Thursday, April 14, 2005

Fight Fire with Fire

If birth in America is to change for the better, things are going to have to get ugly. Hopefully not in the birthing rooms, but at least rhetorically between stalwart clinicians and more progressive practitioners. A few examples:

First, this summary of the turf lines and attitudes toward midwives, nurse midwives, and unassisted births. Unfortunately the article uses a maternal death to lead in to the story. Other than that, it is pretty balanced reporting on what the various birth attendant classes (MD, CPM, CNM) think of one another.

From Australia, here is another story on tensions between doctors and other birth care providers. Though it's overseas, this scenario does not seem out of place in the states either. Here's a story about a Pennsylvania midwife who has had to close her practice because she can't get authority to write prescriptions.

Finally, there is this response from a maternal-fetal medicine doctor, steeped in condescension and contempt, to the ACNM’s call for Congressional Hearings into the escalating rate of Cesarean births.

This last piece, especially, reminds me that if natural birth advocates ever hope to advocate successfully, they (we) are going to have to make sure our efforts are as professional and scientifically founded as possible. This doctor throws away the American College of Nurse Midwives’ concerns as quickly as a soiled pair of surgical gloves. And blames the patients to boot.

Talk of the beauty of birth or the innate power of women is not going to make ACOG change its standards of care. Nor, unfortunately, will a bunch of women with gauzy skirts and Guatemalan bags get the attention of hospital administrators.

To advocate for woman- and baby-friendly care and a true range of birth options, we are going to have to have statistically significant numbers from double blind studies and hard-as-nails lobbyists to present them. By all means let’s not lose sight of birth’s magic or the voices and wisdom of Earth Mother midwives and doulas. We just can’t afford to be viewed as soft, weak, or fuzzy by an establishment that needs little excuse to dismiss us.


Anonymous Tom Wigton said...

A couple of points;
1). Dr. Carr continued, “The debate over elective cesarean section is being driven by fear over litigation..."
The issue is elective cesarean birth, which I do not advocate. However, the debate over elective cesareans is not litigation fear (that is universal); it is a scientific debate over risks and benefits (prevention of pelvic floor prolapse). That is very open to debate and very reasonable people disagree on the merits.
2). Litigation is always an issue, and trial lawyers tell us "you never get sued for the cesarean you perform, only for those you don't perform". Not always true, but that seems consistent with what I read.
3). Congressional hearings do not address the issue of the rising cesarean birth rates, which are being attributed to a rising induction rate, which is also multi-factorial. This includes more high risk pregnancies, and yes, patient demand.
4). I don't blame patients. But patients ask for elective cesareans. I do not offer the procedure.

2:49 PM  
Blogger Dynamic Doula said...

I'm glad to see a medical doctor reading here. There should be more alliances/support/cooperation/community between birth workers instead of divisive lines that run so deep I wonder if they'll ever be bridged. We each have our role to play; we might not all enjoy what the other is asked or feels it necessary to do, but together we paint the picture of maternity care as it is evolving in this country.

Accountability with common sense.. will it ever be possible?

12:36 AM  

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