Before the comments get rolling, let’s just get this out of the way:

HOMEBIRTH IS SAFE. This is a fact (there is a ton of research and experience backing this up). Whether or not it is the right option for you personally is beside the point, but there is no debating that homebirth is as safe as hospital birth.

So, to recap, just like abortion, women should be allowed to choose how they want to give birth. That choice should not be legislated regardless of what you personally think about the issue.

Hopefully, this will not turn into an argument about whether or not homebirth is safe per usual when this topic comes up on Feministing. Just like with abortion, that’s already been established by people more in the know than us, homebirth is safe.

This should be a discussion about choice and how a small group of people want to limit the choices of all women.

Ugh. This makes me glad I decided to leave my OB/GYN practice for a midwifery practice.

And I can't recommend The Business of Being Born enough - even though home birth specifically isn't right for me, I found the movie incredibly compelling on almost every other issue. It raised issues about my (completely uneventful and uncomplicated) hospital labor and delivery that I hadn't even considered. So for number two, I've decided to try to have more control over my experience. Shame on the AMA for perpetuating the myth that women can't decide what's best for them. And shame on them for bolstering a system that results in an extraordinary number of c-sections and non-necessary medical interventions.

Amen, ShelbyWoo. It sickens me that, as you said, a small group of people want to limit women's choices. I couldn't ever have a home birth for medical reasons, but I support the rights of any woman to choose what kind of birth is best for her and her family. Also, what would this do to midwives? Would birthing centers still be allowed? I can't seem to find the actual proposition.

This would change everything for me if I ever wanted to have children, because I am very interested in having a homebirth if I ever do want to have a child. This saddens me that a group of people wants to restrict every woman's choice. It makes me wonder what each presidential candidate feels on the issue (and if it matters).

Holy crap, this pisses me off! This is all about the further medicalization of a non-pathological condition and the disempowerment of women over one thing they're uniquely qualified to do.

Last night I watched a bioethics lecture about patient-centered care (here if you're interested:http://epresence.ehealthinnovation.org/archives/2008_jun11_633488010617968750/?hideSocial=false&archiveID=255)

and was dismayed to hear about how parents of children with special needs were denied the kind of care for their child that they had requested (culminating in the child's death after a series of doctors and nurses had unilaterally decided not to treat, because the child was handicapped)--this was in Canada, and it was clear that cost-cutting and the desires of the majority were driving the events. I associate the ban on homebirth with that lecture because sometimes it's necessary to avoid the hospital if you're going to maintain your autonomy. If there are no alternative spaces, women, children, and the elderly are going to get screwed.

This is all about having choices, and it's a choice I want to have when I become pregnant. Incidentally, I understand that the cervix is a sphincter, and I know that I can't even poop in unfamiliar environments. Ergo, I want to have my baby at home.

anyone follow hathor? she had a comic a few days back about new "boutique" ob/gyns who, for 15,000 out of pocket, will actually give you the type of medical care you would normally expect from a midwife or a good "oldfashioned" family doctor.

so again, this boils down to class and economics. it's about who gets to have good, respectful health care and who doesnt - which is also about who should get to have kids, and who shouldnt. in many cases midwives are the only way to get that quality, respectful care at an affordable price.

http://www.thecowgoddess.com/2008/06/01/birthsmart-tm-concierge-service/

Banning home birth would be SUCH an invasion of privacy! We have always been giving birth and there have always been midwives, we have not always had OB/GYN's

I wish I would have opted to have a home birth. (Not that I could have, seeing as how I was broke at the time.)

My OB/GYN forced me to deliver by c-section. At the time, at least, I wasn't aware that I actually had a choice. I later found out that I could have opted out of it. My doctor pumped me full of drugs I didn't need, and purposefully withheld information from me. I think this might have had a lot to do with the fact that I was on Medicaid. They treat you differently for some reason...when you don't have private insurance.

They also took my son away several times...without telling me where they were taking him or what kind of tests/procedures they were performing.

This pisses me off for so many reasons...

There are only a few cases where hospitalization for birth is necessary. For the vast majority of women, pregnancy and birth are medically uneventful. Midwives have much better stats, too - lower c-section rates, faster recovery periods, more patient satisfaction with the birthing experience, and more support with breastfeeding. AND they're so much more affordable. I hope my next pregnancy will be attended by a midwife, and I may even do a homebirth, even though it will be a VBAC.

AMA and ACOG, you suck big donkey balls for this. Shame on you for you trying to scare women into giving you more money by limiting their birthing choices. I nominate you for a Friday Fuck You feature!

And Miriam, I'm in love with you...will you move down to Texas and be my doula when I get pregnant again? Pretty please?

i'm confused by the ban. would they just like to ban midwifery? or are they banning being at home while you give birth? like, if i go into the labour, they would like it to be illegal for me to stay home? is there anything else your body could do that would legally force you to leave your house? if my appendix burst, it would probably be a good idea to go to a hospital, but there isn't a law that says i must. in fact, i think there are laws saying i have the right to refuse medical attention, right? does that right go out the window when you're pregnant? it doesn't make sense to ban home birth. banning midwifery would be more enforceable, but it still seems like a violation of rights. i suppose they consider banning midwives comparable to banning unlicensed people from performing surgery. i find that an unreasonable parallel though.

christi - im very sorry for your loss (cause to lose the chance to birth how you want is a loss.)

and yeah. medicaid patients are second class citizens in many cases. sadly, one hospital-practice midwife group even had a different office for medicaid patients, another for private insurance. i didnt go there.

How could they enforce such a law?

