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Women’s Reproductive Rights Under Threat in Colombia

10:32 am in Uncategorized by RH Reality Check

Written by Hanna Hindstrom for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Cross-posted with permission from The Women’s News Network (WNN).

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At 11 years of age, Nina was raped by her stepfather. Traumatized and pregnant, she sought an abortion. But every doctor she met claimed conscientious objection and refused. She was forced to travel 35 miles to another city, where she eventually tracked down an obstetrician willing to help.

She was one of the lucky ones.

Despite a landmark ruling five years ago – when Colombia’s Constitutional Court decriminalized abortion in cases of rape, fetal abnormality or to save the mother’s life – less than 0.5 percent of procedures are carried out legally each year. Many doctors simply turn girls like Nina away.

There is endemic confusion about the status of the law, especially the rules for conscientious objection, coupled with a widespread reluctance to obey it. Unsafe abortion remains the third leading cause of maternal deaths in a country where, according to government figures, over 300,000 take place each year.

Upon its inception the law has been the target of an aggressive anti-choice campaign, led by conservative political forces and supported by the Catholic Church. These forces are now threatening to unravel the little progress made.

Since coming into office in 2009, the Procurador-General, Alejandro Ordonez – the official appointed to protect the constitution and promote human rights – has led a vociferous campaign to dismantle the legislation. Read the rest of this entry →

International Human Rights Court Says Governments Must Ensure Timely Access to Maternal Health Services

9:22 am in Uncategorized by RH Reality Check

Written by Editor-in-Chief Jodi Jacobson for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

In 2002, Alyne da Silva Pimentel, a 28-year-old Afro-Brazilian woman, died after being denied basic medical care to address complications in her pregnancy. Her death might be like any one of the other hundreds of thousands of women who die of complications of pregnancy or unsafe abortion each year worldwide, but for one thing: It was taken to court.

Maternal mortality in Brazil is high, especially for a country of its relative wealth and level of development. It is even higher among women who, like Alyne, are of Afro-descent, indigenous, and/or low-income. Alyne died of complications resulting from pregnancy after her local health center mis-diagnosed her symptoms and delayed the emergency care she needed to live.

On November 30, 2007, the Center for Reproductive Rights, with Brazilian partner Advocaci, filed Alyne da Silva Pimentel v. Brazil, brought the first ever maternal mortality case before the UN’s Committee on the Elimination of Discrimination Against Women (CEDAW). The Center’s petition argued that Brazil’s government violated Alyne’s rights to life, health, and legal redress, all of which are guaranteed both by Brazil’s constitution and international human rights treaties, including CEDAW. 

“Alyne’s story epitomizes Brazil’s violation of women’s human rights and failure to prevent women from dying of causes that, by the government’s own admission, are avoidable,” said Lilian Sepúlveda, the Center’s Legal Adviser for Latin America and the Caribbean. “We filed this case to demand that Brazil make the necessary reforms to its public health system—and save thousands of women’s lives.”

In its brief, the Center asked the Committee to require Brazil to compensate Alyne da Silva Pimentel’s surviving family, including her 9-year-old daughter, and make the reduction of maternal mortality a high priority, including by training providers, establishing and enforcing protocols, and improving care in vulnerable communities.

This week, the case was decided in a historic decision by CEDAW, establishing that governments have a human rights obligation to guarantee that all women in their countries—regardless of income or racial background—have access to timely, non-discriminatory, and appropriate maternal health services.

“Sadly,” said a statement from CRR, “Alyne’s story is one of thousands in Brazil, and all around the world, in which women are denied, and in some cases refused, basic quality medical care to address common pregnancy complications. And the countless lives lost unnecessarily as a result mean that today’s victory can only be regarded as bittersweet.”

Nonetheless, continued the statement, “today marks the beginning of a new era. Governments can no longer disregard the fundamental rights of women like Alyne without strict accountability. And while nothing can reverse Alyne’s fate, today’s decision means that Alyne’s mother and daughter will finally see justice served—and women worldwide will benefit from the ruling issued in her name.”

State Legislative Trends in 2010: Abortion Restrictions Once Again Dominate

8:49 am in Uncategorized by RH Reality Check

Written by Rachel Gold and Elizabeth Nash for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

Even as state legislators were largely preoccupied by ongoing budget crises in 2010, issues related to reproductive health and rights nonetheless garnered significant legislative attention. More than 950 such measures were introduced in the District of Columbia and the 44 states in which the legislatures convened.

