Update: AMA Votes Not to Target Ricki Lake


After news coverage spread of the AMA’s recent vote to adopt an anti-home birth resolution and their criticisms of celebrity Ricki Lake and her pro-midwifery/home birth documentary, objections arose from women’s health advocates, reproductive rights organizations, mainstream news outlets, parents and bloggers alike. Even Ricki Lake responded

In response to the criticisms, The Big Push for Midwives Campaign reports that the AMA voted to delete all references to celebrity Ricki Lake in the resolution this week. The AMA cited Lake as a central figure encouraging women to birth at home, apparently against the domineering judgment of the AMA. Even with the deletion of Lake’s name, the organization still voted to proceed with its plans to promote legislation outlawing childbirth at home.

Steff Hedenkamp, Communications Coordinator of The Big Push for Midwives Campaign, says:

"Obviously the AMA was hoping to fly under the radar with its patronizing suggestion that women are choosing to have their babies at home because of something they heard Ricki Lake say on the Today Show. Now that they’ve been called on it, Ricki’s no longer in their sites…If the AMA truly believes that those of us who deliver our babies at home with professional midwives are making such a dangerous choice, then the American public deserves to know exactly how they plan to stop it."

The British Medical Journal’s recently conducted research, obtained from Citizens for Midwifery, shows that a planned home birth or birth center birth, under the care of a CPM (Certified Professional Midwife) is as safe for the woman and her baby as a planned hospital birth – with much lower rates of intervention as well.

There are many states that now have licensed non-nurse midwives but, says The Big Push Campaign, "…no state has passed a law forcing hospitalization of all laboring women or dictating place of birth."

It’s hard to imagine that legislation such as the American Medical Association is proposing would gain enough support to pass in any state. The thought of creating more barriers to safe health care options for healthy, laboring women seems antithetical to what most Americans seek, especially in this election year where health care reform is a priority topic for candidates and citizens alike. However, the AMA is an extremely well-funded lobbying force which makes these threats easier to imagine.

"At best, we can expect to see them push for window-dressing laws that simply condemn home birth as unsafe but are used to harass families who make this choice, as well as the midwives who work with them," said Susan Jenkins, Legal Counsel for the Big Push for Midwives. "At worst, I fear we could see scenarios very similar to the legislative battle in Missouri over legalizing CPMs, where the medical lobby strong-armed law makers into killing a bill that had broad support from both legislators and the general public."

 

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  • invalid-0

    I find it remarkable that the AMA has become so inspired on this. Clearly, the AMA has lost all perspective and should be reorganized. Some women will choose to birth at home. It is a valid and safe choice for healthy women experiencing normal pregnancies. These women deserve access to care and normalcy. The key problems we need to solve are maternal health and access to care. Trampling liberty and a woman”s right of self-determination in her birthing decisions will not solve our problems and is decidedly un-American.

    The AMA notions on this are in stark contrast to their counterparts in the UK.

    http://www.rcog.org.uk/index.asp?PageID=2023

    If this is how the AMA makes priority decisions in establishing their agenda, then this organization has outlived its usefulness.

    I am thankful, however, for the tremendous physicians who do, in fact, support women who choose to birth at home and recognize the value of midwifery care.

    http://www.ncdocsformidwives.org

    Russ

  • invalid-0

    for posting that comment. There are many wonderful doctors who understand the benefits of midwifery and home birth for women and support midwives and women in their quest to birth the way they feel is best.

    It’s important to recognize that not all physicians feel represented by the AMA right now. Stay tuned for a feature article on RH Reality Check exploring midwifery and ob/gyn care during pregnancy and childbirth, the challenges to licensure and for malpractice insurance for midwives around the country, and the ways in which doctors and midwives can complement each other.

    Amie Newman

    Managing Editor, RH Reality Check

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

    Thanks for your coverage of this issue because it is vital that the public understands how the medical system is positioning themselves against midwives and homebirth.

    I am the mother of 7 children. I have birthed in the hospital with CNM’s twice, once at home with a lay midwife and 4 times unassisted. My home births were like apples vs. oranges in comparison. So different. I love birthing at home in my own surroundings, with my family present (but not in my face) and with no strangers. At home I am able to tune into what my body needs so that I can birth without overwhelming pain. At home my baby is better cared for as he/she is not exposed to ultrasound, electronic fetal monitor, germs, etc.. and I am not pressured to give medicines that are not needed.

    Because of my age, I foresee in the future that I may want to call on midwives again, either at home or in the hospital, depending on the situation. I want that choice to be available to me, my daughters and future granddaughters.