You have a kid at home? Who's to say labor didn't just suddenly come on to the point where it really wasn't medically appropriate to move you to a hospital?

I have a feeling, though, that this is politically bad news for liberals (is a partisan Republican behind this). Either liberals make a big deal out of this and we get tarred as a bunch of hippies who reek of patchouli and hate modern medicine or conservatives take the lead in opposing this (the "crunchy cons" would hate this law) and they'll frame it as "see what those abortion-loving doctors want to do? see their real agenda? see why we can't have socialized medicine?".

Something reeks about this proposal. And it ain't just the fact that the proposal itself stinks to high heaven. Maybe I'm being paranoid, but I wonder who's really behind it and why.

It's really important that we have these conversations identifying birth care as a reproductive rights/justice issue. Many midwives and doulas express a sentiment that feminists "don't care" about their plight; discussions and posts like this one are a big step in building bridges for the coalitions we clearly, and direly, need to improve birth and maternity care.

Also, and maybe I missed something, but how would the Business of Being Born ever be "partially to blame" for the AMA's paternalistic resolution?

how, exactly, does one go about banning the housebirth then? By making it illegal to assist? Do you lock up a momma who has chosen to stay home? What exactly would have happened to my mother in law who didn't make it to the hospital with her fourth? I mean, the hell? Have they even thought it through?

Good grief, do we not have enough problems without creating more? Are we going to jail people?

Yesjess, I'd imagine The Business of Being Born is "to blame" for the AMA's action by publicizing homebirth as a legitimate and safe alternative to being pumped with pitocin at the hospital, thereby threatening the c-section industry.

yesjess--

Aimee's article at RH Reality Check mentions this, I think she's referring the way that film has increased the awareness (and popularity of) homebirth.

If homebirth becomes more popular, obstetricians might loss money! Because it's all about the business of it.

And TexasMomma--you're sweet! Thanks for making me blush.

It's about the money, Lebowski.

As for "How could they enforce such a law?" Cast your eyes toward the current Department of Justice.

Also, the resolution specifically mentions Ricki Lake.

Also, what would this do to midwives?

I can tell you that in Indiana, where midwifery is illegal, they have prosecuted midwives if they can prove they attended a home birth – for practicing medicine and midwifery without a license (even though they cannot legally obtain a license in Indiana). I am currently trying to conceive and I really want to home birth – the fact that midwifery is illegal in Indiana means I will have to go “underground,” if you will, to find a qualified midwife and have the birth I think is best.

However, I don’t think the AMA banning home birth overrides state law. 22 states allow certified professional midwifes to attend home births. It does seem from their resolution that they will try to introduce legislation banning CPM’s (certified professional midwives) nationally, which could impact those states if passed.

The resolution says free-standing birthing centers are a-okay, though. I’m not sure how giving birth at a free-standing center 5 miles from a hospital with a midwife and giving birth at home 5 miles from a hospital with a midwife are all that different in terms of safety, but apparently the AMA thinks they are.

I highly recommend watching the Business of Being Born (available to watch instantly if you are a Netflix subscriber). The history of hospitalized birth in our country is fascinating and scary.

Why do I keep wanting to spell home birth as one word (homebirth – that looks so much better to me)?

Um...isn't banning homebirth kind of like banning sodomy and homosexuality? How would this be enforced? I mean, sure I'd think that it would be better for high risk pregnancies to deliver in a hospital, but if someone happens to deliver at home without complications, what would happen? Who would have what to say? And if the first person to arrive "on the scene," as it were, was a midwife and she successfully helped deliver a child would she really lose her license? What if an ob/gyn does the same? Or a nurse? What if the birth was "officially" unassisted? This particular ruling just hurts people who try to follow the rules.

The more I learn about birthing options, the more I lean towards a home birth. So it is really upsetting to read this.

Just another example of how something that is so clearly private (your body, your house, your baby, your choice) becomes about your "well-being" and "society as a whole." I hate this crap.

BTW, where can I find good info, stats, and resources for those planning home births?

The scary thing is that home births would be so easy to find/prosecute; they could just create a law that states that unless you give birth in an approved setting, you can't get a birth certificate, e.g. only hospitals can submit information for birth documents.

I am not at all familiar with the home birth movement, so please correct me if I'm wrong.

As I understand it, the AMA is a trade organization, like the United Auto Workers or any other. They don't have the power to ban home births or anything else. What they can do, is use their vast amounts of money to lobby for legislation that is favorable to their cause.

From reading the resolution, it appears as though they are responding to Ricki's Lake documentary by reaffirming their position that hospital births are safer. Then, they are taking it one step further by saying they will push (ha!) for legislation that is "in support of that concept." I'm not sure what that entails exactly, but I don't like the sound of it...

As an aspiring midwife, this makes me cry out of pure frustration.

visionaria You could start with Midwifery Today's website. There are also many good midwives blogs that will have links to resources. Doing your own research via PubMed is helpful. Read Spiritual Midwifery, Birthing From Within, Pushed, both books by Henci Goer. You can also use the Mothering website and forums for further access to links and for a place to ask questions of women and professionals who have been doing the same research. There are also places that strongly discourage homebirth and it's not necessarily a bad idea to read it all so that you have a fully formed opinion. You might want to visit del.icio.us and do a tag search on homebirth to see what places other people have bookmarked. Good luck!

