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MAIN TALKING POINTS
Shouldn’t women and their families
have access to the full array of healthy, evidence-based maternity care
choices? Should physicians’ trade associations determine what is available?
This section is intended to
help you be more effective in communicating with your legislator and explaining
why the positions and agendas of AMA and ACOG are harmful to mothers and
babies. The Talking Points are based on
information found in "Important Information” and “Resources” elsewhere in the
Tool Kit. If you need citations for
specific facts and can’t find them among these resources, please contact us.
We have listed many possible Talking Points –
no one will use them all! You will know
which ones to use if you know your “target audience” – use the points that are
most appropriate given your audience’s positions, passions, interests and
concerns. You’ll find more “how-to’s”
for this in “Contacting and Communicating with your Legislator” section.
Below is the main message we think
will be most effective and some points to support each that you may find useful
in your discussions. Don't try to memorize these. Use those you think will be
most effective in making your case to your legislator. You probably won’t want to present these key
messages “as is,” but do your best to get the ideas across in your
conversations.
MAIN 4 MESSAGES TO LEGISLATORS
We (women, babies, and families) need
your help!
Despite their claims otherwise, ACOG and the AMA are abusing our trust
by misrepresenting home birth and midwives and by working to outlaw the choice
of midwife-attended home births.
- ACOG and AMA are TRADE ORGANIZATIONS.
They seek to promote self-serving legislation that is more concerned with
market share than the safety and well being of mothers and babies.
- NO SCIENTIFIC BASIS for AMA and ACOG
positions. Recent position statements
and resolutions by these organizations are based on belief and innuendo, with
NO credible supporting evidence. Science shows us that planned home birth with
a trained midwife is safe for most women and their babies.
- US BIRTH OUTCOMES ARE GETTING WORSE.
With 99% of births taking place in hospitals, the positions of the AMA and ACOG
would not solve the problem of poor and deteriorating outcomes. Instead they would restrict all families to
hospital-based, doctor-controlled maternity care, that routinely promotes and
uses unnecessary practices and procedures that are proven to be harmful or
risky to mother and/or baby. In most industrialized countries midwives are the
primary care providers, with better outcomes at far less expense than the US.
- AMA and ACOG positions CONTRADICT BASIC HUMAN RIGHTS. No legislation should
interfere with fundamental human rights to have autonomy over our bodies,
including the right to give birth at home.
Your help is needed to stop ACOG and
AMA and protect planned homebirth, because one-size-fits-all maternity care is
harmful.Stand up for access to healthy,
evidence-based maternity care, including the choice of a midwife-attended
planned home birth.
TALKING POINTS IN SUPPORT OF THE 4 MAIN
MESSAGES
1. ACOG and AMA are TRADE ORGANIZATIONS.
- They seek to promote self-serving legislation that is more concerned with
market share than the safety and well being of mothers and babies.
- Based on their own documents, the
primary goal of AMA and ACOG is promoting the interests of their members. (See
“About the AMA & ACOG " in Important Information)
- AMA and ACOG are not accountable for
their actions or positions – to the general public or to the government. (See
“About the AMA & ACOG" in Important Information)
- Their positions regarding home birth
and midwives are not supported by any credible scientific evidence, but do
serve to advance their grip on market share at the expense of women and babies.
- The most appropriate role for
medical professional associations is to develop and enforce guidelines for the
practice of their profession. If the
medical profession put as much effort into ensuring that doctors followed those
guidelines as they do trying to manage other professions or make policy, the
public, mothers and babies in particular, would be much better off.
- Studies show that when health care
professional associations have too much freedom to make policy, they make
policies to serve their own interests and not those of the public; bad policy
that does not improve health or well being.
- No one professional association
should be controlling policy for an entire sector of the health care industry and thus restricting healthy choices for consumers. Maternity care professionals include
midwives, obstetricians, family practitioners, doctors of osteopathy, nurses,
doulas, lactation professionals, doula nurses, anesthesiologists, and
childbirth educators.
- The AMA has developed the Scope of
Practice Partnership (SOPP), of which ACOG is a member, for the express purpose
of trying to restricting the scope of practice of any non-doctor provider,
including midwives in and out of hospitals, in order to retain control of the
market. The effort to outlaw homebirth is clearly an extension of SOPP and is
about securing market share and NOT about what is best for promoting healthy
mothers and babies. (see the Big Push for more on
this and an AMA Powerpoint).
