I was taking a break from studying last night, i went in search of information on insurance coverage of doulas (short answer: no, insurance carriers generally don't cover doula services for mothers) and ran into an interesting aside.
Warning, this is a rant that deals with women and birth from the perspective of a doula and midwife in training who happens to also be the mother of home-birthed twins. it's not for the squeamish or closed-minded.
It's a chain reaction-type deal, and so terribly transparent. It started with a documentary that came out recently called The Business of Being Born which deals with the differences in care between homebirth (with midwives) and hospital's so-called "managed birth" system. It follows the birth experiences of several different women, including the film's creator Ricki Lake (I know, I know, I felt awkward too.. but after watching the film objectively, as one would with a documentary by someone other than a ex-talk show host.. it was actually very, very well put together, and you could tell that above all else it was her passion to educate others that made the film, not promoting herself or her past. She actually got respect points for that in my book). In my experience, I found that the film fairly portrayed both sides, however, the AMA and ACOG didn't like what they saw.
So after this film came out, the AMA and ACOG jointly worked to pass a resolution (referenced here, for one), tending towards legislation, to outlaw homebirths altogether. If that's not a case of sour grapes, I don't know what is. It's not as if the homebirth movement eats into their profits as it is. In fact, only about 1% of all births in the US are homebirths, and a fraction of those are planned. That means that 99% of all women in the US who give birth in any given year do it in a hospital or birth center setting. As one of the 1%, I'm pretty entertained at the thought of how they assume to enforce this at all. Helicopter and zip-line down to the mother's house when she's in labor? Routine traffic stops to make sure there's no unauthorized birthing in cars? OH NOES! TEH WOMB POLICE! PUT THE BABY UNDER YOUR SHIRT! All for the fear of losing that 6k-12k$ per birth that they already don't get, or at least having to answer questions they usually sweep under the rug that mothers already should be demanding honest answers to, and when they do they get scorned or the "you're not qualified, STFU" head pat.
On a more serious note, the AMA and ACOG are not only overstepping their bounds in terms of privacy, but also in the face of proven statistical evidence from more progressive countries than our own (I daresay, more scientific in this respect), which happens to be nearly ALL other developed countries, regarding the safety of homebirth, the efficacy of midwives, and the general well-being of mother and child. We have one of the highest infant mortality rates in the world, we also happen to have a rising and very worrisome and unacceptable cesarean rate (last i heard, 30%, which is up from the time some of my books were printed (2001, 2004) that stated 21-25% respectively), which tends to vary more by hospital and doctor than by region or whether the mother is actually high-risk. This is in the US, while international studies show that around 70% of all expectant mothers are fully capable and are at no risk (in fact, there may be definitive benefits) when birthing at home.
Add to this that a few insurance carriers (yes, this is how it all ties in) are beginning to deny coverage to women who have had cesarean-section births citing it as a pre-existing condition (link) and you find yourself in a world of hurt as a mom. VBAC (vaginal birth after c-section) is not uncommon, but many women find themselves under the knife yet again after the first c-section, and c-sections aren't cheap... although they are something like the second most popular operation in the states.
OMG LOL WTF IS GOING ON?
Well, for starters, the political climate is just about right for this kind of dirty work. Hell, our illustrious leader, in his capacity to make sure "OBGYNS can practice their love with women" has already moved to make birth control (except barrier methods like the condom) be considered an abortfacent, and conception defined essentially as sex itself..thus making many women immediately "murderers" when their bodies naturally expel fertilized but unsuitable ovum (which is a high percentage of the time)...so why the hell not?
It's an old battle, the midwives vs. the OBGYNs. Fingers are pointed, reactionary messages, the sheer amount of negative information an expectant mother is hit with on a daily basis (doubly so if she chooses a homebirth, lemme tell you) about the process of birth is overwhelming. Popular belief seems to be that expectant mothers are only qualified to open their legs to get the baby in or out, nothing in between. You can't blame popular belief, though.. not at this point. We've been entirely conditioned to think that at home will invariably lead to a dead baby: sensationalist news stories of women birthing in their living rooms as some kind of miracle (I used to contact the news sources that put those stories out every time they did to let them know what a detriment to expectant mothers they truly were.. sadly, I lost the patience after a while), movies of women birthing in places other than a hospital where the baby or mother (or both) die (on an aside: I can only point out one movie recently put out that spins it the other way. Jersey Girl. The mother births in a hospital as planned and then has a spontaneous aneurysm).. Then you've got your doctor playing the fear card on you when you ask questions about procedures; not satisfied with doing it at every prenatal visit, they'll go so far as to do it to you in labor when emotions are already high. Works of fiction and magazine stories along the lines of "if I didn't X then they told me my baby would die.. this person who knows someone who was married to someone who was a distant cousin of this other person didn't do X, and their baby died." Over-emphasis on the pain of labor, the pain of birth, not a single reference to ways to alleviate it without medication other than Bradley or Lamaze (which is not right for all mothers, but you never know for sure until you are in labor).. Is it any wonder people are in the dark about birth? An expectant mother's 9 months have enough potential dead babies in them that you would need more than just a pitchfork to move them. That's not to say hospitals don't have their place, but at the same time they appear to be over-reaching on their own benefits.
