Tuesday, June 24, 2008

A Not So New Attack

Recently the American Medical Association passed Resolution 205 to actively counteract what they perceive is a glamorization of the practice of home birth, and to work to actively discourage the practice. But they do not simply want to discourage it; the wording of the resolution seems to point strongly towards an intention to restrict its practice legislatively through their very powerful lobby. Along with this, Resolution 204 seeks to protect their interests by advocating for legislation that limits the "licensure and scope of practice of midwives." Currently CNMs (Certified Nurse Midwife), who work within hospitals and are certified by the American College of Nurse-Midwives, are licensed in all 50 states, and CPMs (Certified Professional Midwife), who work outside the hospitals and are certified by the North American Registry of Midwives (NARM) , are only licensed and regulated in 24 states currently.

This action is getting heightened attention because the AMA directly cited the efforts of celebrity personality and producer, Ricki Lake, and her recent documentary "The Business of Being Born," which investigated the methods and choices in birthing in the U.S., as an example of the need to step up their efforts to counteract what they infer is a misleading trend of celebrity home birthing. Additionally, the Big Push for Midwives campaign wants CPMs to be licensed in all 50 states so that "families have access to legal midwifery care." Previously the public relations war had been waged with groups of parents that the AMA has been able to marginalize as fringe, alternative, and counter culture. Now, with the visibility of not necessarily an a-list celebrity, but a celebrity nonetheless, the discussion of this issue is starting to work its way into the mainstream, and this is counter to the goals of the AMA. Ricki Lake and her fellow filmmakers address this direct attack of sorts on her film and the prospect of alternative choices in birthing in a response to the AMA posted on The Huffington Post.

This action is concerning, but not new. To gain a historical perspective, in 1634 the assault on midwifery began in earnest according to historian Carolyn Merchant, as recounted in her book, The Death of Nature: Women, Ecology and the Scientific Revolution. Early in the 1600s the Chamberlen family of England had invented the forceps, and had in fact in 1616 tried "to form a corporation of midwives," and also sought to establish "educational and legal restrictions on (the) use (of forceps)." The midwives were not amenable to this effort and resisted, and a public relations and legal battle ensued that has laid the groundwork for the current battle being waged today. Merchant further asserts that the practice of midwifery and the ability of women to have control over their own bodies are closely related, and that by the end of the 17th century "women began to lose control over midwifery and thus over their own reproductive functions."

Ostensibly these battles have been waged over the safety of the methods used to bring our children into the world, but the overtones of the debate are couched in terms of competency that cuts deeply into our philosophical fabric. Is a woman's body competent enough to birth a child with marginal intervention and gently guided care, or is it an unpredictable mechanism that requires a controlled circumstance to perform competently? Many women contend that this should not be a competition, but rather a collaboration to ensure the best outcomes for mother and child.

Groups of parents are mobilizing around the country to make their viewpoints known regarding birth and child-rearing choices, especially as it relates to the health care dimension, and providing support for those who find themselves outside the mainstream as defined by the AMA. The Holistic Moms Network recently issued a press release in response to the AMA's Resolution 205, which questions the basis of the AMA's assertions and expresses the experiences of several member parents that have had safe and enriching home births. Ultimately improving the outcomes of birth, they say, is dependent upon the ability of the citizenry to make responsible and informed decisions, and that necessitates choices and options, including home birth.

For further discussion of modern midwifery and birthing trends in the U.S., read Baby Catcher: Chronicles of a Modern Midwife by Peggy Vincent and Pushed: The Painful Truth about Childbirth and Modern Maternity Care by Jennifer Block.

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