Just want to underscore that the language of the Resolution includes both home births and births at freestanding birth centers as equally 'dangerous' and properly banned. It seems to me that by tossing these two quite distinct hospital-alternatives together as though they were the same, the document makes it even harder to imagine a genuine ethical or scientific rather than profit-based concern/motivation. In other words, isn't it kinda sketchy to say something that boils down to 'Any birth that isn't directly under our control and to our financial benefit is unsafe and should be illegal'? I rather think so ...

In theory we'd all be much safer if we ate every meal in a hospital too. That way if anyone chokes, has an allergic reaction or indigestion, medical care is right there. However, that's a little ridiculous and the AMA would have no business telling people to only eat in hospitals. Childbirth is a natural human body function, not a medical emergency that need intervention.

Also, I imagine they enforce it by dolling out hefty fines to midwives caught practicing, thus discouraging midwives from starting to practice in the forts place.

The scary thing is that home births would be so easy to find/prosecute; they could just create a law that states that unless you give birth in an approved setting, you can't get a birth certificate, e.g. only hospitals can submit information for birth documents.

So people born in taxis, elevators, in blizzards couldn't get birth certificates? I would think (would hope) that would be easily shot down....

So people born in taxis, elevators, in blizzards couldn't get birth certificates?

I never said it made sense, just that it's one easy way they could do it. Probably allow for some sort of judicial hearing in the case of freak occurrences like taxi births...

This is such bullshit. I had a home birth because I thought it would be healthiest for me and my baby, and it was WONDERFUL. it made me want to give birth again. This kind of ruling is more oppressive even than meets the eye. For instance, we leared about small percentage of women who end up giving birth at home even though they meant to go to the hospital because they: 1) didn't realize they were in labor, 2) had a labor that progresed much more quickly than they expected, or 3) were unable to get to the hospital due to outside conditions such as weather, etc. Getting to the hospital when you're in labor is a thing that you have to exert effort to do, and can totally interrupt a labor. I think this is part of the whole movement in this country right now to take away women's controle ENTIRELY over her body and reproductive processes. This would give doctors absolute control over women's labor. And this when there is ample evidence to support the safety of home birth.

Shudder shudder.

I can tell you that in Indiana, where midwifery is illegal, they have prosecuted midwives if they can prove they attended a home birth – for practicing medicine and midwifery without a license (even though they cannot legally obtain a license in Indiana). I am currently trying to conceive and I really want to home birth – the fact that midwifery is illegal in Indiana means I will have to go “underground,” if you will, to find a qualified midwife and have the birth I think is best.

Midwifery is NOT "illegal" in any state. Whats illegal is the practice of NON-LICENSED midwives, e.g. lay midwives as opposed to CNMs.

In the few states that have banned layperson midwifery, ironically it was the CNMs who were the biggest sponsors of the bill. Turf protection is not just an AMA/doctor thing.

Although I obviously disagree with the AMA's stance on home birthing, I think you guys are vastly overestimating the ability of the organization to keep midwives from doing homebirths. Homebirths are currently legal in all states, and the AMA is basically an impotent organization with no real power to do any of the things they are suggesting in this resolution. Its basically a pointless wishlist and will go no further than that.

The real problem with midwives and homebirths is legal liability. Consider that midwives are legally responsible for the birth/health of the child until they are 18 years old. That means you can have a totally normal birth, and then the kid gets diagnosed with some kind of mild learning disorder at age 15. Then the medical records are opened, and it turns out that the baby's FHM showed mild late decels. Out come the lawyers, and the midwife cant do home births anymore because their malpractice premium just skyrocketed.

We've had midwives for centuries, and they are currently able to do homebirths in all 50 states. Yet, very few, as low as 10% in some studies, choose to do homebirths. The big question is why?

The answer lies not with the evil AMA or the ob/gyns but with the finances. As always, its follow the money stupid. A midwife who chooses to do homebirths pays much, much higher malpractice premiums (as much as five times higher) than if they work in a hospital or birthing center.

Midwives follow the money just like doctors do. They see the difference in malpractice rates between homebirths and hospital births, and its a no-brainer.

Midwives are opting out of doing homebirths, and the reason is the malpractice insurance, not anything the AMA or the ob/gyns are doing.

Let me point to another reason why midwives choose to work in hospitals or birthing centers as opposed to home births.

Again, its the money. Midwives working in an institution like a birthing center can count on a regular stream of patients with lower overhead operating costs. Its very inefficient to drive all over the countryside to do home births, its harder to get your name out there because you work basically as a private contractor instead of being affiliated with a birthing center or hospital that can do all the advertising for you. On top of that, your malpractice premiums are lower.

Its really no surprise why the vast majority of midwives are opting out of home births and migrating towards the hospitals.

I've read an article about freebirthing, which is homebirthing except the woman takes no medication. Sometimes, she has no midwife. The stuff the opponents said shocked me. One doctor (suprise surprise) said that if the baby dies as a result of not being born in a hospital, the mother should be tried for murder.

I think the problem people have with homebirths is the money and the safety of the baybees. I'd also say the safety of the mother, but I honestly feel that they don't care about that nearly as much as the other two.

Thanks hsp!

Although Ricki Lake is named specifically in the AMA resolution, I think blame is the wrong word. We should never blame people for trying to enlighten or bring to the forefront issues of injustice in a nonviolent way. The only people to blame are the AMA house of delegates for having such a strong reaction to the documentary.

Just another member of the real liberal Hollywood media, trying to support the important work of her peers.

First of all, the AMA lacks the legal authority to pass this law. They can ensure that no doctor who is a part of their group attends at-home births, or similar, but they cannot force midwives out of practise.

