those silly, silly ACOG fellows…
pamela on Jun 12 2008 at 9:39 pm | Filed under: articles, birth activism, birth trust, media, what???
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?
Linda’s piece…
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?)
This is amazing.
Sometimes it feels like a war.
Thanks for sharing this with us. There are some days that I just can’t tolerate reading about ACOG’s latest statements on these issues. One thing I have noticed is that it appears that ACOG would like others to believe that CNMs want to be under the control of obstetricians, which is probably why they are somewhat ok with nurse midwifery. But as a soon to be nurse midwife I find this insulting.
I personally feel that this is a complete turf issue, and don’t want midwives of any kind taking over normal birth. They want to keep it in the hands of surgeons.
I do not believe for one second that the ACOG is for women. It’s continuing adherence to outmoded and outdated ideas regarding birth and birth attendants demonstrates that their interest is unwavering. The ACOG is for the ACOG. Thanks for posting this, although I am in Canada, I am always interested in how midwifery is faring south of the border. I am sorry that you have to deal with such ignorance.
Well, of course, we can’t have rogue women running around trusting their own bodies and instincts. That would just be way too threatening to society, right? The same is true in home schooling…
Anytime women find their strength, whether individually or collectively, people freak out because it means a shift in the relationships, a shift in how things are done, a shift in the power structure.
The secret is, though, that whenever women find their strength–physical, mental, and/or spiritual–everyone around them, and the world as a whole, is made stronger in the end.
Pam, I have been reading your blog for some time now, just lurking. I am a mother of four (two homebirths, one homebirth/transport/CS, one homebirth/transport/VBAC). I had to comment on this post because after my two hospital birth experiences, I know in my deepest soul that home birth is so important for mamas like me; important in ways that I don’t think the doctors will ever understand.
I love how honest you are about your journey as a midwife. Eight and five years after my two hospital births, I still have some healing work to do, and reading what you have to say has been such a help on that journey, by reminding me that I am not crazy for thinking that my hospital birth experiences kinda sucked. Thank you for sharing here!
i actually see this statement as a good thing, especially when they talk about such things as an unexpected coalition involving lawmakers and homeschoolers and Amish and Mennonite communities, and when they talk about how nurse midwives are no longer the “front-line defense” for ACOG against these scary, scary midwifery bills (ha! ha ha!) and when they talk about how women desiring VBACs in areas where hospitals don’t allow VBACs are going to home birth midwives to get what they want.
they are acknowledging our power. the power of women to make these decisions, the power of nurse midwives to speak their minds without bowing to ACOG, and the power of people to realize a common goal and put forth effort toward that goal - they are acknowledging this power, and it makes them very very uneasy. because they are waging a turf war, no matter if they deny it.
I’m reading the statement by ACOG, and I’m trying very, very hard to laugh to keep from crying. How can anyone make a statement that is so grossly STUPID! It’s disgusting!
I was, originally, quite opposed to homebirth. “What if something goes wrong?!” I know better, now. My last baby was born in my bedroom, where he was celebrated, cheered and cried over (happy tears, happy tears) by a CPM who has delivered a LOT of babies. I mean a LOT (well, 20 years of serving women and babies will do that). I felt safe, protected and calm through the whole thing: much different than my first birth at a hospital with a doctor who refused to believe women could birth without him!
Until people like me, the public, those not “in the business” start to hear about this kind of garbage and know it for the trash that it is, ACOG will be able to assist in trampling the rights of women, babies and the partners/coparents who support them.
Thanks for having such an eloquent blog, and such eloquent friends, that says it all so much better than I can. You have no idea how many of my friends have been linked over here! You’ve helped change minds and hearts, and you’re doing as much for birth choices as you do for birthing women.
ACOG says CPMs are unqualified to attend home births “because they do not work collaboratively with hospital-based obstetric providers”.
Hmmmm.
who created the rift?
who refuses to provide backup (under threat from their collegiate organization)?
which group labels another group of care providers as underqualified and therefore not worthy of a collaborative relationship?
who does this really serve?
Tell it, Linda!
Amen! I couldn’t have said it any better than Linda or any of the others…
Sometimes I imagine that when AGOG’s GOBN (Good Old Boy’s Network) gets together they do it in a *really big* sandbox that is 20 feet deep so that they can bury their heads in the sand and not have to look around at the real world…but that is just me.
Pamela,
Thanks for all you write. This is such an important issue.
Just to be clear, the language you quote is from legislation introduced in Missouri several years ago. To see what we’ve come to after working with interested parties on all sides, you can find our most recent legislation (passed the Senate but not the House this year) at http://www.senate.mo.gov/08info/bts_web/Bill.aspx?SessionType=R&BillID=50641
The midwifery advocates in Missouri have worked hard to be respected for their knowledge of the legislative process and their unwavering cheerfulness. It is an honor to work alongside them as we strive to improve our maternity care system in Missouri
Elizabeth Allemann, MD