Saturday, December 1, 2012

ACOG Continues to Wage War Against Birth Freedoms

My ire was kindled this week by information shared in a news email I received from the Citizens for Midwifery:

ACOG Rejects the Ethic That Autonomy Is a Fundamental Human Right

The newsletter describes yet another attack by the ACOG (American College of Gynecology) on homebirth and patient-centered pregnancy care in the United States.  An October 2012 article in the American Journal of Obstetrics & Gynecology outlines the faulty ACOG position.  The article actually coaches OBs on how to counteract the "resurgence" of homebirths, and on how to deal with mothers who express a desire to birth at home.

CFM summarizes the issue well:
The attack is based on poor research and runs roughshod over established rights to bodily integrity. 
This article was “Presented at European Congress of Perinatal Medicine, Paris, France, June 13, 2012.”  So not only does the article attack home birth, it also represents an attempt to “export” to the rest of the world a position that the obstetric profession, not mothers, should have the final decision on birth, at a time when that isn’t even legally defensible here in the United States.   
The primary author, a Fellow of ACOG, faculty member at Cornell University Department of Obstetrics and Gynecology, should be aware of American jurisprudence supporting patient autonomy and right to informed consent.  We can also assume that he is aware that systems of midwife attended homebirth are well established and integrated into the health delivery systems of many European countries.  And yet, it is the decision of the 2010 European Court of Human Rights case that seems to have prompted this "critical evaluation."  This was a case where obstetrician, Agnes Gereb, was imprisoned for attending home births in Hungary.  Her story is told in the movie “Freedom for Birth,” produced by One World Birth.
The authors’ conclusions are the height of hubris: “We urge obstetricians, other concerned physicians, midwives and other obstetric providers, and their professional associations to eschew rights-based reductionism in the ethics of planned home birth and replace rights-based reductionism with an ethics based on professional responsibility.”  In other words, reject the ethic that autonomy is a fundamental human right.  
Fiduciary responsibility is, by definition, putting the needs of the patient first.  If fiduciary responsibility was the same as professional responsibility, this would not be an either/or proposition.  The author defines professional responsibility as a model of decision making where “the patient has the right to select from medically reasonable alternatives.”  Who gets to decide what is reasonable?  Why, the obstetrician, of course.  And if the patient opts for an alternative the obstetrician has not deemed reasonable, then the obstetrician is justified in placing the “rights of the fetus” ahead of the rights of the first patient (the mother), although what is actually being asserted is the obstetrician’s own agenda over the rights of his/her patient. 
Buried in this article, and lost in the conclusion, is one very true statement: “The first professional responsibility of obstetricians is to ensure that hospital delivery is safe, respectful, and compassionate.” The author goes on to describe what that needs to look like, and in an easily overlooked fashion concedes that hospitals aren’t always safe places either.  In fact, both infant and maternal mortality are on the rise in the United States, at a time when hospitals have a near monopoly on birth.  
This failing falls squarely at the feet of ACOG and the collective actions of its Fellows, which calls to mind this quote:
“ACOG no longer has the moral authority to set standards in maternity care…. It has made too many self-aggrandizing and self-protective recommendations (e.g. against home birth, videotaping birth, and VBAC) that limit the freedom of American women and families.” (M. Wagner, Born In The USA, 2006, University of California Press, p. 32)
Overlooking this reality completely, the author also overlooks the most reliable research on the safety of home birth, while noting that ACOG “accepts the findings of Wax et al,” a thoroughly discredited piece of published research that does not stand as prima fascia evidence against the safety of home birth.  Even Amy Tuteur (no friend to home birth) says this AJOG article is “poorly researched, relies on bad studies and is woefully paternalistic.” 
One contradiction stands out as the authors call for “safe, respectful, and compassionate” hospital delivery.  No hospital birth can be truly respectful if the birth is happening in the hospital because the physician disrespects the woman’s right to an alternative and has rigged the system to eliminate access to all legal alternatives.

This is quintessential ACOG behavior, displayed regularly in the war on Real Birth.  The ACOG's desire to eradicate homebirth is not only fear-based, bad "medicine," it is an assault on our fundamental human rights to make our own life and health decisions.  Pregnancy is not an ailment and birth is not an emergency medical condition.  Anything less than autonomy in this realm (just as in the ream of food choices) is nanny state tyranny.  We are not wards of the government or the food and medical industries.  

We are free, thinking beings; our health and well-being choices belong to us alone. Contrary to ACOG propaganda, homebirths are not the bogey man OBs would have you believe.  Hospital births routinely end undesirably to some degree for mother and/or baby; such is the cost of unnatural, profit- and policy-driven interventions.  The majority of homebirths are beautiful, natural, empowering, spiritually enriching, safe experiences.  (Can we say the same for the industrial birth system?)  Whether at home or in hospital, even in the most blessed of circumstances, unhappy twists can occur.  Such is reality.  But the rare instance of undesirable outcomes certainly does not justify the vilification and outlawing of mankind's successful historical, traditional birthplace: the home.  If that is to be the case, the same measuring stick must be applied to the birth industry itself and hospital births must come under fire.

The fact is that we do not need (nor should we desire) to be protected from ourselves, especially not by the medical industry.  Doctors, of any persuasion, are to be our consultants IF we desire their input...they are not our dictators.  It is neither logical, nor reasonable, to allow the exception (women who suffer pregnancy complications) to define the rule (normal birth).  

Yet, the non-evidentiary technocratic model of birth rules the day.  And the "little gods" in white coats are not content to wield their power over the women who volunteer for their regime.  These practitioners of overplayed intervention seek to exert political power over us all, working to ban the practice of traditional midwifery and homebirth.  Just like Monsanto, the power-hungry conventional birth industry OBs are not content with their market share...they desire to annihilate the competition.

We can fight to stem this tide.  Check out the Citizens for Midwifery website to learn more and see what you can do to help.