Medical care is a state issue. Your best bet is to write to your local representative and ask him/her to introduce legislation that would ensure that midwives and doulas are able to do at-home births.

this (the "crunchy cons" would hate this law)
No kidding. Believe it or not, the pro-lifers hate it - or at least the pro-lifers that I hang with.

My alma mater's Students for Life group did a screening of "The Business of Being Born" and was highly critical of the medicalisation of pregnancy and childbirth. I've met a handful of adult pro-lifers who had at-home births themselves and rave about the experience.

To them, at-home births are life-affirming, which is part of being pro-life. Drop the anti-choice label, please, because it simply is not accurate and fails to reflect the movement.

It upsets me when this is framed as a pro-choice/pro-life issue, because it simply is not the case that pro-lifers support bans like this. In fact, if you make this an issue on par with abortion, you'll lose supporters.

Choice is the issue. The irony is that organized medicine supports some choices in childbirth. Take for example amniocentesis. This procedure is associated with a small but very real risk of miscarriage. ACOG "advises physicians to counsel patients of all ages about the risks and benefits of genetic testing and to let the patient decide whether the benefits of obtaining the test results are worth the risks"

ACOG should follow their own example. Advise physicians to counsel women about the risks of hospital birth and let the patients decide!

Physicians and hospitals should be required to disclose all risks(including the risks of c-sections) to patients.

How would they enforce a ban on homebirth anyways? If a woman starts her contractions and delivers her baby at home, even when she didnt intend to, then why would they fine or imprison her? If she cant help that she gave birth at home, then why would anyone punish her for it? Aside from that point, this is absolutely wrong for many reasons. One OBVIOUS point is that it blatantly infantalizes women.

"I think this is part of the whole movement in this country right now to take away women's controle ENTIRELY over her body and reproductive processes. This would give doctors absolute control over women's labor."

I completely agree. Whats worse, is this also paves the way for indoctrinating anti-choice beliefs about women, anti-choice policies, and it furthers the acceptance of the anti-choice philosophy of taking away womens control over their reproductive functions.

" Drop the anti-choice label, please, because it simply is not accurate and fails to reflect the movement"

Oenophile,
This can easily be compared to the anti-choice cult and their attempts to take away womens abortion rights. These kinds of policies offered by the AMA would only force the women who choose to have babies at home, underground. Therefore, if that happened, it would jeopardize the welfare of the mother and the baby if anything went wrong (as they wouldnt want turn to the hospital and possibly be arrested or fined), and they might hire uncredited midwifes, just like the backalley abortionists in the past who used to exploit the pregnant woman. It is also similar to the anti-choice philosophy because it infantalizes women, childbirth, and pompously takes away a womans CHOICE to have a healthy birth the way she WANTS.

"If you make this an issue on par with abortion, you'll lose supporters."

From who? Anti-choice nuts? I think you only see it this way because youre anti-choice. That claim cant be supported at all.

This is similar, though, of course, not directly tied to the abortion issue.

For me, it all comes down to the same root: my body is my choice, and their bodies are their choices.

It's just that simple. No matter the circumstances, any adult human being has a right to make his or her own medical decisions, whether that means having an abortion or having a home birth, or having a hospital birth, doctors or midwives or solo, it's her business.

I saw something on television about a woman who chose to have her fourth child right by the ocean on the Spanish coastline, accompanied only by her husband. Do I think it was wise? Doesn't matter, it's her choice. (She and the baby, btw, are fine and she was pleased with the experience)

ShelbyWoo commented at June 18, 2008 3:29 PM: "The resolution says free-standing birthing centers are a-okay, though. I’m not sure how giving birth at a free-standing center 5 miles from a hospital with a midwife and giving birth at home 5 miles from a hospital with a midwife are all that different in terms of safety, but apparently the AMA thinks they are."

I got the impression that maybe someone at the AMA thinks free-standing birthing centers have more equipment for emergencies...

molly commented at June 18, 2008 5:22 PM: "Just want to underscore that the language of the Resolution includes both home births and births at freestanding birth centers as equally 'dangerous' and properly banned."

...and now I stand corrected!

Medical Student29 commented at June 18, 2008 7:16 PM: "Consider that midwives are legally responsible for the birth/health of the child until they are 18 years old."

I didn't know that before. Now I wonder if it applies to OBs too.

Medical Student29 commented at June 18, 2008 7:16 PM: "Out come the lawyers, and the midwife cant do home births anymore because their malpractice premium just skyrocketed."

That reminds me of how I heard the rate of medical students choosing to specialize in obstetrics in the first place is going down.

GopherII commented at June 19, 2008 1:43 AM: "These kinds of policies offered by the AMA would only force the women who choose to have babies at home, underground."

Nitpick: force the women who choose to have babies at home underground? I got the impression that this policy would drive the midwives of the ones who choose them for home birth underground. Some others who choose to have babies at home choose to have them without midwives (see http://www.unassistedchildbirth.com/ ). I'm not so sure how ensuring that the only midwives able to practice legally are hospital-based midwives would affect pregnant women and girls who don't want any midwives in the first place...

Mina: Medicalstudent29's comment applies to OBGYNs as well.

I know the AMA and doctors are favorite feminist punching bags, but I think it's important to say that doctors don't get paid for doing more care, so the idea that the AMA is protecting a business is only partly correct. That is, your doc makes no more money if s/he treats you twice or once or ten times, unless you are on a fee-for-service plan. Doctors are salaried employees of a hospital or medical practice, just like the rest of us. It's a lot more complicated, of course, because of the role of insurance companies. But basically, the check your OBGYN takes home does not get bigger if you need more treatment.

