What exactly does the "M" in AMA Stand For?

Let me preface this blog entry by saying this really pisses me off.

The American Medical Association (AMA) recently recommended a resolution in which they want states to pass legislation that discourages homebirth and certified professional midwives. In essence, they are trying to restrict the choice – nay, the right – of every woman to choose the type of birth that they want. This is wrong on so many levels. Hiding behind concerns for the safety of women and their babies, the AMA is transparently trying to decrease the competition that doctors – namely obstetricians – may have to deal with when it comes to labor and delivery.

What makes me say that? Why am I not taking the AMA at its word that this isn’t about money or greed or anything other than babies and mommies? Dissecting the resolution itself gives a clue.

Let’s start at the beginning.

“Whereas, Twenty-one states currently license midwives to attend home births, all using the certified professional midwife (CPM) credential (CPM or "lay” midwives), not the certified midwives (CM) credential which both the American College of Obstetricians and Gynecologists (ACOG) and American College of Nurse Midwives (ACNM)” Yes, 21 states do currently license CPMs, most of whom primarily do homebirths. Are women and babies dying left and right from homebirths gone terribly wrong in those states? No – in fact, the statistics bear out that more injury/death occurs within the hospital setting. CPMs are professionals – professionals in dealing with normal pregnancy and birth. They have gone to school, they have been trained, and they have passed certifications. They are not crazy old women running breathlessly into a home and demanding somebody boil water! They are professionals who know how to let normal labor and delivery progress and when to seek the resources of a hospital and obstetrician.

And for those midwives who do play by the rules of ACOG and AMA, what kind of support do they get? Well, for one, I can tell you that they get kicked to the curb if they are too successful and start bleeding away business from the obstetricians and the operating rooms. Here in Charlotte, NC, a lot of the community is to the point of being up in arms over a policy change at Presbyterian Hospital-Huntersville that restricts certified nurse-midwives from attending vaginal birth after cesareans (VBACs). It is common knowledge that one particular CNM has close to a 100% success and safety record for VBACs – her reward for working so tirelessly to help women achieve vaginal birth? She had her VBAC privileges taken away. I wonder if the fact that the c-section rate for the group practice of head of obstetrics at PHH is at 40% had anything to do with that decision…

“Whereas, There has been much attention in the media by celebrities having home deliveries, with recent Today Show headings such as “Ricki Lake takes on baby birthing industry: Actress and former talk show host shares her at-home delivery in new film”. Oh, heaven forbid that women should become aware that *gasp* there are options out there other than a medically-managed hospital birth! If we’re talking about celebrity bringing attention to birthing options, let’s talk about celebrities like Britney Spears and Christina Aguilera having elective c-sections; a recent study showed that c-sections account for the recent increase in premature births in the US. Funny how the AMA and ACOG aren’t issuing statements about possible celebrity influence on that birth trend.

“Whereas, An apparently uncomplicated pregnancy or delivery can quickly become very complicated in the setting of maternal hemorrhage, shoulder dystocia, eclampsia or other obstetric emergencies, necessitating the need for rigorous standards, appropriate oversight of obstetric providers, and the availability of emergency care, for the health of both the mother and the baby during a delivery”. Yeah, and a routine car trip to the local supermarket could lead to traumatic brain injury, hemorrhage, loss of limb, or death. But last time I checked, my car didn’t come equipped with a trauma team.

"RESOLVED, That our American Medical Association support the recent American College of Obstetricians and Gynecologists (ACOG) statement 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 American Academy of Pediatrics (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’”Ok, guys? I know you all went to medical school and went through residency and all, but here’s a tidbit I’d like to pass along: just because you say something doesn’t mean it’s true. In 2005, the BMJ published a large study showing that homebirth is as safer or even safer than a hospital birth for low-risk women. In fact, homebirth is considered so safe for low-risk women, the British health system is encouraging more women to birth at home.

I’m not saying that all women should have homebirths. Far from it – I think women should have choices in birthing and be informed that they have choices. If a woman wants to have a super-medicalized, pitocin-induced, flat-on-her-back-pushing birth, she should go for it. But the same should go for a low-risk woman who wants to have few to zero interventions and give birth in place that isn’t meant for sick people. And sadly, the latter woman is likely to have fewer choices and options, as well as support, even though her choice is just as valid and may even result in a better outcome for both mom and child.