Tuesday, February 12, 2008

Homebirth advocates respond to ACOG statement

Homebirth advocates have responded strongly to ACOG statement that homebirth is not as safe as hospital birth. As I would expect from homebirth advocates, it is slur and innuendo married to mistruths, half truths and outright deception. There isn't a fact supporting homebirth safety in any of the responses. That's not really suprising when you consider that the facts do not support claims of homebirth safety.

As an example, you can read the press release from the Big Push here. I'd like to analyze it paragraph by paragraph:
The American College of Obstetricians and Gynecologists (ACOG), a trade union representing the financial and professional interests of obstetricians, has issued the latest in a series of statements condemning families who choose home birth and calling on policy makers to deny them access to Certified Professional Midwives. CPMs are trained as experts in out-of-hospital delivery and as specialists in risk assessment and preventative care.
Of course, being a homebirth advocacy organization, they start with a slur. Imagine, ACOG is a trade union representing obstetricians. Wow, healthcare providers shouldn't have trade unions representing their financial and professional interests, right? Well, not exactly. MANA (Midwives Alliance of North America) is a trade union representing the financial and professional interests of certified professional midwives. So actually having a trade union is fine if it represents CPMs and is a dastardly plot if it represents obstetricians. Nothing like a double standard to get the ball rolling.

By the way, we should consider whose financial interests are really at stake here. Obstetricians don't have much to fear from homebirth. Less than 0.25% of births in the US are homebirths with a DEM. In contrast, 100% of CPM income depends on homebirth. NO ONE has a stronger financial interest in homebirth than CPMs and that should be kept in mind when considering the validity of what they say on the topic.

"CPMs are trained as experts in out-of-hospital delivery and as specialists in risk assessment and preventative care." There's that trademark bit of inanity that you see all the time in support of DEMs. CPMs are not "experts" in homebirth, they are RESTRICTED to homebirth because they are considered UNQUALIFIED to provide healthcare. It is really outrageous to claim that they experts in risk assessment, since they have NO EXPERIENCE in assessing and managing childbirth complications, none, zip, zero, nada. Only supporters of CPMs could put out a press release claiming they are experts in something they are not even trained to do.
"It will certainly come as news to the Amish and other groups in this country who have long chosen home birth that they're simply being 'trendy' or 'fashionable,'" said Katie Prown, PhD, Campaign Manager of The Big Push for Midwives 2008.
That's another typical homebirth advocacy tactic: make a statement that is unrelated and irrelevant to the matter at hand. The fact that the Amish choose homebirth for religious reasons has NOTHING to do with the fact that white, Western women choose it to be part of an ideological subculture. However, it is so much easier to insinuate that ACOG was criticizing the Amish or to pretend that women choose homebirth in order to emulate the Amish, then to address the fact that homebirth reflects the ideology of a small subculture.
Besides referring to home birth as a fashionable "trend" and a "cause célèbre" that families choose out of ignorance, ACOG’s latest statement adds insult to injury by claiming that women delivering outside of the hospital are bad mothers who value the childbirth "experience" over the safety of their babies.
ACOG is CORRECT. Women do choose homebirth out of ignorance. Ignorance is the foundation of homebirth advocacy: ignorance about the inherent dangers of childbirth, ignorance about the fact that all existing scientific evidence shows that homebirth has a higher rate of preventable neonatal death than hospital birth, and ignorance about the history of modern obstetrics. In choosing homebirth, women ARE choosing to value the childbirth "experience" over the safety of their babies. Ignorance may be the reason for making that choice, and homebirth advocates are certainly responsible for spreading the ignorance that leads to that choice, but the choice IS valuing the mother's "experience" over the baby's safety.
If every state were to follow ACOG’s recommendations and outlaw CPMs, families who choose home birth will be left with no care providers at all. I think we can all agree that this is an irresponsible policy that puts mothers and babies at risk."
That touching appeal for the safety of mothers and babies would be a lot more believable if it weren't coming from people actively promoting a practice that increases the risk of neonatal death. If advocates of CPMs REALLY care about the safety of mothers and babies, they would strengthen the grossly inadequate standards of education and training for CPMs.
CPMs play a critical role in both cesarean prevention and in the reduction of low-birth weight and pre-term births, the two most preventable causes of neonatal mortality.
Talk about self-aggrandizing baloney. CPMs achieve a low C-section rate because they let babies die from preventable causes. That's not a trade off that obstetricians are willing to make. CPMs have a low prematurity rate because they transfer all patients with risk factors to doctors. To whom are obstetricians supposed to transfer the patients so that they could pretend that they play not just a "role", but a "critical role" in reducing prematurity? Are we supposed to believe that prematurity is a big problem among the white, Western, relatively well educated, relatively well off, less than 0.25% of women who choose homebirth with a DEM? Are we supposed to believe that CPMs reduced the rate of prematurity among this group? I don't believe it, and the mere fact that CPMs and their supporters suggest it tells us that they have no idea what they are talking about.
Moreover, their training as specialists in out-of-hospital maternity care qualifies CPMs as essential first responders during disasters in which hospitals become inaccessible or unsafe for laboring mothers.
LOLOL. I bet the paramedics of the country are suprised to hear that. I'd like to know exactly how many CPMs have been first responders in out of hospital births during disasters. I'd guess ZERO.
The Big Push for Midwives is a nationally coordinated campaign ... to push back against the attempts of the American Medical Association Scope of Practice Partnership to deny American families access to legal midwifery care.
The Big Push for Midwives is actually a nationally coordinated campaign to promote the licensing of a second, inferior class of midwife with inadequate education and indadequate training, because those women won't make money otherwise.

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