So, What Can YOU Do About This?

Sally here. :) I've been thinking about what the average person can do to speak their mind, and maybe you'd like to hear? I thought so. ;)

First of all, to whom to write? In this case, there's no legislation up for consideration. The AMA and ACOG have simply stated that they encourage whatever political entities might so desire, to create legislation based on their ideas. Well, we, the people, have ideas as well. So, pick your favorite:

reply directly to ACOG and AMA

send a letter to your local hospital

write to your local senator and representative about this issue that might be brought up next legislative session

reply to supporters of birth place choice, and thank them

What to write? Well, your opinion, based on facts; and a simple request. For example: "The AMA has recently suggested that the only safe place for childbirth is in a hospital or birth center. I disagree based on this information:.... If a bill comes up that attempts to restrict birth place choice, please vote against it. Thanks." Something like that.

How to write? I searched the web for suggestions on how to write persuasively and kindly, because in my experience, when I'm passionate about something, it's hard to be nice. Well, it's challenging to sift through the emotions and craft a concise statement of opinion based on fact that someone completely uninformed about my passionate beliefs can readily understand. It takes practice, but it's worth it.

I'm refraining from crafting a letter that you can adapt to your own needs because just as I believe you all to be competent, intelligent folks who can make the best birth and parenting decisions for your family, based on your needs, I think you can decide to whom to write and what to say. Your words will communicate your sincerity better than a copied and pasted letter.

Here are some links that may help:

Tips for Writing Your Senator

Become an Instant Activist

A Soft Complaint
(an essay, actually, for an English class, but interesting nonetheless)

Why Don't We Complain?
a 1961 essay by William F. Buckley, Jr. While the reasons we don't complain until we're ready to blow our tops are different than 40 years ago, I think he still makes some interesting points.

~S~

Other Responses to the AMA and ACOG

Rixa at The True Face of Birth compiled a great bunch of responses to the AMA's and ACOG's recent statement about place of birth.

Go and have a read; they're great.

The one I liked the most was a letter by a Canadian obstetrician, Andrew Kotaska, which was posted by Jennifer Block at PushedBirth. Here's a snippet:

" I would invite ACOG to join the rest of us in the 21st century. Modern ethics does not equivocate: maternal autonomy takes precedence over medical recommendations based on beneficience, whether such recommendations are founded on sound scientific evidence or the pre-historic musings of dinosaurs. In the modern age, the locus of control has, appropriately, shifted to the patient/client in all areas of medicine, it seems, except obstetrics. We do not force patients to have life-saving operations, to receive blood transfusions, or to undergo chemotherapy against their will, even to avoid potential risks a hundred fold higher than any associated with home birth. In obstetrics, however, we routinely coerce women into intervention against their will by not “offering” VBAC, vaginal breech birth, or homebirth. Informed choice is the gold standard in decision making, and it trumps even the largest, cleanest, RCT.(randomized controlled trials)."

What a chivalrous and rational attitude!

~S~

Response to ACOG from one of their own

Jennetta asked me to post this letter from an obstetrician and member of ACOG:

From: Stuart Fischbein
Sent: Monday, June 23, 2008 5:35 PM

Douglas H. Kirkpatrick, MD
The American College of Obstetricians and Gynecologists
PO Box 96920
Washington, DC 20090-2188

Dear Sir:

I am a practicing OB/ GYN in southern California and Fellow of ACOG and recently was informed by midwife colleagues of your recommendation and encouragement for the AMA to lobby Congress for a law banning out of hospital birth. Funny that I had to hear of this decision from outside sources and was never approached by my college to see how I or my local colleagues felt about it. I have grave concerns regarding my organization taking such a stand. I think we are all agreed that ACOG has a statement regarding patients¢ rights to informed consent and informed refusal. Yet, it seems with every decision our organization moves further away from that basic tenet.

ACOG's little "guideline" paper on VBAC in 2004 where the word readily was changed to immediately has had the chilling effect of doing away with VBAC options at hundreds if not more hospitals. Not due to patient safety, or the ideal of giving true informed consent but really, let's be honest, to fear of litigation. I have seen how patients have become counseled by obstetricians at facilities where VBAC has been banned. They are clearly given a skewed view of the risks of VBAC but rarely told of the risks of multiple surgeries. If you think this is untrue you are, sadly, out of touch with real clinical medicine.

As to out of hospital birthing, please give me the courtesy of an explanation as to the data you used and the process by which an organization which is supposed to represent me came to this conclusion. Any statement saying that it is as simple as patient safety and that one-size fits all hospital birth under the "obstetric model" of practice should be applied to all patients is, putting it nicely, not really in line with what best serves all our patients. In many instances, hospitals are not safe, certainly not nurturing and have a far worse track record for disasters than home birth. Even when emergency help is nearby this is true. The focus of all of us in medicine should be on reigning in trial lawyers and tort reform and lobbying Congress for that. The best interest of the college members and the patients we serve would be for my organization to spend its time and energy on something that has true benefit.

Removing choices from well-informed patients and caring doctors and midwives is wholly un-American.

