Friday, July 18, 2008

Why Homebirth is Important

There are many people out there that are currently debating the AMA's and the ACOG's positions on homebirth. Actually, that's not really true.
What's really going on is this:
AMA mentioned their stance on homebirth.
The homebirth community went "WTH"

So let's get down to the Skinny of it.
Homebirth is important to the Cesarean/VBAC community because it's the ONLY place they are getting good, individually-based care. They get low cesarean rates, low transfer rates, low complication rates and healthy babies and VBAC's but even more importantly, they are treated well throughout their pregnancy, they aren't scared to death constantly about all the "risks" (less than 1%) of uterine rupture, they aren't told constantly what a risk they are to the physician's practice, they aren't told at every appointment that their baby could die, they aren't told that beginning at 36 weeks, they want the cesarean scheduled (without medical indication) and they aren't told that they have to give birth by 38-39-40 weeks and oh, if you get a REALLY nice dr, 41 weeks.
In other words, they are given good, conscientious, evidence-based care and then, if they do need transfer, their midwife goes with them and tries to maintain that care through what is often a completely nasty process where the OB, nurses and hospital staff feel the need to constantly tell them what risks they were taking rather than treating them where they are standing. A woman who presents with a 102 fever and asks for a cesarean shouldn't be reprimanded for over half an hour about the dangers of VBAC, dangers of a big baby, dangers of uterine rupture and dangers of homebirth. She should be treated clinically and appropriately. Here's wishing that will actually begin to occur in this state or country.

And why is the AMA/ACOG contingent against this? Because they want everyone to believe that VBAC's are dangerous to women and babies rather than just to their wallet. They know that they are not giving good care to women. Not good prenatal care, not complete prenatal care, not accurate care. Their system is built largely on checks on a list and "see you next time" and "screenings" rather than education and choices. They based an entire system on these things and now they are trapped trapped trapped and turn on one another if one OB steps out of line and doesn't practice this way, too.

So the Skinny on why AMA/ACOG want homebirth declared unsafe? illegal?
It's a threat to the way they practice. It's a threat to the money they make. It's a threat to the way they define birth and how they charge for it. It's a threat to the belief system they have set up that others have to follow.

Why do we care?
Because under AMA/ACOG practices, women and babies are being harmed at higher and higher rates. Protocol has replaced the practice of medicine and defensive medicine has replaced the peer relationship between patient and doctor. There is no respect for women or babies or individually-based care in the current world of obstetrics. There is no place for it. It takes too much time and time costs money. Being a doctor is supposed to be a job of prestige and importance with a requisite monetary compensation. But in a world where people realize that most of the time, you can go get tylenol sinus and skip the doctor visit or go to the midwife and just have a baby rather than going to surgeon for specialty care....life is far too simple to pay specialists unless you really need them. And ACOG is terrified women will realize that specialists shouldn't be doing LOW RISK NORMAL CARE.

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