Women and Children First?

The L.A. Times posted an opinion piece from author Jennifer Block. As you are well aware, the American Medical Association, the American College of Obstetricians and Gynecologists et al seem to be on the defensive. Perhaps it has to do with celebrities planning homebirths and making films about it.

These folks are all for patient autonomy when it lines their pockets, e.g., inductions of labor and maternal choice cesareans, but when it doesn't, they have a collective conniption. It's kind of fun to watch.

Block says:

Last year I flew to Britain to be with a good friend for the birth of her first child. She's American but married into Britain's National Health Service, lucky duck. The differences in the prenatal care she got there were striking. First and foremost, she never saw a doctor. As a healthy woman with a normal pregnancy, she saw midwives. And one of their first questions to her was, "So, would you like to give birth in the hospital maternity ward or at home?"

All the available evidence suggests that, with some caveats (the midwife is trained, certified in neonatal resusitation, the mother's health falls within normal parameters, and a cooperating hospital is close by) homebirth is a safe, reasonable choice for many women. Ironically, midwives in the countries whose childbearing outcomes are the best are not nurses as well.

Block goes on:

Organized medicine can't believe this. Dismissing the research evidence, the AMA resolution states that "the safest setting for labor, delivery and the immediate postpartum period is in the hospital" or an accredited birth center. In its own statement earlier this year, the American College of Ob/Gyns went even further, implying that women who choose home birth are selfish and irresponsible: "choosing to deliver a baby at home ... is to place the process of giving birth over the goal of having a healthy baby."

Compare that to this information in Britain's NHS-issued handout my friend was given at her first prenatal appointment: "There is no evidence to support the common assertion that home birth is a less safe option for women experiencing uncomplicated pregnancies." In a joint statement last year, the Royal College of Obstetricians and Gynecologists and the Royal College of Midwives said, "There is no reason why home birth should not be offered to women at low risk of complications, and it may confer considerable benefits for them and their families."

The AMA's statement calls for legislation that could be used against women who choose home birth, possibly resulting in criminal child-abuse or neglect charges. The group says this is about safety, but with no credible research to back up its claim, this argument falls flat. Women are simply caught in a turf war over the maternity market, and it would appear that the physicians' groups are perfectly willing to trample the modern medical ethic of patient autonomy -- grounded in our legal rights to self-determination, to liberty and to privacy -- in their grab for control.

So often we forget that the AMA/ACOG are *trade organizations*, not nice people in white lab coats making objective, scientific decisions based on all the evidence for the benefit of women and children. They are doing what they are supposed to do for their members, that is, protect their market share and find ways to get more.

They can do that in several ways. Creating a demand for their service, check. Keeping out competitors, check. Legislating that all potential customers use services of their members, working on that one.

It's lack of respect for maternal autonomy and restraint of trade, purely and simply.