Birth activists were all pretty happy this week reading about the new U.K. National Health Service NICE guidelines recommending birth at home with a midwife, or in a midwife-unit for first-time mothers. (And again when seeing the ripple headlines here and here and here.)

"The UK gets it right," we posted on The Big Push for Midwives Campaign Facebook page. But, positive as this development may be, it is clear it will take far more than British sanity about birth for US policymakers or the US maternity care system to likewise "get it right" or even to "get it."

As one commenter quickly noted, opponents will quickly hog-tie the new UK policy to British midwifery education, or the integration of home and hospital in that country ... the usual rhetorical smoke-and-mirror tricks used to deflect attention from the fact that US home birth midwives, CPMs, are experts in out-of-hospital care, the gold standard, educated specifically to excel as providers of home and other out-of-hospital maternity care. The casual reader, who does not yet know those facts about CPMs, will then fail to realize that the NICE recommendations hold true also for American women who, like their British sisters, are female mammals (smoke and mirrors be damned).

The good news is that The New York Times journalists saw instantly the real basis for the differences in care between the US and the UK. Read it here. Notice, in the 11th paragraph, right after the obligatory recitation of ACOG's standard rote objection to home birth ("we do not believe" home birth is safe), the article points out:

"If such a recommendation were made in the United States, doctors might worry about losing patients to midwives."

There it is, folks, in a nutshell, laid right out in the open.

The New York Times gets it, it understands that ACOG's opposition to home birth isn't really about safety, or education, or models or care, or liking CNMs better. It is all about competition, losing patients to another type of provider, about money. '

The article continues: "That concern is absent in Britain's taxpayer-funded system. There are no financial incentives in the U.K. for doctors to deliver in a particular setting (that is, hospitals) because there is no personal gain."

Shazam. It is thrilling to read that in (news) print! Yes, the percentage of home births in the US is relatively low, but for heaven's sake, it increased by 29% from 1990 to 2009, and it has continued to rise in an upward trajectory. Consumer choice is a powerful thing.

'ACOG and the hospitals can read these reports too, and they understand the implications for their bottom lines. When MacDorman, Mathews, and Declercq write, in their 2014 Data Brief on 2012 place-of-birth data exactly what those implications are: "If this increase continues, it has the potential to affect facility usage, clinician training, as well as resource allocation," the OBs and hospitals know what is being written on the wall – and we do too.

Add to that the intriguing responses regarding future birth sites provided by the representative sample of women who had given birth in a hospital in 2012-2013 and who responded to Childbirth Connection's 2013 Listening to Mothers III: New Mothers Speak Out Surveys and Reports. Asked how open she might be to a future birth at home, an amazing 11% indicated that they would definitely want to give birth at home, while another 18% said they would consider a home birth. Likewise, 25% of survey participants would definitely want to use a freestanding birth center! Another 39% said they would consider a birth center.

This is huge, friends.

At the present time, the statistics gathered and published by Childbirth Connection reveal that, in 2012, 23% of all hospitalizations were for childbirth and newborn care, and that maternity care is the "single most common" cause for hospitalization in the US.

So, if one owned a hospital, or if one medically managed all of one's patient deliveries at a hospital, how would one feel about handing off 10% or 25% of those families to midwives and birth centers? And not in some distant 20-years-from-now future, but as soon as those Mothers stop speaking out long enough to get pregnant again? Well, if present-day monopolies are any indicator, one would fight tooth and nail to maintain one's market share of the $111 billion one billed for maternity care facility charges alone in 2010.

"First they ignore you, then they laugh at you, then they fight you, then you win."  

~Mahatma Ghandi

Many birth activists understand that the out-of-hospital birth movement in the US is in the next-to-last stage of this lifecycle. "They" are fighting against sanity, reality, and consumer choice. Hard. And when their junk science isn't sticking, they are trotting out the bigwigs at ACNM and ACOG shouting that CPMs need more education in more structured institutions, because those bigwigs have a very long history of taking away existing traditional educational paths and intentionally closing off and slowing down production of their competition (King Bigwig himself Abraham Flexner did it exceedingly well in 1914).

Sadly, it gets even worse when "they" sense the ship isn't sailing solely in their $111 billion direction. Bigwigs like those of Delaware ACOG come out from the bowels of the boat with last-ditch, cut-throat tactics to snatch away legislative victory from mothers and families fighting for increased access to CPMs and more out-of-hospital birth options. And when they slink back below deck, Lady Justice rightly asks why do "they" do it? Are "they" truly concerned for patient safety, or only about throwing all the midwife competitors overboard (or nearly as bad, down into the physician-oversight slave galleys)?

As the Listening to Mothers III: New Mothers Speak Out and the latest CDC Data Brief tell the story, The Big Push for Midwives Campaign (and the whole PushNation) is getting the message across. Women are hearing the true facts, and informing and educating themselves. They are beginning to make new choices.

Dearest birth activists, amazing Pushers, and Salty Dogs, we are all seaworthy!

Don't give up the fight now and don't reach uncomfortable compromises.

Do not even be discouraged, all hands on deck!

We are in the fighting stage to turn this battleship around, and the data point toward the absolute bearing of our winning.

Shannon Earle holds her new baby Kiera Breen Earle, moments after she was born at their home. (Amanda Steen / NPR)

PushNews from The Big Push for Midwives Campaign

CONTACT: Katherine Prown, (414) 550-8025, [email protected]
FOR IMMEDIATE RELEASE: January 26, 2012

CDC Finds Continued Increase in Home Births - Report Highlights Disparities in Access for Women of Color

WASHINGTON, D.C. (January 26, 2012)—A report released by the CDC today found a 29 percent increase in home births from 2004 to 2009. The rate of home births among non-Hispanic white women underwent a dramatic increase, while the rate for women of color decreased or remained stagnant, a trend that reflects racial and ethnic disparities in other areas of maternity care throughout the U.S.

"Unfortunately, the women who could most benefit from out-of-hospital midwifery care are those who are least likely to have access to Certified Professional Midwives with the specialized training needed to provide it," said Susan Jenkins, Legal Counsel for The Big Push for Midwives Campaign. "The CDC report and other research shows that babies born to women cared for by Certified Professional Midwives are far less likely to be preterm or low birth weight, two of the primary contributing factors not only to infant mortality, but to racial and ethnic disparities in birth outcomes."

Barriers to out-of-hospital maternity care include laws in 23 states, the District of Columbia, and Puerto Rico that prohibit Certified Professional Midwives from practicing, as well as laws or policies in all but 11 of the remaining states that deny Medicaid coverage for home births managed by Certified Professional Midwives.

"As we work to address disparities by increasing the cultural proficiency of midwives practicing in out-of-hospital settings and diversifying the midwifery work force, we also need to change laws nationwide so that all women have access to out-of-hospital maternity care with Certified Professional Midwives," said Jenkins. The Big Push for Midwives Campaign represents tens of thousands of grassroots advocates in the U.S. who support expanding access to Certified Professional Midwives and out-of-hospital maternity care. The mission of The Big Push for Midwives is to educate state and national policymakers and the general public about the reduced costs and improved outcomes associated with out-of-hospital maternity care and to advocate for expanding access to the services of Certified Professional Midwives, who are specially trained to provide it.

Media inquiries: Katherine Prown (414) 550-8025, [email protected]
CDC report: http://www.cdc.gov/nchs/data/databriefs/db84.pdf
NPR All Things Considered story  |  Jan 26, 2012

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