Doctor Knows Best

by Shaker Juliemania—Thinking out loud is lot easier, but sometimes, in order to sleep at night or focus on anything else, I must put it in writing and this is one of those times.

As some of you may have heard, the American Medical Association (AMA), at their annual meeting last weekend, voted on two Resolutions that seek to prevent homebirths and to increase MD control over midwives by making the commitment to "... 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...". (Click here to read Resolutions 205 and 239.)

The MSM picked up the story in the entertainment sections here, here, and here on Tuesday, not because of the outrageous resolution to take away a woman's choice, but because Ricki Lake was mentioned. The initial draft of Resolution 205 included a personal attack on Ricki Lake and her film The Business of Being Born.

I won't get into the facts or arguments regarding this; there are many who can represent these much better than I can. See Big Push For Midwives and Reality Check or read comments at Feministing.

I am not a doctor, a midwife, nor have I given birth. My greatest gift was watching my partner's stepdaughter give birth and I will never forget the breathtakingly spiritual experience it was for me. My partner (before we were together) used a midwife for her births, two at home and two at the hospital. Until last fall, that was my only experience or knowledge of child birth.

In October, I was given the incredible opportunity to facilitate a meeting between local midwifes and OBs who were meeting for the first time, primarily because of this tragic story. In preparation, I did extensive research on the various arguments and points of view. I interviewed the midwife and OB contacts, asking numerous questions and tried to determine if there was any common ground; unfortunately there wasn't any. These groups were operating from two completely different paradigms.

I determined that the only productive conversation that they could have was to specifically address the issues and process needed when a woman who has chosen to have an "out-of-hospital" birth with a midwife, has some complication that requires that she be transferred to a hospital. As simple as that may sound, it surprised me to discover many midwives experienced distrust, animosity, judgment, and downright disdain by the OBs upon transfer. And in many cases the mother was treated without respect and with hostile judgment for putting her child at risk.

Amazingly, this local group of midwives and doctors listened to each other and slowly created the foundation for compatible transfer protocols—ones that honored the midwives and the patient, acknowledged what the doctors required from them upon transfer, and even went so far as to begin creating consults between doctors and midwives. It was an incredible experience and I am honored to have participated. Most states only have these relationships with CNMs and occasionally with CMs and lay-midwives.

Sadly, as powerful as that meeting was, the only area that could be addressed was when a mom becomes a "patient". And through this process of understanding I realized the very dangerous paradigm under which much of the American medical community operates.

Much of the American medical community operates under a "Doctor Knows Best" paradigm. Only their scientific methods are considered factual. Only their knowledge and expertise can be used to make decisions on our behalf. This paradigm is frequently used across the board for every issue, even herbal or holistic.

So of course, the AMA "knows better" than midwives about childbirth and pregnancy, dismissing the fact that from the beginning of time midwives (not doctors) have been helping women give birth at home. Hell, they even co-opted the latin word for midwife—obstetricis. It doesn't matter that there is plenty of evidence to prove that homebirth and midwifery is safe and sound; unless the evidence comes from the American medical community it is false!

Many doctors don't believe homebirth is safe at all, and I suspect that many don't believe vaginal births are safe, either. How can they, when they are so grounded in the "doctor knows best" paradigm? One doctor told me that he "would try to honor her request to have a vaginal birth"; he admitted that if he perceived the slightest risk, he would not.

The AMA outlines this clearly. (See at the bottom of Resolution 239.)

H-420.998 Obstetrical Delivery in the Home or Outpatient Facility

Our AMA (1) believes that obstetrical deliveries should be performed in properly licensed, accredited, equipped and staffed obstetrical units; (2) believes that obstetrical care should be provided by qualified and licensed personnel who function in an environment conducive to peer review; (3) believes that obstetrical facilities and their staff should recognize the wishes of women and their families within the bounds of sound obstetrical practice; and (4) encourages public education concerning the risks and benefits of various birth alternatives. (Res. 23, A-78; Reaffirmed: CLRPD Rep. C, A-89; Reaffirmed: Sunset Report, A-00)

They rule out homebirth in support of an "environment conducive to peer review" and advise that hospitals and staff "should recognize the wishes of the women" but only "within the bounds of sound obstetrical practice". But they would encourage education "concerning risks" (read: homebirths) and "benefits of various birth alternatives" (read: c-sections).

The AMA has an appalling history when it comes to their "doctor knows best" methods and expertise regarding women's health. In the 1950's, they still touted the clitorectomy hysterectomy as the cure for "hysteria" in women. Today many doctors still consider menopause to be a disease. I could go on, but you get my point.

What frightens me is that, should the AMA successfully assist states in developing legislation that would force all women to give birth in a hospital because of safety, mother and child will effectively become property of the hospital. The "doctor knows best" will have complete and full control of the decision-making of how she will give birth. Women who refuse will be forced to hide, and, should anything happen to the baby, held criminally negligent.

Control over women's bodies will be given to the American medical community in the same way the Church and State had control of women for centuries (and in some countries still do).

We can not acquiesce by leaving this fight to the midwifery community. This will have far-reaching ramifications for all of us. As difficult as it may be, we need to change the "assumptions, concepts, values, and practices" (a paradigm shift) of the medical community to reflect feminist principles, as well as enforcing the concept that we can make the right choices for ourselves.

I don't want to live in a country where women do not have control over our own bodies, our own lives.

Pro-Choice, to me, means that every woman has the absolute right to make choices about her body, her life, her heart, her mind, and her future. Period!

Where shall we put our teaspoons?