By year’s end, 89 new laws had been enacted in 32 states and DC. (This is an increase from the 77 laws enacted in 2009 and the 33 statutes enacted in 2008.) As always, abortion received the lion’s share of the legislative attention, accounting for 39 of the 89 new laws. While the new abortion laws are overwhelmingly restrictive, the reinstatement of public funding for abortion in DC (permitted by federal law for the first time in almost three decades) is a notable exception.

States were also able to take some significant steps to promote reproductive health in other areas, however, by mandating that sex education be comprehensive and medically accurate; requiring coverage of contraception in health insurance plans; and allowing a health care provider to prescribe treatment for a patient’s partner for STIs.

Abortion

Over the course of the year, 15 states enacted 39 laws related to abortion. The most high-profile abortion-related debate in 2010 came as the result of the passage of the federal health care reform legislation in March, the peak of the state legislative year. By year’s end, legislators in 14 states had introduced measures relating to insurance coverage of abortion in the exchanges that will be established as a result of health care reform; new laws were enacted in five states and vetoed in Florida and Oklahoma.

Laws enacted in Arizona, Mississippi and Missouri limit abortion coverage to extremely rare cases, such as life endangerment, severe health impairment, rape or incest; the laws enacted in Louisiana and Tennessee prohibit coverage of abortion altogether (see Restricting Insurance Coverage of Abortion). The Missouri law, which prohibits abortion coverage except in cases of life endangerment, applies to all insurance policies written in the state, whether or not they are offered through an exchange; four other states have similar blanket restrictions. Arizona, meanwhile, moved to restrict the insurance coverage for abortion offered to state employees to cases where the woman’s life is endangered or her health threatened, bringing to 12 the number of states limiting coverage for public employees.

In a groundbreaking move, Nebraska used largely scientifically suspect claims about the ability of a fetus to feel pain to justify legislation banning abortion after 20 weeks’ gestation, except in cases of life endangerment or when necessary to “avert substantial and irreversible impairment of a major bodily function.” Although the law conflicts with several Supreme Court rulings that abortion must be permitted until viability (which generally occurs between 24 and 26 weeks’ gestation), the measure has not been challenged and is in effect. Moreover, the law is serving as a model for legislative action in other states. Including Nebraska, 38 states restrict later-term abortions (see Policies on Later-Term Abortion).

In another attempt to ban abortion, antichoice activists in Colorado put an initiative on the ballot that would have defined a fetus, for purposes of Colorado law, as a “human being from the moment of conception.” The measure was soundly rejected by voters in November; it had met the same fate in 2008. Taking different approaches to the same goal of banning at least some abortions, Oklahoma moved to ban abortions for purposes of sex selection  and Utah enacted a measure that makes self-inducing an abortion illegal.

In August, the District of Columbia resumed funding abortion services for low-income women. The ability of the District to use its own locally raised revenues had been restricted by Congress since the early 1980s; this prohibition was lifted beginning with fiscal year 2010. The DC policy change brings to 18 the number of jurisdictions that fund abortion services (see State Funding of Abortion Under Medicaid). A measure enacted by Arizona limits funding to cases of life endangerment, rape or incest; the state, however, remains under a court order to fund all or most medically necessary abortions, although it does not appear that eligible procedures are actually being funded.

Three of the 24 states that require a woman seeking an abortion to receive counseling designed to deter her from having the procedure moved to tighten their existing mandates (see Counseling and Waiting Periods for Abortion). A law adopted in Nebraska would have required abortion counselors to inform women that they are at high risk of adverse consequences resulting from an abortion because of their physical, psychological, demographic or situational circumstances; the measure was immediately challenged and never went into effect. Missouri expanded its counseling law to require abortion counseling materials to state that abortion terminates the “life of a separate, unique, living human being;” it also requires that a woman seeking an abortion after 21 weeks’ gestation be told that a fetus can feel pain beginning at 22 weeks’ gestation. Finally, South Carolina expanded the required waiting period between the counseling session and the abortion procedure from one hour to 24 hours.

