AMA's Resolution on Homebirth

By Rachel Walden — June 23, 2008

As you may have heard by now, the American Medical Association recently met and adopted a resolution similar to ACOG’s position on homebirth, stating

“That our AMA support state legislation that helps ensure safe deliveries and healthy babies by acknowledging of the concept 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 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.”

Not all physicians agree with the AMA’s position, however. Dr. Andrew Kotaska, noted Canadian researcher and Clinical Director of Obstetrics and Gynecology at Stanton Territorial Hospital, issued the following response:

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 scienctific 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.

Science supports homebirth as a reasonably safe option. Even if it didn’t, it still would be a woman’s choice. ACOG and the AMA are, by nature, conservative organizations; and they are entitled to their opinion about the safety of birth at home. As scientific evidence supporting its safety mounts, however, (to which BC’s prospective data is a compelling addition) they will be forced to accede or get left behind. The concerning part of this proposed AMA resolution is the “model legislation.”

If ACOG and the AMA are passive-aggressively trying to coerce women into having hospital births by trying to legally prevent the option of homebirth, then their actions are a frontal assault on women’s autonomy and patient-centered care. Hopefully the public and lawmakers realize the primacy of informed choice enough to justify Deborah Simone’s words: “We don’t need to be angry or even react to these overtly hostile actions from the medical community. We just need to keep doing what we do best; the proof is always in the pudding.”

It is sad to see the obstetrical community still trying to earn itself a wooden club as well as the wooden spoon; if the resolution passes, it is sad to see the politico-medical community helping them.

Andrew Kotaska

Dr. Kotaska centers the discussion around issues of autonomy and choice. Indeed, there has been considerable discussion about what form AMA-supported legislation might take. and what this would mean for women’s autonomy in choosing a birth place and provider. Would the organization support the criminalization of women who give birth at home? Would it support making it illegal for providers to attend home births? In either case, home birth is a choice that women will continue to make, not unlike abortion as described in a recent essay in the New York Times:

“It is important to remember that Roe v. Wade did not mean that abortions could be performed. They have always been done, dating from ancient Greek days. What Roe said was that ending a pregnancy could be carried out by medical personnel, in a medically accepted setting, thus conferring on women, finally, the full rights of first-class citizens — and freeing their doctors to treat them as such.”

Likewise, no state laws can prevent home births from happening. They will, however, determine whether women can make this personal choice without fear of persecution, and whether midwives are free to support this choice. Ultimately, AMA’s resolution, though couched in safety language, may encourage states to further restrict the available choices women have regarding their own bodies.

Finally, the original version of the resolution included the following language specifically attacking Ricki Lake: “Whereas, There has been much attention in the media by celebrities having home deliveries, with recent Today Show headings such as ‘Ricki Lake takes on baby birthing industry: Actress and former talk show host shares her at-home delivery in new film.’” Lake (along with Abby Epstein and Jennifer Block) issued a response via the Huffington Post, stating, “if U.S. women are to have real birth choices, everybody needs to be working together to provide them, not waging turf wars at their expense.”

Although the language was pulled from the final version of the resolution, I find it extremely insulting to women, as it reveals an assumption that women will just do whatever a celebrity recommends. It precludes the possibility that women make this personal choice based on their individual preferences and available options in an educated manner. It dismisses those choices as simply “trendy,” rather than asking (rather than assuming) why women might be making the choice to give birth at home in the first place.

A number of other bloggers have been discussing this topic; try this Google blog search to browse among them. You may also wish to visit our page on Choosing Your Health Care Provider and Birth Setting.

4 responses to “AMA’s Resolution on Homebirth”

  1. Doctors have been doing this kind of crap for more years than I’ve been alive, and I don’t think it’s going to end any time soon. When I was 25 (almost 30 years ago now), I wanted to have my tubes tied. I was single, had one child at home (and had been pregnant 4 times, 1st time was an accident (gave that child up), 2nd time I was on the pill (the son at home), 3rd and 4th times I had an IUD [ending in abortions]). The doctor who was to do my tubal ligation tried his damnedest to talk me out of it, knowing my history and that conventional bc didn’t seem to work for me. He kept saying things like “What if you meet a man and marry him and he wants children? You won’t be able to give him any, and he might not want to stay with you.” I told him that any man I met that I would want to marry would know that I couldn’t have more children, that I didn’t want more children, and would be fine with that, or he could hit the road. It took me two hours of argument to show him that I was serious about wanting my tubes tied. I finally told him: “Fine, you don’t want my insurance money for this procedure, I’ll go somewhere else where they do want my money and won’t presume to know what is best for me and my life.” Then it was all “No, no, we’ll do it, that’s fine, whatever you want.” Yeah, right, whatever I want as long as you get to do your nasty hounding propaganda that it’s all about what the next man in my life wants me to do, I don’t really have a say in the matter till it hits you in your wallet.

  2. On the celebrity influence: the AMA and ACOG didn’t seem to mind when the headlines were boasting planned elective c-sections among the celebrities. Apparently if celebrities are doing things that will ultimately support, or boost rather, their obstetrics practice and income then it isn’t an issue that needs to be addressed via a resolution. Weird, huh?

  3. I find it simply fascinating (horrifying?) how US history is repeating itself in regard to the hospital vs. homebirth arena.

    Historically, physicians lobbied to move childbirth into hospitals, muscling midwives out of practice on the grounds of improved safety and better outcomes.

    And they won.

    And once they did, childbirth outcomes plummeted. “Childbirth fever” (or infection spread from lack of handwashing) claimed thousands needlessly and birth became a scary, much feared medical procedure.

    Now, once again, the modern maternity machine still isn’t satisfied with the extent to which they’ve cast the midwifery model of care into the shadows.

    I have to wonder what impact this will have on childbirth outcomes if they are to again succeed.

    This time, the effects won’t be evidenced in maternal and infant mortality rates, but in the form of increased fear of medical liability, which will then translate into higher rates of unnecessary interventions, c-sections and other such CYA procedures, not to mention skyrocketing the cost of maternity care services.

    One thing is certain this time around – we won’t go quietly into the night. ACOG and the AMA have thrown the gauntlet and we’re here to answer the challenge.

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