Seriously folks, I'm exhausted. This whole midwifery legislation thing has worn me out.
It started a couple of weeks ago with some frustration that consumers seemed too busy to get involved with passing legislation. A small handful of people were scrambling and juggling to put together a fund raiser and it was a little disheartening. But then it raised a great question, "Are the consumers onto something that I am missing?"
This caused me to go a little deeper in my thinking and really question whether legislation is what I really want. I mean, it's supposed to make homebirth better for the families as well as them midwives. If the consumers are ok with the state of things, should I be also? I still haven't come to a firm conclusion. But in the midst of my pondering I come across this article this morning:
http://www.foxcharlotte.com/news/top-stories/Charlotte-Moms-Ditching-Hospitals-For-Home-Births--148412775.html?m=y&smobile=y&clmob=y&c=n
And as is typical of FOX news to go out and find a qualified expert, they interview Dr. Amy. This is irritating, but predictable and something I don't really think will change. When we want the social scoop with flair, we turn to Us Weekly, Entertainment Tonight and Perez Hilton. In the world of birth, we have Dr. Amy. It's a few facts, mixed with some partial information then shaken and stirred to sound really intelligent for the fans and PRESTO! we have an expert. Funny how even physicians never call on her expertise when they talk about this issue though...just the media. Things that make you go hmmmmmm.......
But I digress.
My issue today is that slowly but surely, women stand by and allow their rights to be trampled on by the government whether it is state or federal. And I will be honest, I have waffled back and forth on my own feelings about that. Some days I'm all for regulation of midwives in NC and some days not so much. I see both sides. But my pre-conclusion(I may have possibly made up that word) is that this boils down to personal choice and responsibility.
You see, if I am 38 to 39 weeks pregnant and I don't want to endure the challenges of labor, then I can walk into my doctors office and request a cesarean. This will be granted to me. And if my insurance doesn't pay, then my doctor will be happy to do a few tests to find a marginal result that will change their minds and convince them that I not only need this surgery, but also that they need to cover it. Please don't write some cheesy comment that says, "That is not true! I tried to get my doctor to give me one and he/she wouldn't." Please.....you only need to google some mommy message boards to find overwhelmingly that what I am saying is true. It is YOUR RIGHT to have a cesarean if you want one in the eyes of medicine. Our state does not intrude upon that as it is considered to be your decision. And you know what, I support that. Even though we have statistics that show that surgical birth is more harmful to mother and baby unless there is a true medical condition that contraindicates vaginal birth, we trust the mother to make that decision for herself and for her baby.
In the case of VBAC, we allow women to have a repeat cesarean if that is what they want. Even though the medical evidence does not support that this is the better or safer option for most women, we trust the mother to make the decision for herself. The government is not concerned about this issue because it is considered a woman's given right to judge for herself whether she wants to try a vaginal birth the next time around, or choose another surgery.
At any point in a woman's pregnancy, she may choose to terminate it. Yes, she may have to do some legwork to find a place that will do it at different stages, but she can find a safe and secure place for abortion at any time. Our government says this is her right regardless of whether or not the baby could sustain life outside the womb. Again, though it will make me very unpopular with many of my friends(not the first time, won't be the last), I support the government staying out of it.
If I am pregnant, I can take any number of prescription medications that may or may not harm my baby. You see, we aren't sure because there aren't millions of pregnant women stepping up to be guinea pigs for the pharmaceutical companies, but most of the drugs we "assume" are OK. But regardless, we consider it a woman's right to make an intelligent decision and weigh out her need for a drug treatment and the risk to her unborn child.
Parent may choose to circumcise their boys. It doesn't matter that there is no significant proven benefit, that it is painful, or that there are small, but some risks associated with it. It doesn't matter that it inflicts pain on a child for what is not much more than cosmetic reasons. We honor that as a parent's right and choice to make that decision for their child.
So why do we consider having a baby at home with a Certified Professional Midwife any different than any of these other things that our government consider OUR RIGHT AND OUR CHOICE. "Well, they don't have enough education." many would say. "Well, homebirth is risky. What if......." And it's not just Dr. Amy saying these things. Sometimes it is local Certified Nurse Midwives who don't appreciate losing their cut of the homebirth population or other local birth professionals who have their own agendas and of course, some consumers whose only knowledge of homebirth is from the show "I Didn't Even Know I Was Pregnant". They believe because of whatever information they have taken the time to gather(which is usually limited as the data of on all of this is extensive and has been interpreted and re-interpreted more times than the Bible)and they protest and stand in the way of decriminalization for the supposed good of mother and baby. This is rubbish. The point is that as long as there is informed choice, meaning the parents know exactly what the risks and benefits are of their decision, it should be honored. "WHAT?" you say. "We should just allow moms to make a decision even if it is risky?" This we know......all birth is risky regardless of where it takes place. Our state maternal and infant mortality numbers reflect this. Most people DO give birth in the hospital with the good ole local MD, but that hasn't removed the problem. Understand this, MDs do risky things too. I have been in many hospital births where AROM was performed simply as a routine procedure. This is risky - the baby may not tolerate it, but it doesn't stop people from letting them do it. We know that an epidural carries a small amount of risk to mother and baby, but the epidural rates in most L&Ds here in Charlotte and surrounding are over 90% and physicians are happy to order them. Pitocin carries risks with it, but doctors don't hesitate to order it when things are taking longer than their time clock allows. I could go on. Birth in ALL environments is risky. Your biggest risk as a healthy, low risk mom going into the hospital......CESAREAN. In Charlotte, your risk is practically 1 in 3 depending on the hospital. Do physicians really expect us to believe that over 30% of these women actually needed a cesarean? Because if it's true that all of those were medically necessary, then something is happening in these hospitals that is a lot more concerning than babies born at home. Statistically, there shouldn't be that many risky situations.
