Citizens for Midwifery - Home Page Citizens for Midwifery - Search Page Citizens for Midwifery - Contact Page CfM Blog CfM on myspace CfM on facebook

CfM Home Page
Supports the Midwives Model of Care!
Support your local midwife - Join CfM!
Support midwifery education - Donate to CfM!
Midwives Model of Care
FAQs and Midwife Credentialing Information
Status on midwifery around the country
Resources on midwives and midwifery
Advocacy tools for midwifery advocates
Links on midwives and midwifery
Finding a Midwife
Press releases on midwives and midwifery
Brochures and other midwifery related info
CfM Midwifery Blog
Midwives Model of Care Supporters
Midwives Alliance of North America
North American Registry of Midwives
Midwifery Education Accreditation Council
CopyRight Citizens for Midwifery 2010


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. 

  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.

  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 and their babies.

  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.

  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.

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.

 

 

 

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

 

 Do you find this information useful?  Learn more about CfM and consider Joining CFM.