Right to Choice of Birth Location and Attendant (re: AMA homebirth resolution)

[mrsfrenchy]

I posted a couple of weeks ago that I have an upcoming speech for a class and I wanted to do something homebirh related. I've decided that my proposition will be that we should "oppose the AMA/ACOG resolutions against homebirth and support the choice of both birth location and attendant for women"

I'm having some problems formulating my ideas about why it's important that we have this choice and how limiting this choice could lead to the limitations of freedoms in other areas.

For example, I think it's similar to abortion and being pro-choice because even if you don't agree with abortion, it's important that I have that legal right.

However, abortion is a devisive issue and i'd like to explain it some other way. Can someone help me? Why is it important that we be allowed birth choice and how could limiting birth choices lead to other limitations of freedom?

Thanks ladies. You guys always give me good insight.

[DahliaRW]

It seems like dictating birth could be a gateway to dictating other parenting choices, perhaps. And it could also have sway over other reproductive freedoms such as birth control, sterilization, etc.

[Full Heart]

I think its scary when we start dictating which kind of medical care people can have. That can be a very slippery slope. We already have a precedent with vaxes (which I know was used as an argument to go one step further for sterilization). Even if we take the medical aspect out of it and make it about parenting there are precedents for that too such as choice of school.

It can also be argued that it is a gender issue in which simply because the patient is female she is unable to make decisions regarding her care and so it must be made for her. Again another slippery slope. How soon we forget the lessons of our past, it wasn't so long ago we couldn't even vote or own property for very much the same reasons.

[jennyfah]

Have you read "Pushed" by Jennifer Block? She has a couple of chapters on this very issue, especially the last one in the book.

HTH!
Jen

[D'sMama]

It's late and my brain is not functioning that well at the moment, so this might be a bit rambling, but here goes...

For the same reason that legal abortion is important: some women WILL get abortions, but without a legal avenue, they can be incredibly unsafe and life threatening.
Well, IMO, the same goes for birth. Some women WILL birth at home without assistance (and I'm not talking planned, prepared UC here), and some of those births will not go well. It's better public policy to have a system in place to support women who choose to birth out of hospital than to force them to either conform or do it alone/under the radar. (Of course, this system is not currently in place in every state and a whole lot of homebirths do take place under the radar, which sucks for everyone.)

Also, it's kind of bullsh!t that the professional organizations for the largest supplier of childbirth services and maternity care are attempting to throw their weight around and gain a complete monopoly. That wouldn't fly in any other kind of business - the biggest, most powerful company says it's not "safe" for the little independent companies to provide a similar service and so they should therefore not be allowed to operate? I don't think so!

Personal physical autonomy and freedom are considered very important in this country, last I checked. Forcing women to give birth in one kind of location with one kind of attendant and to submit to rules and regulations and unwanted care is a kind of restraint on physical freedom - but because it's "medical" and takes place for a relatively short period of time during a vulnerable moment in a woman's life, somehow that's okay? I don't think so, but custom is powerful, especially when fear is involved.

[PTmorgan]

Another point: In many of the documentaries (BOBB, for example) and articles that I've read, the MDs and OBs that are making these decisions have NO experience with homebirth. Therefore, they are not making an informed policy decision.

[Gena 22]

Setting the issue of safety aside, since HBs can be as safe as hospital births, choice of birth location is an issue of bodily autonomy. Question that and we've seriously impinged on both the civil rights and mental health of women. Look at PPD. The levels of PPD are much, much lower for HBers and highest for c/s patients.

My mother had some PPD, and couldn't believe I didn't have a moment of baby blues. It was one of the wonderful side effects of a HB. But this isn't just a luxury. Starting life with a new child, the mother and family should be as mentally healthy and happy as possible, not assaulted as some are in coercive hospital births.

Physical autonomy is one of the most basic rights of a civilized society.

[mamabadger]

Originally Posted by Gena 22

Physical autonomy is one of the most basic rights of a civilized society.

Good point. Instead of relating it to other parenting choices, why not identify the more basic rights being infringed upon? Forcing a woman to go to or remain in a specific place against her will just because she is pregnant seems like unlawful detainment to me.

[Full Heart]

You know it really is about choice pure and simple. Not really about location and birth attendant. Thats just part of it. We aren't allowed a choice in vbac or ercs. We aren't allowed to walk around, eat, drink, refuse cefm, ve, arom, pit, iv, induction. Slowly any choice we had concerning anything about pg and birth are being taken away. If it wasn't an assembly line before it will be shortly. Some places won't allow doulas and or cameras. We are dropped from care from mws and drs alike for refusing testings, going post dates, wanting choice. I think its pretty clear the people making these statments want women to have NO choice in anything concerning their care. Not just location and attendant. If we start forcing the issue of location and attendant perhaps we can get choice in other areas as well, like VBAC and cefm, and induction.