Six states with existing abortion counseling requirements either instituted or expanded provisions related to ultrasound. Oklahoma brought back a provision that was enacted in 2008, but voided by state court on purely procedural grounds. The law requires that a woman seeking an abortion undergo an ultrasound, receive a verbal description of the image and be shown the monitor; the law does, however, permit her to “avert her eyes” while the image is displayed. The measure, which is stricter than that in effect in any other state, was immediately challenged and enforcement is enjoined. Louisiana, which already required that a woman seeking an abortion undergo an ultrasound, expanded its mandate to require that the woman be given the option to view the image and hear a verbal description. (A separate provision of the Louisiana law that would have required that the woman be given a hard copy of the ultrasound image was struck down in court.) Including the new Louisiana law, five states have ultrasound mandates in effect (see Requirements for Ultrasound). Stopping short of actual mandates, Utah and West Virginia adopted measures requiring women to be given the option to view an ultrasound image if the procedure is performed; Missouri and South Carolina require that women be offered the option to have an ultrasound performed prior to an abortion.

A handful of states took actions related to minors seeking an abortion. In the most high-profile move, voters in Alaska approved a ballot initiative requiring parental notification for a minor seeking an abortion; this brings to 36 the number of states requiring parental involvement (see Parental Involvement in Minors’ Abortions). Two states enacted measures requiring detailed reporting related to a minor’s abortion. New laws in Arizona and Oklahoma require abortion providers to give the state information on the number of minors requesting a judicial bypass and the number of petitions approved by the courts; this brings to 11 the number of states with reporting requirements specific to minors. Both of these states also expanded their overall abortion reporting requirements to include, among other topics, the woman’s reason for obtaining an abortion. Gov. Mark Parkinson (D) vetoed a similar measure in Kansas (see Abortion Reporting Requirements).

Virginia joined Montana and Pennsylvania in authorizing the sale of prochoice license plates; funding generated by the sale of the “Trust Women/Respect Choice” plates will be used to support family planning services in the state. At the other end of the spectrum, Delaware became the 23rd state to authorize the sale of “Choose Life” license plates (see ‘Choose Life’ License Plates). Louisiana, which has offered the license plates for many years, increased the purchase price; the proceeds are earmarked for support of alternatives-to-abortion services. Kansas, Missouri and Pennsylvania also continued state funding for these alternative services.

Three states enacted laws related to abortion facilities. Tennessee and Oklahoma approved measures that require facilities where abortions are performed to post a notice stating that women cannot be coerced into having an abortion and informing them that they can contact a law enforcement agency if they feel that they have been the victim of coercion. Louisiana, meanwhile, authorized the closure of any abortion provider found to be in violation of federal or state law, a stricter standard than under previous law, which had permitted closure only for a “substantial” failure to comply with legal mandates.

Two states adopted other measures related to abortion providers. Louisiana enacted a measure that denies abortion providers who perform “elective” abortions after viability the protections of medical malpractice law, even though state law permits abortions after viability when the woman’s life or health is endangered (see Policies on Later-Term Abortions). The Oklahoma legislature, meanwhile, overrode the governor’s veto to enact a measure that protects health care providers who withhold information from women who might otherwise choose abortion. In a separate measure, Oklahoma also moved to limit the provision of medication abortion only to physicians.

Sex Education

Measures relating to sex education were introduced in 27 state legislatures in 2010, but only one was enacted. Read more

Advocates Push ACOG to Remove Barriers to VBACs

7:05 am in Uncategorized by RH Reality Check

Written by Amie Newman for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

Birth activists including providers have waged a long fight against barriers to VBACs (Vaginal Birth After Cesarean). For too long, they say, women who have had a prior c-sections and would like to attempt a vaginal birth for subsequent pregnancies, have had inadequate access to at least attempting a trial-of-labor. The reasons for the lack of access? Well, it depends upon who you ask.

Ask many hospital adminstrators and ob-gyns and they’d say there’s a risk of uterine rupture (which is true), and that recommended hospital policy, via organizations like the American College of Obstetricians and Gyneocologists (ACOG), has made allowing for women’s access to VBACs extremely challenging. Many hospitals have enacted bans on VBACs. State legislators have even jumped into the fold, attempting to ban VBACs in birth centers and elsewhere.

On the other hand, the recently held National Institue of Health consensus conference on VBACs, led by a panel of maternity care experts concluded that,

“…a trial of labor is a reasonable option for many women with a prior cesarean delivery. They [the panel] also urged that current VBAC guidelines be revisited, malpractice concerns be addressed, and additional research undertaken to better understand the medical and non-medical factors that influence decision making for women with previous cesarean deliveries.”