That said, midwives and doctors both have to deal with liability costs. I have seen quite a number of women who were all about home birth trot out the lawyers years later because there was a problem that *might* be related to birthing. If i were a midwife I'd say to hell with it.

Also, licensing requirements and all that aren't some evil tool of the patriarchy, they are an imperfect solution to making sure that absent magical mind reading powers we have *some* way of seeing if someone is minimally competent. Just like if someone has a driver's license you can expect that they aren't complete idiots on the road (which is one reason you are legally liable for getting into accidents).

As far as I can tell the AMA's problem is with unlicensed midwifes and such. And you know what? Good on them. If i have a midwife providing anything like care to my wife I damned well want to know they didn't mail the classes in to Sequoia University. You want to practice medicine -- and a midwife or a doula is doing just that, no excuses-- then you give up your right to privacy in your business. And yes, doctors should be under the same constraint (and in many states they are). Full stop.

Home birth isn't in and of itself a bad thing. But I do have a problem with people painting doctors as a bunch of tools of the patriarchy all the time without acknowledging that there was a time when most women gave birth at home and the death rates were insanely high. Just walk around any graveyard Pre -1900 and look around. Count up the number of women dead in childbirth. It's scary. (And think of the fact that since WW II death in childbirth for first-world women is very rare, whereas for all those women in third world countries forced to give birth at home it's pretty grim).

Y'know, it's *just* possible that many OBGYNs -- a chunk of whom are women -- might actually care about people having children and living through the experience.

They prosecute home births by prosecuting midwives. As far as I know, you're not going to be arrested for having your shild at home, but your midwife can be arrested for attending the birth. This can happen one of two ways. The first is that you live in a state where only Certified Nurse-Midwives (who go to nursing school and then attend a Master's program in Nurse-Midwifery, which is the educational path I've chosen to follow) are permitted to attend births and your midwife is a direct-entry midwife (an apprentice-like program than involves both book instruction and attending a certain number of births before taking a test) who will then be prosecuted for practicing medicine without a licence. The second is that your CNM is not permitted by your state to attend a home birth.

A midwife can be prosecuted even if there is no negative outcome for the child. S/he can be prosecuted even if the parents of the child have no desire to prosecute him/her. A midwife can be prosecuted if the "negative outcome" (which is a phrase that bothers me because it implies that "imperfect" children are undesirable and should be "prevented") is not a result of anything that happened during the birth. A midwife can be prosecuted for the simple act of attending a normal, low-risk pregnancy and birth. It happens now, and don't believe for a second that ACOG and the AMA are trying to block midwifery practice in low-risk births because it's unsafe.

Also (sorry my comments are approaching War and Peace length; this is a topic I'm passionate about) the vast majority of women who died in the early 1900s and who die now in third-world countries during childbirth died/die for lack of someone who washed their hands and provided good prenatal care, not for lack of Pitocin drips and forceps. Comparing these birth situations to those of first world countries is apples and oranges.

More scientifically accurate and fair is to compare the United States to other industrialized nations. Despite our high reliance on hospital birth settings and medical technologies, we're lagging behind many industrialized nations in both infant and maternal mortality. The nations with the lowest rates tend to have much higher rates of home births, midwife use, etc. So please don't fall on the "Birth is sooo dangerous that we HAVE to rush to the hospital immediately or we'll DIE like the do in Africa!" It just doesn't work like that.

GopherII,

I'm not anti-choice; I'm pro-life. If you can't tell the difference between wanting to "limit women's sexual options" and wanting to save the lives of humans, then you're more demented than Ted Bundy.

It's an unborn child, not "tissue" or a "choice." The only "choice" that I oppose is the one to kill other human beings. If by "choice," you mean "abortion," say it - otherwise, can it.

If you don't want to be called:
anti-life
pro-baby-killing
anti-science
anti-family,
or the like, don't call me "anti-choice." Incidentally, you don't seem to up on giving the child a choice on whether or not to continue its life - it's not like it chose to be conceived in the womb of a woman who doesn't particularly want it.

Apparently, y'all aren't up on your science, because you don't seem to understand that those "products of conception" are human beings.

Nor are any of you up on the law. Kiddies, the AMA lacks the ability to throw people in jail. I'm sorry to regress to fifth grade, but only the state can throw people in jail. You also need to violate a "law" in order to be thrown in jail. "Resolutions" are not "laws."

So this bullshit about "throwing women in jail who have births at home" is just that - bullshit. It's good anti-life propaganda, but, like most anti-life b.s., lacks any connection to reality.

oenophile,

What exactly are your "scientific" qualifications? Something which does not have a developed brain does not have the capacity to make decisions. And science does not say that a fertilized egg is a person. That is a matter of belief.

Also the AMA "adopted a resolution at its annual meeting last weekend to introduce legislation outlawing home birth", so I think it's clear the intention is to make it a law eventually.

I can tell you that in Indiana, where midwifery is illegal, they have prosecuted midwives if they can prove they attended a home birth – for practicing medicine and midwifery without a license (even though they cannot legally obtain a license in Indiana). I am currently trying to conceive and I really want to home birth – the fact that midwifery is illegal in Indiana means I will have to go “underground,” if you will, to find a qualified midwife and have the birth I think is best.

I'm a newish resident of Indiana and I've wondered about this. I have found two in my area thru internet searches and they both advertise freely that they attend home births and many families post their home birth stories on the websites.

So, it's illegal, but they aren't hiding by any means. Maybe it's something that overlooked until there is a death or injury?