[sunflowergirll]

Well, I suppose I would oppose it because the ACOG's basic premise is just not true. There are numerous studies that show that in low-risk women with skilled attendants, the morbidity/mortality outcomes are the same. In many countries. If I remember correctly, ACOG's premise is based on a study that lumps in unintended and intended HB, and does not account for risk or skill of attendants.

So, if their premise is not true then why should we support it. Especially when it affects millions of women/babies a year. When it drives up the cost of health care. When it can affect postpartum depression and breastfeeding. When being in the hospital increases interventions (e.g. pitocin, epi, csections) which can have risks of their own. When many women would WANT to birth at home but don't know enough to ask for that choice, or don't feel they can contradict their HCP.

How long is your speech again? :P

[MegBoz]

Originally Posted by mrsfrenchy

we should "oppose the AMA/ACOG resolutions against homebirth and support the choice of both birth location and attendant for women"

But I'm confused... ACOG sets policy, they don't actually set any rules, or make laws. Their own members don't even have to follow their policy recommendations if they don't want. And I'm pretty all American OBs don't even have to be members of ACOG.

So... ACOG can issue "resolutions" however they like... no one is obliged to follow.

Let's also turn this on it's head.... Can we, or should we, FORCE OBs to provide HB services? Nope. We can't, and we shouldn't. It's a (mostly) free-market system.

IOW, I'm asking what your thesis statement is. What does it mean that we should "oppose" ACOG? What, specifically, are you advocating?

if you want to address the question of 'why it's important that we have this choice' ... well, I think the answer to that lies in the fact that:
1. It's as safe, if not safer than hospital-birth for low-risk women
2. It's much, much cheaper
3. It often leads to a fabulous experience*

*in turn, this "fabulous experience" has it's own benefits (even though the medical establisment seems to scoff at the absurdity of actually being concerned with the experience ). The experience is often empowering for women, helps with bonding to the baby, strengthens & bonds families, reduces PPD - which is just good for the whole of society.

That's "Why," IMO

[Full Heart]

Originally Posted by MegBoz

But I'm confused... ACOG sets policy, they don't actually set any rules, or make laws. Their own members don't even have to follow their policy recommendations if they don't want. And I'm pretty all American OBs don't even have to be members of ACOG.

So... ACOG can issue "resolutions" however they like... no one is obliged to follow.

Let's also turn this on it's head.... Can we, or should we, FORCE OBs to provide HB services? Nope. We can't, and we shouldn't. It's a (mostly) free-market system.

IOW, I'm asking what your thesis statement is. What does it mean that we should "oppose" ACOG? What, specifically, are you advocating?

if you want to address the question of 'why it's important that we have this choice' ... well, I think the answer to that lies in the fact that:
1. It's as safe, if not safer than hospital-birth for low-risk women
2. It's much, much cheaper
3. It often leads to a fabulous experience*

*in turn, this "fabulous experience" has it's own benefits (even though the medical establisment seems to scoff at the absurdity of actually being concerned with the experience ). The experience is often empowering for women, helps with bonding to the baby, strengthens & bonds families, reduces PPD - which is just good for the whole of society.

That's "Why," IMO

The problem is that in states that require a back up mds can quote the ACOG statements as a reason not to provide that back up. In essence than forcing women who would want a mw attended hb to either do it under the table or uc or go to the hospital. It can also be used as a catalyst to laws banning hb, as well as insurance not covering hb based on the statement.

[jennyfah]

Originally Posted by Full Heart

The problem is that in states that require a back up mds can quote the ACOG statements as a reason not to provide that back up. In essence than forcing women who would want a mw attended hb to either do it under the table or uc or go to the hospital. It can also be used as a catalyst to laws banning hb, as well as insurance not covering hb based on the statement.

:


I don't think opposition to the (ridiculously poorly researched, non-evidence based, self-serving, etc.) ACOG statements would be forcing anyone to do anything; it would simply be an acknowledgment that their 'opinions' are not fact that the media and insurance companies take them to be.

[mrsfrenchy]

Originally Posted by Full Heart

The problem is that in states that require a back up mds can quote the ACOG statements as a reason not to provide that back up. In essence than forcing women who would want a mw attended hb to either do it under the table or uc or go to the hospital. It can also be used as a catalyst to laws banning hb, as well as insurance not covering hb based on the statement.

the bolded part is my biggest concern. there really is a potential for states to start outlawing homebirths (there are already 9 states +DC where its illegal for a CPM to attend a HB) because the AMA/ACOG are developing Model Legislation. Did you know that the AMA spend 20 MILLION a year on lobbyists? I think its a defnite possibility.

[MegBoz]

Originally Posted by mrsfrenchy

the bolded part is my biggest concern. there really is a potential for states to start outlawing homebirths

Gotcha!
I still think that your speech should focus on either:
1. WHY we ought to "oppose" AMA
2. HOW we ought to "oppose"
... either the justification of the fight for the right to HB - or the specific strategic/ tactics.