to safer homebirth.

    Oh…but keep in mind, I *did* include races other than white, because by eliminating African Americans from the mix I believe that Dr. Amy gives an unfair advantage to the MD stats. Including other races barely budges the MD stats–even though they represent 40% of the births. But since they represent 10% of CPM births (perhaps more of “other midwives?”) and 0% of the “other midwife” neonatal deaths…that does significantly affect the midwife stats. Yes, there are more African Americans giving birth in hospitals (13% of births) than in homes (1.5%), BUT…in hospital birth Hispanics (which fall under the “white” category) represent 20% of the total birthing population but only 18% of the neonatal deaths–they have a lower neonatal mortality than non-Hispanic whites. They only represent 4% of the homebirth population, so the homebirth population suffers from not having that “healthy boost.”

  • invalid-0

    I don’t know about those CDC statistics above, but are they broken down in a way to compare states with licensing and certifying boards for certified professional midwives versus those that are not?

    With this search tool you can’t really compare states with and without licensing, because you can’t find out how many births occurred with “other midwives” in states where no deaths occurred–which is the majority of the states that have licensure, thus you can not come up with an accurate neonatal death rate. I’m on your side with this though!

  • http://momstinfoilhat.com invalid-0

    I don’t want to post my long response on this issue on everyone’s website, but here it is, please check it out:

    http://momstinfoilhat.com/2008/06/18/rrrrg-stinking-ama/

  • invalid-0

    And it was intended that a *doctor* attend. (Doctor of Osteopathy, as I recall the story.) Mind, I had other ideas and showed up 15 minutes before he did, but there was a general nurse present anyway. (My mom went into labor during a social event.)

    My brothers, also born at home, did have that doctor in attendance.

    I suppose doctors just don’t make house-calls anymore.

  • invalid-0

    Where on the CDC link does it indicate that the neonatal mortality rate occurred with planned home births overseen by NARM-certified midwives? I couldn’t find the definition for “other midwives.” I could easily be overlooking something, but I didn’t find anything by clicking around . . .

  • http://www.ravenimages.net invalid-0

    Someone we should be looking to as well is Naomi Wolf. Wolf’s book Misconceptions is another great text to read about these issues. It touches on the very reasons the AMA would be trying such an underhanded tactic. If the AMA actually got its way, regardless of its unconstitutionality (for it could take years to take the fight to the Supreme Court), the hospitals would stand to make a windfall of a profit beyond the multi-billion dollar racket it already has working for it. Considering the current practice in many U.S. hospitals of putting many mothers on monitors and preventing a natural posture to be taken by a laboring woman, labor can easily become arrested leading to the even more profitable C-Section. Ultimately this is about money. The AMA isn’t really concerned with the health of mothers or their infants, it’s concerned about the bottom line.

    What the numbers above don’t take into account are the many home births of women who had attending naturopaths and certified midwives, it only shows home births as attended by uncertified midwives. In my state, there are no such creatures legally allowed to practice midwifery.

    I was delivered on a futon by a naturopath, women have been giving birth outside hospitals for the majority of human history. It was only recently that we turned pregnancy from a natural act into a disease that needed to be treated, and we need to make certain that our choices for how we give birth continue to be made by us.

  • invalid-0

    http://www.childbirthconnection.org/article.asp?ck=10463
    has charts on what the costs are for birth center vs hospital with & without complications & C–sections w & w/o complications. It is 10X more than a birth center to have a C-section!! As far as I can see the AMA has no right since they have a HEAVILY vested in the outcome of banning homebirths and bashing midwives. This is beyond greedy!!!

  • invalid-0

    It was pointed out at citypaper.com that Amy Tuteur is NOT licensed to practice medicine. One who sells herself as an “MD” and is then exposed as unlicensed is
    not a valid expert. For her to be dishonest about her credentials is unethical and dishonest. The truth about her “credentials” alone discredits her and shows that she should not be taken seriously, in my opinion.