Just wanted to point out that reducing the AMA and antiabortion stances to being "all about limiting choice" is silly. Perhaps it compares, in some ways.

But it is so simplistic; if you really think that prolifers all/only want to control other people and are just lying about the issues of personhood in the philosoph(ies) behind being that way... that is just brutish and bigoted thinking.

It also stifles/limits discussion because then we have to entertain another useless argument about tissue/fetuses/people and science because of the obvious ridiculousness of the comparison.

Lots of issues of social living are about limiting choice. It's the reason, and the manner, that makes the difference.

Anyways, The AMA just looks stupid by doing this. Let's hope they lose even more credibility. I don't think that the public is so easily fooled anymore by this stuff.

re: ShelbyWoo & Mina (and my earlier point): I totally screwed up reading the resolution--sorry! It clearly does 'okay' approved freestanding birth centers. Whoopsies; I feel stupid now ...

Medicalstudent29 said:
"Homebirths are currently legal in all states"

Technically, true. They can't arrest a PARENT for having their baby at home - at least not yet. However, what is illegal in 26 states is for non-licensed midwives to attend home deliveries. So it's not illegal for you to HAVE your baby at home, just for someone who is skilled to be there to help you.

You mention that fewer than 10% of midwives choose to offer home birth. However, it would seem that you are referring only to Certified NURSE Midwives (CNMs). You forget, or perhaps don't know, that most home births are attended by non-nurse midwives. These are midwives who get their training through apprenticeship and individual or group study, and sometimes through attending schools that are accredited through the Midwifery Education Accreditation Council (MEAC). The credential that many of these midwives earn is the Certified Professional Midwife (CPM) from the North American Registry of Midwife (NARM). It's a valid credential that is being used by most states that DO license non-nurse midwives as their credentialing requirement for becoming an LM (Licensed Midwife). Midwives who follow this path are experts in out of hospital birth. And it's THIS credential that the AMA is trying to invalidate and eliminate.

So while it may be true that not many CNMs are attending home births for some of the financial reasons you mentioned, as well as for political ones, families wanting to birth at home most often choose a non-nurse midwife, usually a CPM.

The midwives you refer to in your post, who are not doing home births because of the cost of malpractice insurance, are CNMs. They are required to carry such insurance, and I'm sure this is a serious drawback for them. But many of them would love to attend home births and don't, not only because of the malpractice issue, but also because in many states they are required to have signed practice orders from a doctor, and few docs will collaborate with a CNM who wants to do home birth.

CPMs, on the other hand, aren't required to carry malpractice insurance. I am an LM/CPM in a state that does provide licensing, and our law specifically states that we cannot be required to carry malpractice insurance. It's a good thing too, since there are no providers who offer such insurance. Only Florida requires malpractice insurance of its LMs, and the state had to underwrite the cost of that insurance, since there are no providers who offer it for out-of-hospital practitioners. The cost of this was, of course, passed on to the midwives in the form of significantly higher licensing fees, which got passed on to the consumer, making home delivery much more costly that it used to be there. Nonetheless, Florida has a large number of LMs providing care for home and birth-center delivery.

So your argument that " The answer lies not with the evil AMA or the ob/gyns but with the finances" is actually not true for many of us who are actually attending the 1% of births that currently occur at home in this country. Malpractice insurance just isn't a factor for most of us. Midwifery care is also significantly cheaper than hospital delivery, yet provides much more personalized care with the same (or better) outcomes for low-risk women - at least that's what the data says.

Your statement: "We've had midwives for centuries, and they are currently able to do homebirths in all 50 states" is technically true. We CAN attend homebirths anywhere. But in 26 states, they do it at their own peril, because there are no laws licensing them or preventing them from being prosecuted for practicing medicine without a license.

Again, remember, it's not CNMs that the AMA is after. In fact, what they want to do is make it illegal for there to be any other kinds of midwives besides CNMs, and then to ensure that all CNMs must practice under a physician. Sounds like monopolization to me.

>>lilianna28: how, exactly, does one go about banning the housebirth then? By making it illegal to assist? Do you lock up a momma who has chosen to stay home?

One way to effectively ban homebirth is to legislate that birth be defined as a medical event, so that anyone attending a birth (even the father) without a professional medical attendant present can be charged with "practicing medicine without a license," and the mother herself can be charged with negligence (even if the birth went well, because it's all about the intent) and have children's protective services become involved, which can result in the baby being removed from the parents' care. In fact, this has happened, and is an issue in the alternative birth community in places where midwifery is not legal or in situations where the parents choose not to have professional attendants present for whatever reason.

>>medicalstudent29: Midwifery is NOT "illegal" in any state. Whats illegal is the practice of NON-LICENSED midwives, e.g. lay midwives as opposed to CNMs.

Last I heard, there was still a furious battle going on in Missouri, where it has historically been illegal for any midwife to attend a homebirth. I don't believe that's been resolved yet. But yes, in nine states it is still illegal for a non-CNM to attend a homebirth. And just to clarify for others reading, "CNM" is not synonymous with "licensed" and "lay" is not a blanket term for everything outside of obstetric midwifery.

>>medicalstudent29: In the few states that have banned layperson midwifery, ironically it was the CNMs who were the biggest sponsors of the bill. Turf protection is not just an AMA/doctor thing.

It's not ironic at all. There are different kinds of midwifery. CNMs are trained in obstetrics and are essentially obstetricians without the surgical aspect. That's not to say that they all have a technocratic approach to birth, but they more likely to given the path to midwifery they've chosen.