The biggest moaning I heard as a pregnant woman was "people gave birth like that in the 1800's, and their babies/the mothers died. You're a fool for putting your/your child's life on the line like this, you're endangering your child!"
I could never say to those people that what they were telling me was fear-mongering, disrespectful (after all, isn't a pregnant woman the property of everyone else but her?) and cruel. I could never find enough abstracts or data to sate their opinions.. After a while I gave up on them and determined to shut them up by action, not word...
But let me introduce you to a man named Semmelweis...and a tale of two clinics.
There were once two clinics in Vienna who worked side-by-side to deliver the children of the local poor populace (back when birthing in a hospital was a luxury most women couldn't afford), one was run by midwives and the other by doctors. One had lower-than-average cases of childbed fever and infant death and the other had an average amount of cases for the time. This was 1847, a time our media and obstetric-run histories never fail to remind us is when every baby born was most likely a dead baby... The midwife-run clinic was the one with the lower incidence of childbed fever and infant mortality (shock and awe!), and many of the impoverished mothers begged to be let in the midwife's clinic..failing that, they ran out of the delivery rooms, jumped out of the windows or birthed in the streets if they found themselves among the unlucky in the doctor-run clinic.
Semmelweis was a Hungarian doctor who worked with both of these clinics and after significant comparison of the two found a deceptively simple way to reduce both childbed fever and infant mortality in the doctor-run clinic to the level of success in the midwife's clinic: the doctors should wash their hands. Doctors in the second clinic tended to move back and forth from cadaver work to catching a birth throughout the day, while in the first clinic (midwives, remember.. the unwashed and uneducated, merely tolerated, women "helping" with the women's work, weren't they so cute?) there was no cadaver work. Semmelweis theorized that "cadaverous particles" were making the mother and child ill and increased their chances of death.
Semmelweis: "WASH. YER. GODDAMN. HANDS. WASHEM! WASHYERGODDAMNHANDS!"
So you'd think that someone with a breakthrough like this would have been lauded as a hero and savior of women among his peers... it never happened in his lifetime. He was shunned, ridiculed and kicked out of practice. Doctors then believed they were "gentlemen" and thus cleaner than the average person, their hands looked clean enough, clearly this Semmelweis fellow is a quack.
Semmelweis himself spent the rest of his life devoted to his findings and cause, even going so far as to call the Viennese medical board murderers for not accepting his findings. This only hurt his cause, however, and his former peers had him locked up in an asylum in 1865 where he died some 2 weeks later after complications from being beaten by caretakers... the complication? Puerperal fever, also known as...childbed fever.
It was 20 years after his death that Pasteur formed his germ theory, following that Semmelweis was given the post-mortem title of "Savior of Mothers"...and thus the wheel of irony turns 'round.
The reason I bring this up is that not only is it indicative of the kind of fraternity medical boards keep, but it's also another case of disbelieving evidence to maintain the status quo...one that appears to still be pretty common, at least here in the states. In the back of my mind 1885 is not too long ago, and medicine is arrogant to think that they can't fall into that kind of trap again. Meanwhile, people suffer because of this arrogance. Mothers continue to be put in positions that compromise their physical ability and self-esteem, all in the pursuit of that golden mechanized birth.
I think one thing that the american medical system has yet to recognize is that people are still very much mammals, and that pregnancy and birth are not (and will never be) medical conditions. One is not infected with baby, and the current american OBGYN thinking on the matter goes against humanity-as-mammal itself. The more they intervene, the more problems they cause, and the more they scratch their heads and wonder why. It's a sad time, indeed, when most healthcare professionals.. who have never even seen a birth without intervention.. think it is their place to scorn and ridicule those who desire one and those who not only witnessed one, but partook in it as well.
Choice for women, give it or GTFO.