So if you really want homebirth with a Certified Professional Midwife to remain a criminal act for the midwife, then you must believe that anything that presents a minute risk to the life of the mother or baby is also criminal. Therefore, we should ban epidurals except when surgical birth is imminent. Oh, and we should ban surgical birth unless it is proven to be a medical necessity(we think you have a big baby is NOT one of those medical necessity diagnoses). We should ban convenience inductions which are also currently a woman's choice. We should ban all women from taking prescription drugs that may or may not cause harm to her baby unless she can prove that she really needs to them sustain her life. And of course, we should ban abortion. We should also regulate doctors to force them to be at the hospital at all times when patients are in labor because nurses are not doctors and anything go go wrong at anytime and there should be a doctor within arms reach if that happens(what?You thought a doctor was there at all times during your labor????? Don't make me laugh. How would they see there 5 bazillion other patients if they spent all their time focusing on you. Did I tell you the story about my friend's baby who was delivered by the nurses because NO doctor...not even the GP downstairs could get there fast enough because no one believed her when she said she felt pushy since they had just checked her and she was only 3cm..... and the nurses not only had to deliver a baby with heavy meconium but also had to treat the hemorrhage afterward with NO doctor on the floor of one of the largest hospitals in this city? And the mother and baby actually SURVIVED! But again....I digress).
You see, it's a double standard. We should be able to choose and accept all types of interventions which have been proven relatively safe but do carry some risk as long as a doctor or CNM is involved. But if a parent chooses homebirth, which has also been proven safe for low risk mothers, and they want it attended by the only midwife that is trained specifically in out of hospital birth, then our local government feels the need to tell us that you can't have that. It is legal for you to have the baby by yourselves, or with your neighbor, or with any other person, but if you choose a trained professional with the letters "CPM" behind her name, then we are going to have to charge her with a crime.
What if the government decided you couldn't have a repeat cesarean just because you had already had one? Would you stand for that. what if the government said you could only circumcise your son if it was deemed medically necessary? Would you be ok with that? What if your government decided that you could not take medications for nausea, depression or any other issue during pregnancy unless it was proven completely and absolutely risk free? Would it be ok with you.
All women, regardless of where and how you birth, should be fighting for the state to get out of birth all around. Women are intelligent human beings who can educate themselves on their options and make their own decisions. We should give them the benefit of the doubt as long as they are willing to accept responsibility for their decision. But therein lies my other issue:
PERSONAL RESPONSIBILITY
We only have ourselves to blame for the current state of medicine. You see, we all want a GUARANTEE. We will fore go our personal freedoms for a perception of safety and security. That is what the MD designation holds for many expecting families. They really feel that as long as an MD and a hospital is involved, their birth will be completely safe and their baby will be born healthy and DEFINATELY alive. This is just not true. We have elevated physicians and yes, sometimes even midwives to the level of gods that are to be worshipped and every word from their mouths heeded with blind acceptance. We have created a legal environment where you do what your doctor says and if you don't like it, you just sue them, even if you knew there was minute risk involved. One lawsuit can wipe out a doctors career, even if he or she wasn't negligent in their care. Sometimes things just happen. We don't know why, we don't have all the answers, but they do happen.
We will never be able to remove the element of risk from our lives. If we reacted to risk in all other areas of our lives that we do with birth, we would never leave our homes. And our homes would be turned into fortresses that isolated and sheltered us from the risky outdoors, the risky interstates, the risky people around us.
When we have information that proves something is safe, we should have the freedom to choose it. We should take responsibility for our own health by gathering our own information, asking lots of questions, seeking second, third and even fourth opinions. In the absence of criminal neglect, we should not hold those who care for us solely responsible for our health outcomes. If you were deceived by a health professional, did you search out their reputation? Did you ask about his/her education and experience? I have never heard anyone say they have actually asked their doctor that. Why not? It is not only your responsibility to be informed about your health choices, but also about your health providers.
Take responsibility NC. Tell your representatives that you do not want the government involved in the choices you make about your personal health. Call them today and tell them that HB522 and SB662. Don't know who they are? http://www.ncleg.net/representation/WhoRepresentsMe.html No matter where you birth, this is a step in the right direction for all of us. And don't worry, the surrounding states that have already done this....Virginia, South Carolina and Tennessee aren't seeing moms and babies dropping like flies. I'm sure that FOX News has done full research to verify Dr. Amy's 900% stat. They should ask her for all the other statistics on all the other states as well. Since she's no longer a working OB, I'm sure she has had time to compile them since she at the computer all day. Wonder how she gets it done so much faster than Vital Statistics and the CDC. She must me superwoman.
At the end of the day, it is the consumers who must fight this battle. I, as a birth professional who is no longer having children, can only do so much. I will accept whichever way this legislation goes and the consequences that both decisions could bring. I can't say right now that I am still pro-legislation. I can say I am pro-decriminalization and pro-parent choice. But as a professional, I'm stepping back and leaving this to the consumer. Midwives will have to adjust their practice to the climate and no one is certain what that will bring, but the consumers will need to choose their fate and make their beliefs and wishes known. They will either choose to let the government determine their rights, or not. Right now, the government is telling them that their choice to birth at home is too far out of the box and punishing them by forcing experienced providers underground.
Big Brother is alive and well. Are you feeding him?
