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Parsing the politicization of childbirth

23 July 2008 by Mike Gogulski
Posted in economics, people | 4 Comments »

The American College of Obstetricians and Gynecologists, with the backing of the American Medical Association, loves mothers. They love babies, too. Of course, everyone loves babies, right?

In the spirit of doing only the best things possible for mothers and babies, ACOG and the AMA are now pushing to eliminate a terrible danger to babies and mothers alike: home birth.

Eamon greets the world, at home. Image from chrisandjenni @ flickr.com

Eamon greets the world, at home. Image from chrisandjenni @ flickr.com

Now, babies have been born at home, or in fields or forests or any number of other places for millions of years. I even had the pleasure recently of meeting a young woman who was born on a train in Russia. The distinction between “hospital, medical” birth and anything else is a rather modern invention. Just a hundred years ago in the West, and even today across huge portions of the planet, children were always born at home. Birthing carries risks for both mother and child, and sometimes medical intervention is needed to save lives. In many parts of the world, the expertise and facilities aren’t always there.

From ABC News:

Are Home Births Dangerous?

AMA Says Women Should Use a Hospital — Some Doctors Disagree

The American Medical Association has agreed to support proposed legislation that, some physicians say, could make make having a planned birth in one’s home difficult, to virtually impossible.

As of now, no actual legislation has been drawn up, but the AMA has agreed to back a measure called “Resolution 205,” a request to support the American College of Obstetricians and Gynecologists’ (ACOG) position that home births are not safe.

“We are against home births, period,” said Gregory Phillips, an ACOG spokesman.

What does Resolution 205 say?

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)

Jennifer Block, writing for the LA Times, rightly questions what’s going on here:

The AMA’s statement calls for legislation that could be used against women who choose home birth, possibly resulting in criminal child-abuse or neglect charges. The group says this is about safety, but with no credible research to back up its claim, this argument falls flat. Women are simply caught in a turf war over the maternity market, and it would appear that the physicians’ groups are perfectly willing to trample the modern medical ethic of patient autonomy — grounded in our legal rights to self-determination, to liberty and to privacy — in their grab for control.

Block’s op-ed makes a lot of good points, and asks a very cogent question: “Why do U.S. doctors strong-arm women into our standard maternity care system?”

ACOG, the AMA and other organizations like them are, effectively guilds in the medieval sense. Guild membership or approval is required to practice the guildsmen’s trade, manifest in all sort of licensing and education requirements that these groups have managed to write into law with the “objective” criteria for inclusion or exclusion of any given would-be practitioner being left up to those who have already passed whatever arbitrary bar for inclusion they have set, and backed up by the unlimited violence that is the state. That organizations such as these serve to limit the supply of medical services and thereby increase costs to patients while enriching their members has been analyzed in great detail elsewhere.

Born free, born at home. Everett with mom. lobo235 @ flickr.com

Born free, born at home. Everett with mom. lobo235 @ flickr.com

Quibbling a bit about how the mechanics of guild exclusionism get written into US law, I doubt that mothers would be penalized for choosing to give birth at home. No, what AMA and ACOG are really after here is the criminalization of midwives, and especially those who aren’t members of the various AMA-approved midwifery guilds or who haven’t passed stringent certification requirements. The guilds don’t give a damn about unlicensed midwives’ patients. What they care about is limiting the supply of childbirth-assistance services, to the benefit of their members’ profits.

ABC’s headline, “Are Home Births Dangerous?”, really might be better written as “What Penalty Should Home-Birthing Mothers and Midwives Face?” AMA/ACOG are calling for legislation. There will be fines and disincentives, penalties and prison terms, police raids and prosecutions, all against midwives practicing a skilled trade that has existed for thousands of years.

But the penalty for violating statist law is always death. Deconstructed, what we see is the physicians’ and obstetricians’ guilds calling for non-guild midwives to be killed for practicing their trade.

Now how is that good for mothers or babies?

  1. 4 Responses to “Parsing the politicization of childbirth”

  2. By Jenni on 23 July 2008

    Yes I find all this very frightening, in light of the four, soon to be five, homebirths that we have experienced. They have all be very wonderful, amazingly peaceful experiences. And every time we have all been well watched after and safe. I have many friends who have their babies at home, non of which who’ve lost their babies or been at risk of losing their babies. The midwives are well trained and they know when to send someone to the hospital. Thanks for this post, it’s definitely a topic that is outraging and frightening to say the least. One wonders what birth will look like 10-15 years from know. Thanks for using our photo in your post.

  3. By Peter Kovar on 26 July 2008

    see? this is great, the language of liberty camp gave you a hat tip on your blog post. that’s one more reason to come again :) interesting article, by the way

  4. By Kelly on 28 July 2008

    Well said- we had a hospital birth for our first daughter and it amazed me how much the hospital wanted to control every aspect. From trying to micro manage the natural, unpredictable flow of birth to “mandating” that our daughter be injected with poisonous vaccines and such. We managed to escape most of it, but our next birth will be at home and that is an option I will never give up. Readers should check out Jennifer Block’s book entitled Pushed. She presents teh whole picture on birth in America.

  5. By Pedro Cevallos on 13 October 2008

    I wish my son could have been born at home but my wife had placentia previa. If she did not have a planned C-section in a hospital, the baby would have suffocated and my wife would have bled to death. I agree with the home birth movement — it just was not an option for us.


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