>>jess: As far as I can tell the AMA's problem is with unlicensed midwifes and such. And you know what? Good on them.

Not everyone shares that opinion, so not everyone should be governed by it. There are problems that come with licensure, one being the assumption that there is an objective definition of birth as a medical event, and an objective standard for appropriate practice of midwifery, and that a small group of people can mandate what that must be for everyone. I chose an unlicensed midwife because I *don't* agree with the state's mandated standards of practice and have good reason to believe that it would have resulted in an unnecessarily dysfunctional birth for me. Yes, if someone wants an official designation, they may be expected to jump through official hoops. But to mandate regulation of women assisting other women in birth ("midwifing", i.e. being with woman) is absurd.

>>jess: But I do have a problem with people painting doctors as a bunch of tools of the patriarchy all the time without acknowledging that there was a time when most women gave birth at home and the death rates were insanely high. Just walk around any graveyard Pre -1900 and look around. Count up the number of women dead in childbirth. It's scary. (And think of the fact that since WW II death in childbirth for first-world women is very rare, whereas for all those women in third world countries forced to give birth at home it's pretty grim).

Right. And myths about birth practices (obstetrics existed long before hospitals did,) sexual shame, malnutrition, and lack of sanitation, antibiotics, and access to medical care when needed couldn't have had *any*thing to do with the malfunctioning of an extremely sensitive hormonal process. No, not at all. Birth is "just" dangerous. Yeah, and I've got a bridge I want to sell you.

Regardless, this is not about safety. Even if there were *guarantees* that obstetric management of labor could not cause dysfunction in labor and bonding, it would not be an issue of safety. It is an issue of control. Do you, or anyone, really have the right to tell me how I approach a natural process of my body?

>>jess: Y'know, it's *just* possible that many OBGYNs -- a chunk of whom are women -- might actually care about people having children and living through the experience.

Sure. And that's relevant to this issue how?

Apparently, y'all aren't up on your science, because you don't seem to understand that those "products of conception" are human beings. - oenophile

Your declaring something to be true doesn't make it true, and it certainly doesn't make it "science." Why are you wasting your time commenting here? The chances that you are going to change anyone's mind about abortion are slim to none.

Jessica F. commented at June 19, 2008 9:06 AM: "A midwife can be prosecuted if the 'negative outcome' (which is a phrase that bothers me because it implies that 'imperfect' children are undesirable and should be 'prevented')..."

Either that or implies that certain outcomes are negative for the children themselves and should be prevented instead of inflicted on the children.

For example, suppose someone drops a newborn on her head and the newborn's mother calls that a pretty damn negative outcome. Does this necessarily mean that she thinks the child shouldn't have been born in the first place, or could it mean that she thinks the child should have been born and should not have been dropped on her head?

Jess:
As far as I can tell the AMA's problem is with unlicensed midwifes and such.

Did you actually read the resolution? There is nothing in it about unlicensed midwives. The whole resolution is about banning home births, not unlicensed midwives. The only reference to midwifery is to say that they do not approve of certified professional midwifes (CPM) which are licensed by 22 states. The rest of the resolution is about the “dangers” of home birth and that they recommend hospital births only (they even say they develop model legislation stating as much – again, no references to midwives, licensed or otherwise).

Olivia:
I have lived here for about 15 years and only know of one midwife that was prosecuted after she had attended a birth where the newborn died. She was not charged with anything related to the baby’s death, just practicing medicine and midwifery without at license. She was (and may still be) a certified midwife, but since Indiana does not license certified professional midwives, so they said she was unlicensed. So, I am inclined to agree with you that, in Indiana at least, they don't go after midwives unless there is a death or injury.

Or as mjw put it:
[midwifes] CAN attend homebirths anywhere. But in 26 states, they do it at their own peril, because there are no laws licensing them or preventing them from being prosecuted for practicing medicine without a license.

Mina: Yes, dropping a baby on her/his head is negative from all points of view. Which is why I also said I am bothered when the negative outcome "is not a result of anything that happened during the birth". Blatant negligence is not the same as choice in birth environment for low-risk pregnancies.

Outlawing home birth = outlawing abortion?

YIKES

Oenophile, I don't want to speak for anyone else, but if I had to guess, I would say that not a single prochoice person cares what you call them. You want to call me pro-babykilling? Have at it. I'm still going to say that you are anti-choice. If you aren't pro every single choice that a pregnant woman could make concerning whether or not to continue said pregnancy, then you are anti-choice. You are literally for limiting that woman's choice. I happen to be not only for supporting a woman's right to choose abortion, but for supporting a woman's right to choose to continue a pregnancy, regardless of the circumstances or her reasoning (none of which is any of my business). That's why I'm pro-choice. But, hey, if you want to say I'm pro-murder, that's your thing. If you want to be a condescending sanctimonious asshole, that's your prerogative, too. Not that you need encouragement.

I don't think this is as simple as liberal v. conservative or pro-choice v. anti-choice.

I'm pro-choice, but I know families in my parents town who are vehemently anti-choice, have 10-13 children, and have brought most of those children into the world at home.

Maybe because there are many conservative, traditional people who believe home birth fits in with that identity. Maybe because they were born at home, as were there mothers and grandmothers. Maybe because once you have that many children it's really damned expensive to keep going to the hospital and paying all those bills every time you have a child.

In any case, I just want to make the point that this is something that affects ALL women who choose to have a child or children. And I would think and hope that there are both women and men from such "conservative" groups who in fact have a strong interest in maintaining the legality and safety of home births, and who would bristle at the possibility of legislation outlawing it.