    The day this story broke I had been watching A Birth Story on TV before turning on the computer and being smacked in the face with the AMA’s resolution.

    You can read what I wrote on my blog:
    http://www.spiritledbirth.blogspot.com

  • jalan-washington

    Dear Amie, I was intrigued after reading your article. However, I just read the AMA’s Resolution 205 and am a bit confused by your interpretation that it seeks to "outlaw home birth." What I got from the AMA’s press release is that they argue that birthing in a hospital or hospital-accredited environment is the safest option for birth. It does not say that it is the only option nor does it say anything about outlawing alternative options.

    Am I missing something? Am I reading an old version of this resolution? Additionally, I am confused by the fact that you didn’t quote the AMA directly nor provided a link to the AMA’s press release but instead used the interpretation of a third-party organization. I searched the AMA’s website and followed the link that you offered for the midwifery organization (which did not work) and cannot find any mention of "outlawing home birth." Please clarify . . . Thanks.

  • invalid-0

    about the resolution, in particular Resolution 205.

    The resolution states:

    That our AMA 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, or a birthing center within a hospital complex, that meets standards jointly outlined by the AAP and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers.” (Directive to Take Action)

    What I, and many others, have ascribed to that section is that the AMA is seeking to actually develop legislation that would, in some way, set government restrictions on where a woman could/could not birth. While certainly this resolution does not say that they are developing specific legislation at the moment that would outlaw home birth, after being in contact with the Big Push for Midwives Campaign, their legal experts have interpreted this AMA resolution to mean nothing less than the AMA, as a lobby, supporting legislation to criminalize home birth. If you read my posts, I have been careful to write, "according to The Big Push for Midwives…"

    There is no need to create legislation that simply says that the AMA believes that hospitals and birthing centers are the safest place to birth – they can certainly cite that on their web site, even promote it to women (though it would be a lie). But legislating where a woman can/can’t give birth is harmful to women, women’s health access and babies as well (in my opinion and the opinion of many others). It is clear to me that their resolution is about banning home birth as an option for women. 

    I didn’t feel the need to quote anyone from the AMA since these are blog posts about the issue and as such more about my thoughts and opinions on this issue. As far as I can tell, the AMA has not put out a press release about this but if you have a link to one, please do post it.

    As for the link not working, please let me know which one specifically – when I checked them they all appeared to work. Thanks again for commenting, Jalan. I do want to get to the bottom of this issue but I feel it’s important to be clear here – the AMA is seeking to ban home birth as an option using legislation as its tool.

    Amie Newman

    Managing Editor, RH Reality Check

  • invalid-0

    Cute song a lady did as a response to all this on youtube
    http://www.youtube.com/watch?v=2pN58kf3Ims

  • invalid-0

    I am an obstetrician and I subscribe to RH Reality Check because I am pro-reproductive rights. However, I am bit concerned about this article and the “right” to home birth. I am not a member of the AMA but I am member of the American College of Obstetricians and Gynecologists (ACOG). The ACOG statement can be found at http://www.acog.org/from_home/publications/press_releases/nr02-06-08-2.cfm. There are a few points to make here. If you are pregnant and don’t want an intervention, tell your provider you do not want a fetal monitor, an induction or a c-section etc. You will then learn about the general attitude of your midwife or doctor about these issues. Birth plans are generally helpful in prompting these discussions and if done early enough you can change to another practice. They can even begin at the pre-conception visit. The most common item I see on birth plans is “no episiotomy” and I have not done routine episiotomies in a decade. I should point out that in recent years, the patients requesting unindicated and elective induction of labor outnumber the women requesting no intervention about five to one. I am certain that failed indications cause a number of the c-sections mentioned in the ACOG statement.
    There are at least three other points. Number one is that there are number of studies that show babies born at home have worse outcomes. There was a study in the official medical journal of ACOG in 2002 that showed the newborn death was doubled in home birth. This was a large well done study covering nearly a decade of births in Washington state. If you are an ob doctor and you looking in textbooks or medical journals, this is most likely the first study you will see.
    Number two is that most ob doctors are very comfortable working with certified nurse-midwives, they have been around long enough that any ob doctor under 50 has probably worked with a midwife at some point in her or his career. Again this is part of the ACOG statement. In a previous setting, I was the “back up” doctor for certified midwives and it was probably the easiest job I ever had. They were experienced and managed patients well, and if they called me I knew it was a real emergency and I needed to get to the hospital ASAP.
    Point number 3 is that there are lots of lawyers in the United States. A ruptured uterus during labor while attempting a VBAC is a $ 20 million dollar lawsuit, and the lawyer would get one third of this amount. Hospitals and insurance companies are dictating to doctors not to offer VBAC because of the very small risk of a very expensive lawsuit. Also malpractice risks enter into the home birth arena. If you are a doctor at a local hospital and you are called about a complication from a home birth, you are very likely to transfer that patient to the nearest university hospital just to avoid potential lawsuits. Early in my career I was sued when a woman showed up at my hospital with a stillborn baby after an attempted home birth. She was advised by her attorney to sue the hospital and doctors rather than the lay midwife because we had more money. That case was eventually dropped but I have certainly seen similar cases every few years.
    So the summary of my post is that home birth may have added risk and some of the risks cannot be anticipated. Women should decide what is important to them about their birth experience, and find the safest place to have that experience. Some advance planning should be done, even before a planned pregnancy.