As well, the panel chair, Dr. F. Gary Cunningham, chair of obstetrics and gynecology at the University of Texas Southwester Medical Center said, of the findings, “The use or employment of VBAC is certainly a safe alternative for the majority of women who have had one prior c-section.”

Then, this summer, ACOG responded. Read more

Does Health Care Reform Do Anything for Midwifery?

6:56 am in Uncategorized by RH Reality Check

Written by Eileen Ehudin Beard for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

This post is one in a series of pieces RH Reality Check is publishing to highlight National Midwifery Week 2010 (Oct 3- 9).

Most midwives would agree that The Patient Protection and Affordable Care Act has several concrete benefits for the midwifery profession. The act establishes reimbursement for certified nurse-midwives (CNMs) at 100 percent of the Medicare Part B fee schedule, which means that as of January 1, CNMs will be reimbursed at the same rate as physicians. The law also recognizes freestanding birth centers under Medicaid, which allows birth centers to receive reimbursement for their facility fees.

But since these parts of the legislation have not yet gone into effect and do not affect all midwives, does health reform really mean anything for the thousands of US midwives and their patients?

The answer is yes! To the prospective midwifery student, I can now say that more money will be available for graduate nursing education and that there will be more help with loan repayment for midwives who practice in maternity care shortage areas. When I am asked how reform legislation has affected midwifery practice thus far, I can say it has brought the evidence forward as we move towards some major changes and improvement in care for women and infants.  . . . Read the rest of this entry →

ACOG Says Yes to VBACs

7:18 am in Uncategorized by RH Reality Check

Written by Amie Newman for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

Good news from the American College of Obstetricians and Gynecologists (ACOG), on VBACs (Vaginal Birth After Cesearean). New guidelines were released by the organization yesterday marking a significant change in their recommendations regarding VBACs:

"Attempting a vaginal birth after cesarean (VBAC) is a safe and appropriate choice for most women who have had a prior cesarean delivery, including for some women who have had two previous cesareans," note the guidelines released today by the American College of Obstetricians and Gynecologists.

VBACs have been treated controversially over the years by hospitals and organizations like ACOG, with guidelines and hospital policies designed to bar women from choosing a "trial of labor" for a birth, even after they’ve had one or more prior c-sections. The thought process behind these bans seemed to be most often connected to the fear, by hospital administrators and doctors, of uterine rupture and other complications. Unfortunately, the fear is more perception and suggestion than rooted in fact. The risk of uterine rupture, according to ACOG themselves, is extremely low, occurring in one-half of one percent of all cases (though serious, requiring emergency surgery). It is unquestionably a serious risk to take into consideration when planning for the type of birth one wants to have – but it has been "over-emphasized" by ACOG, according to Lamaze, International, making it more difficult for women to authentically assess the risks vs. complications of a VBAC. Cesarean sections are major surgery though and come with risk and potential complications as well. In addition, the c-section rate in the United States has climbed to dangerous levels, according to the World Health Organization, with one out of every three women birthing via cesarean section.

Just last year Joy Szabo of Page, Arizona was told she’d essentially be forced into have a c-section because her local hospital refused to allow VBACs. She decided, instead, to drive the 350 miles into Phoenix to a hospital that "allowed" her to birth vaginally.

In fact, the hospital in Page, AZ adopted their guidelines banning VBACs because of the way administrators interpreted the original ACOG guidelines suggesting hospitals have a surgeon and anesthesiologist on call during a VBAC. The Page hospital understood these guidelines to mean they needed coverage of both a surgeon and anesthesiologist at the hospital "24/7" as well as two physicians present at any VBAC. Unfortunately, other hospitals followed suit after ACOG released their original guidelines (which did recommend the "immediate availability" of surgical and anesthesia personnel before allowing a trial of labor for a woman who has had a previous c-section) and VBACs became less and less available over the years.

Birth activists and birth-bloggers who advocates for increased access to VBACs shared their thoughts on the updated guidelines calling them a "breath of fresh air" but also "long overdue."

ICAN, the International Cesarean Awareness Network, issued its own press release yesterday stating:

“VBAC bans place women in the untenable situation of being forced to undergo unnecessary major surgery if they are unable to find a VBAC supportive alternative. This is a first step in
returning to women an appropriate respect for patient autonomy.”

