Friday, February 8, 2008

Citizens for Midwivery offers facts as talking points

This is a really nice collection of talking points (in no particular order) from Citizens for Midwifery (CfM):
  • Twenty-four states license direct entry midwives, several for more than twenty years. Twenty-two use or recognize the Certified Professional Midwife (CPM) credential administered by the North American Registry of Midwives (NARM) as the basis for licensing, and two states have voluntary licensing. In all theseyears, no state has repealed their midwifery law for any reason. Furthermore, in 9 states licensed midwives receive Medicaid reimbursement for their services. These records demonstrate that CPMs do not pose any threat to the health and safety of pregnant women and newborns.
  • An economic analysis of the cost benefits of a licensed midwife program (Washington State) indicate that the cost savings to the health care system (public and private) is estimated to be ten times the cost of the program, even with this licensing program being the most expensive in the country. (Midwifery Licensure and Discipline Program in Washington State: Economic Costs and Benefits, (A report to the Washington Department of Health), Health Management Associates, October, 2007)
  • Contrary to ACOG’s uninformed assertion, many rigorous scientific studies, published in leading medical journals, have found that for a healthy woman having a normal pregnancy, a planned, midwife-attended home birth is as safe as a hospital birth and with far lower rates of medical interventions. The most recent is also the largest study, based on prospective reporting for all the births attended by Certified Professional Midwives in 2000, published in 2005 in the British Medical Journal . ("Outcomes of planned home births with certified professional midwives: large prospective study in North America." Kenneth C Johnson, senior epidemiologist, Betty-Anne Daviss, project manager. BMJ 2005;330:1416 (18 June). Also see CfM’s summary fact sheet.
  • About 99% of births in the US take place in hospitals. If standard obstetric practice is so good, why does the US rank so abysmally when it comes to maternal mortality and neonatal mortality?
  • The Complete Mothers’ Index 2007 shows that mothers in the US have a higher lifetime risk of maternal mortality than the mothers in 27 other developed countries.
  • The World Health Report (from the World Health Organization) indicates that the neonatal death rate (death in the first 28 days of life) is greater in the United States than in 35 other countries.
  • ACOG claims that "complications can arise with little or no warning even among women with low-risk pregnancies". However, complications seen in low-risk women laboring in hospitals are often related to the many routine practices and interventions that disturb the birth process and cause or lead to complications and more interventions. In fact, most of these practices were adopted without being studied for safety, and many are still routine even after being studied and found to be either worthless or harmful or both. (Enkin et al. A Guide to Effective Care in Pregnancy and Childbirth) Midwives attending home births avoid unnecessary interventions and the use of drugs, allowing normal birth to proceed. They are trained and experienced in noticing any signs of problems and taking appropriate action, including transfer to medical care in a hospital when necessary, which is rarely. (see the BMJ article cited above)
  • The press release states "ACOG acknowledges a woman’s right to make informed decisions regarding her delivery…" but goes on to say that ACOG does not support any of the alternatives to a doctor-controlled birth in hospital or birth center, or anyone who provide or supports home birth. So how is ACOG supporting informed decisions?
  • ACOG claims that an "emerging contributor" to the rise in cesarean section rates is "maternal choice." However, there is no evidence for this claim. In fact, recent surveys of mothers found that less than 0.08% of pregnant women request a C-section. Applying these numbers to a recent figure for annual births, a scant 2,600 out of 4.1 million pregnant women actually requested a C-section. (Declercq ER, Sakala C, Corry MP, Applebaum S. Listening to Mothers II: Report of the Second National U.S. Survey of Women’s Childbearing Experiences. New York: Childbirth Connection, October 2006.) Clearly, this number is so small it could not possibly explain the doubling of cesarean section rates in the last decade. Furthermore, when he was President of ACOG, Benjamin Harer publicly promoted maternal choice cesarean sections on popular TV news and talk shows, for reasons for which there was not evidence. (for example: Benjamin Harer on Good Morning America, 2000. Having actively worked to create a market for cesarean sections for no medical reason, based on lies and misinformation, ACOG is now blaming women for the increased cesarean rate??
  • When attending births outside the hospital, both Certified Nurse Midwives and Certified Professional Midwives referred fewer than 5% of mothers for cesarean sections, while obstetricians were performing cesarean sections on nearly 20% of low risk mothers in hospitals. (see CfM fact sheet with references)
  • Some women are going to choose to deliver their baby at home, for a variety of very legitimate religious, social, health or economic reasons. These women deserve to have the best care available the care of a well-trained midwife with experience in out-of-hospital settings. (Firefly Mama thinks this is the most important point!)
  • While ACOG states that childbirth is a normal physiologic process, today’s obstetrical profession performs cesarean sections for nearly one third of births, induces labor in nearly half of births, and administers drugs of one kind or another to more than two thirds drugs that pass through the placenta and harm the baby. In fact, almost the only women who give birth with no interventions are those who give birth at home. (Listening to Mothers: Report of the First National U.S. Survey of Women’s Childbearing Experiences. New York: Maternity Center Association, October 2002.)
  • Apparently obstetricians are not trained to support normal birth, but oppose the very health care providers who are: midwives who are trained and experienced in attending births outside the hospital. The Certified Professional Midwife credential is the only maternity are credential that requires experience in out-of- hospital settings.

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