So please send me detailed information on how ACOG decided outlawing home birth was a wise thing to do. You must have scientific data to take such a drastic stand. Please make it available to me so that I may share it with like-minded colleagues. I would also like to know the process by which this came to pass. Who first raised this issue and why? What committee reviewed all the data and did its due diligence in interviewing those of us with long-standing experience in backing midwives who perform out of hospital births. There must be a fine, non-confidential paper trail you can share with your members. Specific names of committee member who voted for this would be enlightening and I am requesting this information. I would like to know the background and expertise regarding out of hospital birth for each member who had a hand in the decision to go to the AMA.

We live in an odd era where once something is said or recommended by a legitimate organization such as ACOG it has deep ramifications never intended, such as becoming fodder for trial lawyers trying to squeeze the lifeblood and dignity out of your members. Or forcing women to travel hundreds of miles in labor to find a supportive facility. Or even worse, to have them arrive in a VBAC banned hospital and refuse surgery. Can this be the best we can do for our patients? Remember, your VBAC statement was meant to be only a recommendation but quickly became the rule by which hospital administrators, risk managers and anesthesia departments of smaller hospital banned this option for thousands of women. An option, that in proper hands, was the safe and accepted standard of care for 30 years. In fact, you still have an ACOG VBAC brochure that recommends this option!

For those of us working at smaller hospitals where VBAC was banned due to lack of emergency help (anesthesia, OR crews, etc.) there is a big question that has perplexed us, that no administrator seems to be willing or able to answer. That question is: "If a hospital cannot handle an emergency c/section for VBACs, and most emergencies are for fetal bradycardia, hemorrhage (ie. abruption) or shoulder dystocia, not for ruptured uteri, then how can they do obstetrics at all?" For they seem to still be able to have a maternity ward without in house anesthesia. Will someday ACOG, in their great wisdom but seeming disconnect from reality, make a "recommendation" that little hospitals stop providing obstetric services? Will this better serve women and their communities throughout America?

I am frightened and angered by what you have done in my name. Now I ask you to defend your position in encouraging the AMA to lobby Congress for another restriction on the freedom of choice that belongs to women and their families. Those choices include midwifery and the right to have the most beautiful and life changing event occur wherever best fits their desire.

Midwives are well trained and required to have obstetrical backup. They have very special relationships with their patients and want the very best outcomes for them. They do not need me or you to police them. We have a habit in our country over the past 40 years of thinking we can legislate out stupidity. All that has done is erode the individual freedoms that belong, by birthright, to each of us. I would hope you trust your Fellows to know their specialty, their colleagues, and what is best for the patient as an individual.

These decisions do not belong to politicians or faceless committees. You should have more faith in your members to give balanced informed consent. Again, my recommendation to you is to put all your considerable energy into changing our legal malpractice system. Those of us actually practicing medicine and caring for patients know this to be the greatest threat to the mission and responsibility we have chosen to undertake.

I look forward to your response and possibly the beginning of a meaningful dialogue.

Sincerely,

Stuart J. Fischbein, MD FACOG

Medical Advisor, Birth Action Coalition

~J~

Who gets to decide where you give birth?

Well, according to the AMA, it should be doctors and the law. The AMA and ACOG sites don't link to this statement (scroll down) yet, but it's all over the news.

Essentially, the American Medical Association has resolved to create model legislation that mandates 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.” (link to quote)

Whether you agree or disagree, what do you think? Whose choice is it? Who gets to evaluate safety?

~S~

This article is from one of Marsden Wagner's books. Marsden Wagner, MD serves on The Association for Wise Childbearing's Advisory Board. Your responses are welcome!

FISH CAN'T SEE WATER:

THE NEED TO HUMANIZE BIRTH

Marsden Wagner, MD, MSPH International Journal of Gynecology and Obstetrics, 75, supplements 25-37, 2001

INTRODUCTION Humanizing birth means understanding that the woman giving birth is ahuman being, not a machine and not just a container for making babies. Showing women---half of all people---that they are inferior and inadequate by taking away their power to give birth is a tragedy for all society. On the other hand, respecting the woman as an important and valuable human being and making certain that the woman's experience while giving birth is fulfilling and empowering is not just a nice extra, it is absolutely essential as it makes the woman strong and therefore makes society strong. Humanized birth means putting the woman giving birth in the center and in control so that she and not the doctors or anyone else makes allthe decisions about what will happen. Humanized birth means understanding that the focus of maternity services is community based primary care, not hospital based tertiary care with midwives, nurses and doctors all working together in harmony as equals. Humanized birth means maternity services which are based on good scientific evidenceincluding evidence based use of technology and drugs. But we do not have humanized birth in many places today. Why? Because fish can't see the water they swim in. Birth attendants, be they doctors, midwives or nurses, who have experienced only hospital based,high interventionist, medicalized birth cannot see the profound effecttheir interventions are having on the birth. These hospital birth attendants have no idea what a birth looks like without all the interventions, a birth which is not dehumanized.
This widespread inability to know what normal, humanized birth is has been summarized by the World Health Organization: By medicalizing birth, i.e. separating a woman from her own environment and surrounding her with strange people using strange machines to do strange things to her in an effort to assist her, the woman's state of mind and body is so altered that her way of carrying through this intimate act must also be altered and the state of the baby born must equally be altered. The result it that it is no longer possible to know what births would have been like before these manipulations. Most health care providers no longer know what non-medicalized birth is. The entire modern obstetric and neonatological literature is essentially based on observations of medicalized birth.

~J~