One of my closest birth friends, Linda, recently wrote her reaction to a statement put out by ACOG (part of their annual legislative review). The statement (entitled “‘Lay’ Midwives and Homebirth: Troubling Trends in Legislation”) reminds me of the propaganda pushed in the early 20th century to sway women from midwives to physicians. Could it be that the pressure is on for ACOG?
First, let me clarify for those of you unfamiliar with ACOG, the American College of Obstetricians and Gynecologists, that it is not a college in the modern sense. It comes from the latin collegium, meaning “association”. So it’s an organization of people who have a shared purpose, which in this case is to promote and advocate for professional obstetrics and gynecology. And more specifically, to promote and advocate for obstetrics as the sole valid approach to care in childbearing (with nurse-midwifery allowable as an obstetric practice minus the surgical training.)
ACOG does not support homebirth as a choice, nor midwifery as an autonomous profession.
This isn’t meant to be just an opinion. This association of medical professionals (some 50,000 of them) is actively working at the level of state legislature to force all childbearing women to submit to hospital-based obstetrics as practiced by obstetricians, family practitioners, or certified nurse-midwives overseen by a doctor, and its efforts have resulted in the illegalization of homebirth midwifery in many states.
Yes, there are still places where a woman can’t decide for herself where and with whom she is going to allow her body to engage in this particular autonomic physiological process. ACOG sees this as a good thing, and is extremely concerned that some states are passing bills to give this choice back to individuals, and it regards arguments for such autonomy as “propaganda”. As if the right to autonomy in a normal bodily process isn’t self-evident.
In its latest yearly review of the situation, ACOG observes, correctly, that the general attitude of non-obstetric midwives has shifted from wanting to protect midwifery from the control of the state, to embracing licensure and the associated regulation. It clearly has no understanding, however, of what motivates that and does not attempt to understand it, because it doesn’t care. All that matters is that the midwives are coming, and even establishment-controlled nurse-midwives “no longer can be counted on to speak publicly against home birth or lesser trained midwives.” Clearly, things are spiraling out of control.
ACOG complains that the push to legalize homebirth is based in propaganda. This is hilarious, given that ACOG itself is not above making statements that are misleading, untrue, irrelevant, or just outright illogical. In this document alone it claims or implies that
1. midwives have traditionally preferred to be underground
2. CPMs (midwives certified by associations of midwifery professionals) are largely self-taught, completely ignoring the fact of the existence of schools of midwifery
3. all training outside of ACOG-approved institutions is inadequate
4. midwives who do not work with obstetricians cannot be properly qualified
5. legalization is occurring because
-a. conservative lawmakers, legislators in general, and the general public are too stupid to understand the difference between types of midwifery training, as well as too stupid to understand that the right to personal autonomy is not important
-b. midwives have “huge numbers” on their side and “play” to the sympathy of the public
-c. nurse-midwives are “fickle”
-d. lawmakers see it as “just a turf battle between doctors and non-doctors”
6. the conditions that make homebirth relatively safe in other countries do not always apply here, therefore it follows that homebirth should be illegal here
7. all studies that find favor with homebirth midwifery are “not scientifically rigorous and unconvincing.” (Oh, okay, if you say so, then I guess it must be true.)
ACOG finds Missouri’s homebirth legalization bill “deceptively simple” (no elaboration on that, unfortunately.) The bill reads:
“Nothing in Missouri law shall encroach on a mother’s right to give birth in the setting and with any caregiver of her choice.”
Yeah, I don’t know what that’s covering up, but it must be something dastardly.
Seriously, though, I just don’t understand why ACOG would so furiously oppose such a thing. Is it a pride issue? The idea that a woman might reject a doctor’s sacrifice of having gone through the hazing of medical school, that she might not consider a doctor deserving of esteem and exaltation just by virtue of being a doctor, is just too horrible to allow? Is it money? Is the existence of midwifery and homebirth really so financially threatening to the practice of obstetrics? Is it that ACOG really does care so much about me an individual that it will fight so hard to protect me and my family from supposed danger even when I am angrily yelling “NO”?
Whatever it is, it all boils down to arrogance, doesn’t it? Either this group of people deserves to have control over the rest of us as a sort of reward for their specialness, or they consider it a moral imperative because they are smarter and therefore know best what is good for us. Either way it’s galling.
Thank goodness for women like Linda. Thoughtful, articulate and spot on.
It has seemed like ACOG has really started to get their panties in a wad over homebirth. Just like a solo blogger that has put so much time, money and energy into criticizing this one issue, I wonder if those that shout the loudest are those that are hiding their own small voices of truth.
(I specifically take issue with ACOG’s reference to CNMs as “fickle”…the sexist language throughout this entire statement is troublesome. Is this not 2008? Is this an organization that serves women?)
