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End the “Battle
over Birth” by Letting Women Win
by Brynne Potter, CPM
In Time’s
American Women: Birthing Babies at Home, Catherine Elton
discusses the “battle over birth” between midwives and
obstetricians. As she reviews the recent skirmish related to a
controversial meta-analysis by Dr. Joseph Wax published in the
American Journal of Obstetrics and Gynecology that throws the
safety of home birth into question, she highlights the primary
factor where the US fails in providing high quality maternity care
to women: collaboration.
If this truly is a battle, then women and babies are the collateral
damage. Mothers need to take charge of their own healthcare
decisions by designing and managing their own collaborative care and
the US government is now giving them to tools to do it.
Many healthcare consumers are creating collaborative care for
themselves when they hire multiple providers, like doulas and
obstetricians, to support different aspects of the same conditions. They take what they like from each provider and then try to leave
the rest behind. It amounts to a customized “standard of care”. The
US government is now supporting this movement with the adoption of
Final Rules from the Dept of Health and Human Resources on
Electronic Health Record (EHR) Incentives. Mandates for patient
access to their own electronic medical records will put the flow of
information directly into the hands of consumers who will then be
able to share their health information with multiple providers
during the course of their care. No longer will they need the
permission of their primary provider (through a request form) to
access their records.
The implications of this simple change in “who really owns the
information” stand to create ripple effects in the status quo. Despite the clear challenges presented when collaborating providers
don’t even know they are collaborating, there are significant
benefits to a shift in power from provider to patient. Changes in
maternity models will soon be driven by the economics of consumer
demand rather than a profession that holds a lock on our current
healthcare system through a monopoly on insurance reimbursement and
standards of care. When providers stop fighting over the slices of
pie, maybe women will stop being unnecessarily cut when they have
their babies.
Why Can’t the Maternity Care Providers Work it Out?
Elton says:
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Some
observers, including Wax, further suggest that American
women should draw only limited conclusions about the
safety of home birth from studies conducted in other
countries. The experience of home birth in the
Netherlands, for instance, where 1 out of 4 mothers
delivers at home, bears little resemblance to the
process most American women endure.
…In the Netherlands, moreover, midwives are fully
integrated into the health care system and obstetrics
practices, making transfers to hospitals routine. In the
U.S., where 1 out of 200 women gives birth at home,
midwives can be and have been arrested for bringing
their patients to hospitals in states that do not
license CPMs. |
It is unacceptable for US obstetricians to point to the lack of
timely access to hospital care for women choosing to labor at home
when those same obstetricians refuse to adopt integrated
collaborative systems like those utilized by countries that support
out of hospital delivery and have better outcomes in maternity care
as a whole.
Melissa Cheyney discusses one of the biggest obstacles to
collaboration in her Huffington Post article,
Why Home Births are Worth Considering. She envisions the most
important step in improving outcomes in maternity care:
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Instead of
a maternity system based on fear and misinformation, we
need a system based on collaboration and mutual respect. |
Cheyney highlights a
lack of mutual respect and understanding between midwives and
obstetricians as impacting collaboration and transfer of care:
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…research
has shown deep mistrust between doctors and some
midwives. Many doctors have expressed the belief that
only hospital births are safe, while midwives say they
often feel marginalized and disrespected. |
Such studies [e.g. Wax] only deepen this mistrust and have the
potential to increase hostility during encounters when midwives and
their clients have to seek hospital care for complications. The end
result is a system that can be detrimental to women and their babies
because of the impaired ability to communicate across a cultural
divide.
Peace between providers due to a change in perspective from either
side is an unlikely outcome. As good negotiators know, the best way
to mediate any dispute is to find compromises that result in a win
for everyone. Everyone “wins” in the birth battle when women have
better outcomes. It is the result we all want and we have great
examples of birth models that work, and what makes for better
outcomes is collaboration.
The question remaining is: how will obstetricians and midwives meet
the challenge of a newly empowered patient who creates her own
collaborative care?
Brynne Potter is a
mother, a midwife, and community activist. She has two
children, ages 13 and 17, who were born at home in Virginia with the
aid of midwives. She became a CPM in 2005 and shares a thriving home
birth practice,
Mountain View Midwives, with Deren Bader in the community of
Charlottesville, VA. Between 2002-2005, she served as the
Legislative Coordinator for the grassroots efforts to pass a
licensing bill to allow CPMs to provide midwifery services in
Virginia. She also helped to found the VABirthPAC. She has
served as Policy Coordinator for Commonwealth Midwives Association
(CMA), serving as liaison to the state Board of Medicine, their
professional lobbyist, and coordinated educational efforts of state
agencies regarding the practice of licensed midwives. She
serves on the board of directors for the North American Registry of
Midwives (NARM), the credentialing agency for CPMs and is on the
Steering Committee for the MAMA Campaign, an effort to achieve
federal recognition of the CPM credential. She is the managing
editor for
The Midwives Monologues, a web log dedicated to all things
related to midwifery.
Visit
The Midwives Monologues to view the above article along with
comments from the readers.
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