Response to AMA Resolution 205

Recently, the American Medical Association (AMA) released a resolution in favor of lobbying for legislation stating that hospitals are the safest place to birth:

RESOLVED, That our AMA develop model legislation in support of the concept that the safest setting for labor, delivery, and the immediate post-partum period is in the hospital, or a birthing center within a hospital complex, that meets standards jointly outlined by the AAP and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers.” (Directive to Take Action) (http://www.ama-assn.org/ama1/pub/upload/mm/471/205.doc)

While this does not blatantly state the AMA will seek to outlaw home birth, one can imagine that legislation dictating that women should give birth in a hospital or birthing center within a hospital would imply women will forfeit the right to give birth at home. The AMA makes this resolution based upon issues of safety. However, safety may not be the true issue behind this resolution.

According to a study published in the British Medical Journal by Kenneth C. Johnson and Betty-Anne Davis, home birth is just as safe as giving birth in the hospital and associated with lower instances of intervention in low-risk pregnancies (http://www.bmj.com/cgi/content/full/330/7505/1416?ehom). In fact, the ratio of women undergoing continuous electronic fetal monitoring (EFM) is remarkably lower at home than in the hospital.. From my personal experience, the belts for the EFM were uncomfortable and easily moved by my unborn children. Isn’t it obvious that you wouldn’t receive accurate readings of the baby’s vital signs if s/he kicks it away? Moreover, a study published in The Journal of Perinatal Education shows that routine interventions do not improve maternal and infant outcomes (http://www.lamaze.org/Default.aspx?tabid=461, http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1905822). In fact, these routine interventions – which are more often than not performed in hospitals20– cause more harm than good in low-risk pregnancies and lead to unnecessary c-sections. The World Health Organization (WHO) actually recommends the midwifery model of care for the majority of pregnancies and seeks to lower the number of unnecessary c-sections being performed (www.who.int/entity/making_pregnancy_safer/documents/newsletter/mps_newsletter_issue5.pdf). It would seem the medical model of care in this country is currently failing us in that c-section rates have sky-rocketed, along with the rates of interventions.

I suggest instead of lobbying for legislation stating what setting is best for childbirth we review the United States Constitution, the Bill of Rights, and the Patients’ Bill of Rights. Passing any legislation that would define where a woman could give birth is a blatant violation of our rights as citizens of this country. We should also review studies from all ends of the spectrum to make informed choices.