We should remember that two women can have vastly different opinions about the choice to reproduce, the choice to carry a pregnancy to term, the choice of how many children to have, and still have a strong shared interest in the right to have their children at home.

No regrets, Coyote:

This is definitely a pro-choice vs. anti-choice issue. The pro-choice movement is about letting women make their own reproductive choices and not just in regards to abortion. If some people (in this case, the AMA) are trying to limit perfectly valid and safe options for women (i.e. home birth), they are anti-choice.

I just want to make the point that this is something that affects ALL women who choose to have a child or children.

Yes. That is why it is a pro-choice issue. Again, that’s the purpose of the pro-choice movement, to allow ALL women the freedom to make the best choice for themselves.

I agree with you. I didn't say this isn't a pro-choice issue. I said I don't want to oversimplify it into something totally polarized along the common usage of pro- and anti- choice.

I was just trying to say that I think there are women who identify as "pro-life" (or anti-choice, as I would call it) who would probably speak up were legislation to be introduced to ban home birth.

I'm not saying it's not anti-choice to limit home birth. I'm concerned about comments about how this will be a political mess for liberals, or how this is a liberal issue, might elide the difference between the conservative paradigm/institution/political machine and women and men who might identify as conservative who may strongly object to limits on home birth.

Please don't confuse that point with the suggestion (which I did not intend to make, and don't think I did make) that this isn't a choice issue.

And, my point was that there is no other way to frame the issue. Choice is not a liberal issue. It’s a human rights issue. Again, the whole point of pro-choice is that your own personal choices don’t matter, what matters it that you don’t want to legislate your personal choices. So, if a “pro-life” is against banning home birth but won’t take a stand because of the “OMG! Liburelz!” there is not much I can say to change their mind, nor do I care to.

Some OBs ride roughshod over the agreements they make with their patients. They will fully take advantage of a woman's being in no state to advocate for herself (i.e., in labor) to disregard her previously agreed-upon wishes about how she wants to do labor. The pain of birth might fade in memory, but I know a handful of women whose righteous indignation about the hubris of their OBs appears to be lasting a lifetime.

It is totally about choice and control, but it only begins with the choice about where to birth and with whom. Everybody has a right to make her own decisions about giving birth. Importantly, she also has a right not to have her wishes and needs ignored once a birth is in progress.

The AMA should be taking this as a warning shot. If they want more women to be giving birth in hospitals, they should concern themselves with making that work well for women.

Peepers- wasn't that an issue in Knocked Up, where the regular doctor was unavailable, so the substitue Doc wanted to do things the way he was most comfortable, which caused the mother some distress until the father "spoke" with the doctor. That scene kind of scared me.

I am not surprised, although I am very disturbed by the vote of the AMA. The AMA is one of the worst organizations for using its power in abusive fashion against all those who they perceive as even a tiny threat: alternative practitioners, chiropractors, and now midwives.

The medical industry is incredibly political and in concert with big pharma, the AMA and FDA have persecuted doctors who don't toe the line, especially in cancer treatment.

But, now after over 20 years of being hounded and nearly losing their practices, some, though, having their clinics closed and having to move off shore, some of these doctors have been vindicated and are now conducting research and studies funded by the FDA - although with many restrictions and gag orders.

The AMA is a sick group - and the "doctor god complex" is real.

Hey, Voila. I didn't see Knocked Up. That scene sounds both scary and pissoffmaking.

The 4 people I know had problems with their regular OBs, not a stand-in. One woman had the same issue twice about her decisions being disregarded. (Her first 2 births were about 14 years apart. She chose home birth for her 3rd and now lauds it enthusiastically.) Another ended up with lasting problems as a result of a botched episiotomy (that she never wanted).

Women need to be able to birth with people whom they trust. The best way to gain women's trust is to be trustworthy.

"They will fully take advantage of a woman's being in no state to advocate for herself (i.e., in labor) to disregard her previously agreed-upon wishes "

A woman in my sexualities class told us that she has a friend who had a hysterectomy after she had her baby. The doctor asked her if she wanted one, when she was still under the influence of the drugs they gave her. Unfortunetely she "consented." Of course, she had just finished having a baby, and was still under the influence of the drugs - of course she said yes! Shes 34 today, and wishes she still had her uterus because she wants another baby. I cant believe they would even perform a HYSTERECTOMY on a woman that didnt ABSOLUTELY NEED it! Its shocking that they asked her, when she was in no state to lucidly consent. Its like doctor rape.

Crap. That is horrifying.

Physicians and hospitals should be required to disclose all risks(including the risks of c-sections) to patients.

This is already required. Informed consent laws apply here.

I'm a newish resident of Indiana and I've wondered about this. I have found two in my area thru internet searches and they both advertise freely that they attend home births and many families post their home birth stories on the websites.

So, it's illegal, but they aren't hiding by any means. Maybe it's something that overlooked until there is a death or injury?

There is a lot of confusion about this, so let me clarify. In Indiana and a handful of other states, its only LAY MIDWIVES who are not allowed to do home births. CNMs (certified nurse midwives) are allowed to do homebirths in all 50 states.

The midwives you are talking about are probably CNMs. If not, they are breaking the law.

You mention that fewer than 10% of midwives choose to offer home birth. However, it would seem that you are referring only to Certified NURSE Midwives (CNMs). You forget, or perhaps don't know, that most home births are attended by non-nurse midwives. These are midwives who get their training through apprenticeship and individual or group study, and sometimes through attending schools that are accredited through the Midwifery Education Accreditation Council (MEAC). The credential that many of these midwives ea