  • http://www.feministmormonhousewives.org invalid-0

    Thank you for this response. I wish there were more OBs like you. I just wanted to respond to a couple of your points, first about the safety of homebirths–from what I’ve read, it seems that the studies that show homebirths as being more dangerous than hospital births don’t separate numbers for planned homebirths with qualified attendants and unplanned or unassisted births, which are much, much riskier than the planned ones. So the numbers in those studies are misleading. There have been a number of studies that do separate these categories and, when you look at those numbers you see that planned homebirths with qualified attendants for low-risk women are no more risky than low-risk births in hospital, with much lower rates of interventions and much higher rates of client satisfaction. And any midwife worth her salt will transfer high-risk pregnancies to an OB, even if the risk develops after care has started. The most-cited study that I know of is this one, and it seems very well designed: http://www.bmj.com/cgi/content/full/330/7505/1416

    As for your 2nd point, it’s my experience that most OBs are not comfortable pre-arranging backup care for midwife births that develop a risk and need to be transferred, particularly for transfers during labor. I live in Utah and I know that here, at least, it’s very difficult, if not impossible, to find such an OB. Believe me, I’ve asked around. I had my 1st baby in Utah’s only freestanding birth center (accredited, professional, with CNMs attending the women), and I couldn’t even find a backup OB for that, despite its being a “facility”, which, using the ‘hospital is safest’ argument, has got to be better in an OB’s eyes. On the contrary, the center is constantly under pressure, either legislative or professional, from the OB community here.

    On your 3rd point, I realize that there are frivolous medical lawsuits (directed at midwives as well as OBs), but I don’t think you can blame the legal system entirely. Taking your VBAC example, my understanding is that there’s a low risk of uterine rupture for VBACs unless drugs to augment labor, particularly cytotec, are used. And since the FDA has never approved cytotec for pregnant or laboring women–in fact, it’s contraindicated for such women–if a woman has a bad outcome from it, or any other care that’s not evidence based, then she and her family are reasonably going to feel wronged. Often litigation is the only viable option for these families. So while frivolous lawsuits should definitely be avoided, we should look at WHY there are so many lawsuits in the first place, taking into account that they’re usually filed by women and/or their families who felt safest with an OB, which is why they went to one in the first place.

    I’m expecting my 2nd child in November and am planning a homebirth with a very well qualified midwife and we are making contingency plans for where to go and what to expect if we need to transfer during labor. We can’t arrange a backup OB, as much as I’d like to, but I think we have a good plan and that my course of action is reasonable given the evidence and my low-risk status.

    I would also add that hospitals also have risks, both unforseen and preventable, and that this needs to be a more prominent part of the discussion as well; what we really need is better reporting by hospitals about actual rates of interventions and outcomes, with at least the same level of scrutiny midwives receive. U.S. mortality and morbidity rates for mothers and infants are quite bad compared with other industrialized countries and you can’t blame it on a segment of 1% of planned homebirths skewing the numbers. In fact, the countries with the best outcomes encourage homebirths for low risk women. So, clearly, our current hospital standards and their outcomes are not doing what’s best for mothers and babies.

  • invalid-0

    I would have to guess that the high infant mortality rate in the United States is due to the tens of millions of women who do not have health insurance and do not get adequate reproductive health care, such as prenatal visits or contraception to help plan/space pregnancies. Don’t most of the best countries on the list have socialized medicine and relatively liberal attitudes about women’s health?

  • invalid-0

    That is cute, and she has had a lot of views.