- Obstetricians are surgeons and not
trained to support normal birth, but oppose the very health care providers who
are: CPMs who are trained and experienced in attending births outside the
hospital. The Certified Professional Midwife credential is the only maternity
care credential that requires experience in out-of-hospital settings. ACOG
brags about relying on a “show of force” to stop CPM licensing legislation.
2. NO SCIENTIFIC BASIS for AMA and ACOG
positions.
Recent position statements
and resolutions by these organizations are based on belief and innuendo, with
NO credible supporting evidence. Science shows us that planned home birth with
a trained midwife is safe for most women.
- Research Shows Planned Home Birth Is
Safe:
- The preponderance of all
scientifically credible studies of home birth outcomes have found that planned
home birth with a qualified provider is as safe or safer for most women and
their babies.
- The very few studies that show
otherwise are flawed or include unplanned or unattended births, skewing the
results.
- AMA and ACOG positions on home birth
are based on the lowest level of “evidence” and “expert opinion”, not on RCTs
or prospective studies.
- Randomized controlled trials (RCTs)
have not been carried out because they are unethical, impractical and
inappropriate for studying place of birth. Prospective studies, such as the
CPM 2000 study provide scientifically sound information when RCTs are not
practical.
See the About Home Birth section of the Resources Page.
- The Hospital is NOT the “Safest” Place
to Give Birth: Hospital-based obstetricians often
claim that dire emergencies can occur without warning during childbirth. In
fact,
- Many of the “unforeseen emergencies”
cited by medical professionals are in fact caused by the inappropriate use of
routine practices, procedures, interventions and medications by those
professionals. Most routine hospital birth practices and medical interventions
disturb the process of labor and often cause complications.
- Pregnancy and childbirth are normal,
healthy physiological processes. For
most women and babies the optimal outcome, with both mother and babies as
healthy and whole as possible, is best achieved in the absence of routine
intervention and interference. That is
best achieved outside the hospital.
- CPMs:
- ACOG and AMA statements reveal
ignorance about the education and qualifications of CPMs and about the quality
of their outcomes. (see CPM Issue Brief at
http://mana.org/pdfs/CPMIssueBrief.pdf for detailed information about
certification requirements.)
- The CPM has midwifery training is
similar in content to training for CNMs (see comparison chart on ACNM’s website
at http://www.acnm.org/siteFiles/legislative/CNM-CM-CPM_chart_FINAL_March_07.pdf).
There is no evidence that requiring a college or graduate degree improves
midwifery practice or outcomes.
- The CPM is the only maternity care
credential that requires experience in attending out-of-hospital birth. Since
no physicians, including obstetricians, are required to even observe a single
normal, undisturbed birth, such as an out-of-hospital birth, the profession
lacks essential knowledge about safe, out-of-hospital birth practices.
- Contrary to implications by doctors,
the highly skilled and well trained professional midwives, such as CPMs, who
attend women at home, have the knowledge, skills and experience to recognize
potential problems and when transport to a hospital is needed. At home births
women are not treated with drugs nor subjected to intrusive medical
interventions, and serious complications are very rare; the great majority of
transports for medical care during labor are for fatigue and desire for pain
medication.
- None of the nearly two dozen states
that currently license CPMs has expressed concern about "safety"; nor
have they reversed their legislation or prohibited home births.
- The International Perspective
3. US BIRTH OUTCOMES ARE GETTING WORSE.
With 99% of births taking place
in hospitals, the positions of the AMA and ACOG would not solve the problem of
poor and deteriorating outcomes. Instead
they would restrict all families to hospital-based, doctor-controlled maternity
care, that routinely promotes and uses unnecessary practices and procedures
that are proven to be harmful or risky to mother and/or baby. In most
industrialized countries midwives are the primary care providers, with better
outcomes at far less expense than the US.
- With 99% of births in hospitals, US
outcomes are poor and getting worse.
- The US has the worst infant
mortality rates in the industrialized world -- behind 26 other countries -- and
worse maternal mortality than 13 other industrialized countries.
African-American women and their babies have much higher rates of mortality
(see State of Maternity Care in the US fact sheet).
