At its annual meeting June 14-15, 2008, the American Medical Association voted on two Resolutions that seek to prevent home births and to increase M.D. control over midwives.

DOCS TO WOMEN: PAY NO ATTENTION TO RICKI LAKE’S HOME BIRTH

Ladies, the physicians of America have issued their decree: they don’t want you having your babies at home with midwives.

We can’t imagine why not. Study upon study has shown that planning a home birth with a trained midwife is a great choice if you want to avoid unnecessary medical intervention. Midwives are experts in supporting the physiological birth process: monitoring you and your baby during labor, helping you into positions that help labor progress, protecting your pelvic parts from damage while you push, and "catching" the baby from the position that’s most effective and comfortable for you—hands and knees, squatting, even standing—not the position most comfortable for the midwife or attending physicians.

When healthy women are supported this way, 95% give birth vaginally, with hardly any intervention.

And yet, the American Medical Association doesn’t see the point. It adopted a policy written by the American College of Obstetricians and Gynecologists against "home deliveries" and in support of legislation "that helps ensure safe deliveries and healthy babies by acknowledging that the safest setting for labor, delivery, and the immediate post-partum period is in the hospital" or accredited birth center.

"There ought to be a law!" cry the doctors.

The trouble is, they have no evidence to back up their safety claims. In fact, the largest and most rigorous study of home birth internationally to date found that among 5,000 healthy, "low-risk" women, babies were born just as safely at home under a midwife’s care as in the hospital. And not only that, the study, like many before it, found that the women actually fared better at home, with far fewer interventions like labor induction, cesarean section, and episiotomy (taking scissors to the vagina, a practice that, according to the research, should be obsolete but is still performed on one-third of women who give birth vaginally).

This is why the American Public Health Association supports midwife-attended home birth. The British OB/GYNs have read the research, too, and have this to say: "There is no reason why home birth should not be offered to women at low risk of complications... it may confer considerable benefits for them and their families. There is ample evidence showing that labouring at home increases a woman’s likelihood of a birth that is both satisfying and safe..."

The other trouble with the American MDs is that they seem to have lost all respect for women’s civil rights, indeed for the U.S. Constitution – the right to privacy, to bodily integrity and the right of every adult to determine their own health care. The "father knows best" legislation they are promoting could indeed be used to criminally prosecute women who choose home birth by essentially equating it with child abuse.

Research evidence be damned, the doctors want to mandate you to go to the hospital. They don’t want you to have a choice.

We think they’re spooked. The cesarean rate is rising, celebrities are publicizing their home births (the initial wording of the AMA resolution actually took aim at Ricki for publicizing her home birth on the Today Show!), people are reading Pushed and watching The Business of Being Born, and there’s a nationwide legislative "push" to license certified professional midwives in all states (The AMA is against that, too, by the way).

The docs are on the defensive.

After all, birth is big business—it’s in fact the most common reason for a woman to be admitted to the hospital. And if more women start giving birth outside of the hospital, who will get paid? Not doctors and not hospitals.

"The AMA supports a woman’s right to make an informed decision regarding her delivery and to choose her health care provider," the group said in a statement. But if it really supported women’s birth choices it wouldn’t adopt a policy condemning home birth and midwives.

If U.S. women are to have real birth choices, everybody needs to be working together to provide them, not engaging in turf wars at their expense.

Late in the day on June 17, the AMA changed the wording on the final resolution 205 to omit the line about Ricki. (Hmmm...) They are now attributing the original language to the American College of Obstetricians and Gynecologists (ACOG) who drafted the initial statement.

THE BUSINESS OF BEING BORN

A Review by Rachel Walden

The Business of Being Born is a documentary film on childbirth practices in the United States directed by Abby Epstein and produced by Ricki Lake. It was inspired by Lake’s first hospital birth, after which she felt that there must be a better way for women to give birth, and set about finding out how and why midwives are supporting that very thing.

The film follows several women throughout pregnancy and labor, primarily depicting midwife-assisted home births and dispelling the myths of home birth as unsafe and of midwives as eccentric hippie women. In fact, the midwives in the documentary are women who could be your neighbor or your friend, trudging around New York City in taxis in order to help women give birth in supported, non-interventionist environments. In other words, normal.

The births we see on screen, however, are anything but normal under today’s active management of labor—they starkly illustrate how different a physiological birth can be as compared to the restrained, flat-on-her-back screaming and poking of the hospital environment. Although many of the physicians interviewed said they had never seen a normal birth, the viewer is treated to something that feels just right—women in a comfortable environment, supported by caring and skilled individuals, rocking their hips and giving birth with a grunt and a smile. The imagery of the medically managed woman with her whisked away infant, separated and left lying alone on a table, could not contrast more with the imagery of women who are instructed to "reach down and take your baby," whose babies are immediately cradled against their damp skin and welcomed into the world in a hands-on, not instruments-on, manner.

The film also incorporated historical trends in the management of labor that clearly demonstrated how much of what was done, as is being done now, was not properly understood at the time for the real or long-term effects on women and babies, such as anti-midwife propaganda despite higher death rates in hospitals, and the use of thalidomide and cytotec. It reminds us that many of the interventions used so commonly today are often not medically necessary and that very few have stopped to ask an extremely important question—is this helping or harming?

The Business of Being Born has two major strengths. The first is that important information about the cascade of interventions in managed birth, U.S. practices vs. other countries and the resulting outcomes, drugs, c-section rates, and medical evidence is presented in a way that is accessible and informative even to those who are taking their first look at birth issues. The relevant information is conveyed alongside the women’s stories, leaving the viewer better informed without beating her over the head with medical jargon and data, making it a perfect introduction to the topic for those who have not already immersed themselves in the literature of birth. There is a growing contingent of women who are informing themselves and speaking out on birth practices, but this film presents the story of birth management in a way that could reasonably encourage the uninitiated to seek more, and to speak up.

The second major strength is that the film clearly locates birth issues inside feminism and choice, noting the power disparities of the traditional hospital birth system, the often misguided focus on outcomes and potential litigation that ignores women’s needs and experiences, and the empowerment that many women feel when able to give birth on their own terms. The film notes the current emphasis solely on "taking a healthy baby home" and the playing of the "for the baby" card in hospitals that strips women of their ability to fully participate in a life-altering experience, and contrasts this with home birthing women who state afterwards, "If I could do that, I can do anything."

While the documentary does not suggest that the outcomes for babies are not important (as anti-home birth/anti-midwifery folks often seem to think), it does clearly illustrate how women are ignored, under-informed, over-powered and failed by the current system. I would recommend this film to anyone who has given birth, plans to give birth, knows someone who might give birth, or assists women in birth. In other words, just about everyone.

The Business of Being Born on DVD, 85 min., $32.50. Each DVD includes the option for closed captioning and Spanish subtitles as well as the booklet The Guide to a Healthy Birth published by Choices in Childbirth, 2008. Send check of money order to - Business of Birth LLC, P.O. Box 594, Orange, CT 06477 or order online at www.thebusinessofbeingborn.com A percentage of proceeds from sales of the DVD will be donated to The Coalition for Improving Maternity Services (CIMS).

A few statistics cited in The Business of Being Born:

• The U.S. has one of the highest maternity death rates in the world

• The U.S. has the 2nd worse death rate for newborns in the world

• In Europe and Japan, midwives deliver 70 percent of all births; in the U.S. midwives delivery a mere 8 percent of births

• In the U.S., as of 1900, midwives delivered 95 percent of all babies; by 1938, midwives delivered 50 percent of all babies and; by1955, less than 1 percent of all babies born were delivered by midwives.

 www.proliberty.com/observer/20080603.htm