Thoughts on the AMA Homebirth “Ban,” Ricki Lake, and Midwifery
Just my initial thoughts on the birth-related resolutions that came out of the American Medical Association this week. I’m still kicking these around. I don’t want to get into the much bigger issues of homebirth safety, reproductive choice, or why the AMA felt these resolutions were necessary in this post, but am attempting to clarify my thoughts (and maybe yours!) on what the recent AMA resolutions may actually mean.
The AMA did what?
First, the AMA did not “ban” home birth. The AMA did recommend for adoption an amended resolution (205) on home birth, as follows:
“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.”
While their policies and resolutions may guide their activities, these do not become the “law” in your state – birth is typically regulated on a state-by-state basis, with policies differing between states. The original resolutions mentioned developing “model legislation.” The amended versions refer to supporting state legislation, which is about the only way the AMA could effectively advocate in this area.
Aren’t they just saying that certain types of trained professionals should be the only ones to attend home births?
Not exactly. There were also two resolutions on the table (204 & 239) that were combined and adopted as amended. They stated that the AMA should “support state legislation regarding appropriate physician and regulatory oversight of midwifery practice, under the jurisdiction of either state nursing and/or medical boards.”
The resolution also asks that the “American Medical Association only advocate in legislative and regulatory arenas for the for the licensing of midwives who are certified by the American College of Nurse-Midwives.”
In other words, the AMA is formalizing in the form of a resolution the notion that CNMs and CMs recognized by the ACNM should be the only legally practicing midwives, and that “lay” midwives (there is a lot of term confusion here, but CPMs, direct-entry, that type of thing) who are not regulated by a nursing/medical board (because they are not doctors or nurses by training/certification) should not be allowed to be licensed to practice under state regulations.
Several states already make these types of midwives illegal (or legal), and some states have not yet passed legislations making them il/legal. This resolution does not specifically address home births, although these unofficial midwives typically are the ones attending home births, while CNMs tend to practice in birth centers and hospitals rather than homes. These non-CNM providers typically do not have hospital privileges.
In effect, encouraging states to explicitly make non-ACNM-certified midwives illegal would probably reduce the pool of available homebirth providers in a given state considerably, even though this particular resolution doesn’t specifically address home births.
How can legislation ban home birth?
No state, to my knowledge, has made it illegal for women to give birth at home or in a non-medical environment. State legislation also doesn’t typically just express a feeling on something like birth – legislators want to *do* something. If the AMA is not going to support legislation criminalizing women (and I’m guessing they’re not), then their approach would be to support legislation that makes it illegal for providers to (charge for) attend(ing) home births. This would presumably take the form of “practicing medicine without a license” (for non-traditional providers) or sanctions/potential loss of license for CNM/MD/licensed providers who elect to attend home births.
Again, the AMA itself cannot make states do this, but state supporters of such legislation can look to the AMA and say, “See, the AMA says…” I wonder to what extent this would reduce the pool of women actually wanting and having home births vs. increasing tension between women and their healthcare providers (such as claiming an “accidental” home birth or avoiding healthcare altogether) and unassisted births.
If you want to know whether this ends up having any real effect, you need to watch for legislation in your own state.
What does Ricki Lake have to do with anything?
Ricki Lake recently did a film, “The Business of Being Born,” which prominently featured home birth (including her own). The AMA’s resolution on home birth, in it’s original version, specifically referred to Lake in the portion of the document that is intended to outline why the resolution is needed. This was removed prior to recommending that the resolution be adopted, but stated, “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.’”
In other words, if Ricki Lake jumped off a bridge, every other woman’s gonna want to jump, too. It’s sort of unseemly to call her out individually as somehow responsible for all the women who make this choice, not to mention insulting to women who decide that a home birth is their best personal choice. To assume that women are making these decisions just because “Ricki Lake said…” – well, it doesn’t think too highly of women, and yet it doesn’t do anything to educate them if you believe that Lake’s film is inaccurate or doesn’t present the whole picture with regards to choice of place for birth. It also doesn’t do anything to address the reasons why some women choose home birth in the first place.
Ricki Lake (along with Jennifer Block and Abby Epstein) has issued a response via the Huffington Post. There are a ton of other blog posts on this topic, so I suggest you browse around in this Google blog search.