- We have high and raising rates of preterm birth
and low birth weight babies, tied in part to increasing rates of induction of
labor and scheduled cesarean births prior to term.
- Cesarean section rates have
increased dramatically in recent years and are now the most common surgical
procedure performed in the US – over 1 million per year. – and at least half of these are unnecessary or
preventable. Cesarean section carries increased risks to mothers, including up
to 4 times the risk of maternal death, risks of injuries and morbidity to babies, and
higher costs. Furthermore, thousands of
women are forced to have repeat cesareans because of hospital policies
unrelated to promoting the health and well-being of mothers and babies.The high
rates of interventions, cesarean sections and repeat cesarean sections
dramatically increase the costs of maternity care for everyone.
- Breast-feeding rates are reduced by
inappropriate overuse of routine medical interventions that can interfere with
successful establishment of breastfeeding. In contrast, the many short and
long-term benefits of breastfeeding are widely recognized by the medical community and the
government.
- The fact that OBs are not able to
help healthy women have babies without drugging almost all of them and
performing surgery on at least a third of them is an indication that the
obstetrical profession is not competent to provide care for healthy women with
normal pregnancies, and should only be called in when there is a real medical
problem for which they have appropriate training. Therefore, ACOG and AMA should not be
considered authorities when it comes to midwifery and normal birth.
- Hospital births carry their own risks.
- Risks of hospital acquired infection
for both mothers and babies: higher for those undergoing surgical procedures
and for those who undergo Artificial Rupture of Membranes (a routine part of
induction of labor).
- Risks of medical error: childbirth
is the most common reason for the hospitalization of women in the US and the
fifth most common reason for hospitalization overall. Childbearing women comprise a high proportion
of hospital patients and are therefore at risk.
- Ironically, childbirth is a normal
physiological process, and most women start labor in good health, yet virtually
none escape medical procedures in the hospital.
- Risks of inappropriate intervention:
for economic and time-saving reasons, hospitals and OBs have incentives to
speed up labor, make labor more predictable, and perform interventions that are
billable procedures. Thus:
- Women are often pressured to accept interventions to start or speed
up labor, or cesarean surgery to end the labor, even though these almost always
go against evidence-based practice.
- Women are often pressured to accept electronic fetal monitoring and
pain relief drugs to keep them quiescent so nurses can manage multiple
patients, keeping costs low, but not
promoting healthy mothers and babies.
- Women are usually denied food
and drink while doing the hardest work of their lives in order to protect
anesthesiologists from liability. Women labor better when they can take
nourishment and fluids freely.
- Thousands of women have been manipulated into multiple cesarean
births to protect hospitals from perceived liability risks from vaginal birth
after cesarean (VBAC). While OBs frequently bring up their difficulties
regarding liability and lawsuits to excuse the rate of cesarean sections, legal
fears do not constitute any kind of an ethical justification for performing
unnecessary surgery, and women are seldom if ever informed of the real reason.
Furthermore, ACOG has never publicly acknowledged that their members find
themselves in a problematic situation or asked for help to address it; we are
just told that’s the way it is.
4. AMA and ACOG positions CONTRADICT BASIC HUMAN RIGHTS.
No legislation should
interfere with fundamental human rights to have autonomy over our bodies,
including the right to give birth at home.
Women and families should decide.
- Women and their families have the
most at stake in the decision of where to give birth and do not make this
decision lightly.
- Many of the women who plan to give
birth at home are trying to avoid the many risks inherent in hospital birth –
primarily routine procedures, medical errors, and infection. To have a normal,
vaginal birth and a healthy baby, they see a midwife-attended home birth as
their healthiest option.
- Women labor most effectively and
most safely at the place they choose.
- Some women will choose to give birth
at home, for a variety of reasons, and should have trained care providers to
ensure the best possible outcomes. State
legislatures are mandated to “protect the public welfare”; ACOG and AMA have no
such responsibility.
- Human Rights declarations on
bioethics support autonomy in decision making, informed consent, and
appropriate assessment of risk.
- Such declarations also support
pluralistic debates, multiple opinions, transparency, and integrity in
decision-making, particularly for developing policy and laws.
TOOLKIT CONTENTS -- Main Sections
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