ACOG acknowledged that these guidelines imposed an undue onus on hospitals:

"Given the onerous medical liability climate for ob-gyns, interpretation of The College’s earlier guidelines led many hospitals to refuse allowing VBACs altogether," said Dr. Waldman. "Our primary goal is to promote the safest environment for labor and delivery, not to restrict women’s access to VBAC."

ACOG likely took into consideration the recent NIH Consensus Development Conference on VBACs in March of this year, from which a statement was developed by a panel of medical experts on the safety of VBACs. The statement included an agreement that VBACs are a "reasonable option" and "safe alternative" for women who have had a prior c-section.

In fact, the chair of the panel of NIH Consensus Conference experts, Dr. F. Gary Cunningham, chair of obstetrics and gynecology at the University of Texas Southwestern Medical Center, noted in reference to the panels’ findings on the safety of VBACs:

"The VBAC rate has gone from 30% to 10% over the last fifteen years… [which] would seem to indicate that planned repeat cesarean delivery is preferable to a trial of labor. But the currently available evidence suggests a very different picture: a trial of labor is worth considering and may be preferable for many women…The use or employment of VBAC is certainly a safe alternative for the majority of women who have had one prior c-section."

ACOG clearly took note and focused squarely on the rising cesarean section rate in the United States as a key element of their decision to update their guidelines:

"The current cesarean rate is undeniably high and absolutely concerns us as ob-gyns," said Richard N. Waldman, MD, president of The College. "These VBAC guidelines emphasize the need for thorough counseling of benefits and risks, shared patient-doctor decision making, and the importance of patient autonomy. Moving forward, we need to work collaboratively with our patients and our colleagues, hospitals, and insurers to swing the pendulum back to fewer cesareans and a more reasonable VBAC rate."

But The Feminist Breeder, a birth activist and blogger, gave credit where she feels credit is due:

And I don’t think they get the credit here.  I think we do. That’s right – you and me.  So thank you to the the women like Joy Szabo, and Jill from Unnecesarean.  To the women like Desirre Andrews, and Jennifer Block.  To Nicette Jukelevics and Jen from VBACFacts.com.  To the women of ICAN, and the midwives who risk prosecution to attend a home birth after cesarean where the state doesn’t support it.  To all the women who Tweeted, and Facebooked, and Blogged this issue until government health experts couldn’t help but take notice.

We did this.  We made this change happen because we spoke up and insisted on being treated better. But the work is not done yet. Now, we must take this statement to our providers and hospitals and challenge those VBAC “Bans.”  Send the statement to your sisters, coworkers, and friends who may be considering a VBAC.  Write about it, talk about it, and keep spreading the message until VBAC is no longer a four letter word.

These updated guidelines encourage physicians to discuss VBAC "early in the prenatal period" to develop a plan. The group also strongly recommends that hospitals put in place policies that ensure any and all personnel needed for an emergency c-section can be gathered quickly. Unfortunately, it’s this language that still "troubles" Lamaze, International. While the organization was pleased to see updated guidelines, they did take issue with some of the language and what they perceive to be an over-emphasis on the extremely low risk of uterine rupture:

The revised guidelines acknowledge that requiring “immediately available” resources for an emergency cesarean have resulted in hospitals, insurers and the obstetric community issuing formal or informal bans of VBAC, effectively denying women access to care and choice in birth.  While this was not the intention, the “immediately available” language remains in the new guidelines, which may continue to unfairly limit women’s access to VBAC.

Additionally, the guidelines continue to emphasize risks of uterine rupture, a rare, but potentially dangerous complication, for women who choose a VBAC.  Unfortunately, this does not help women contextualize the benefits and risks of VBAC versus elective repeat cesarean delivery (ERCD). 

Women still experience high rates of particular medical interventions which not are always necessary, when birthing at hospitals in this country – from electronic fetal monitoring to labor-inducing drugs – and therefore, even with a trial of labor allowed, it’s important that pregnant women understand how best to reduce their chances for an unnecessary c-section.

Once a Cesarean, Rarely A Choice

6:33 am in Uncategorized by RH Reality Check

Written by Gina Crosley-Corcoran for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

Gina agreed to write from the NIH VBAC conference for RH Reality Check as an advocate, a writer and a valued voice in birth activism. For more coverage of the conference, please visit Gina’s coverage on her site The Feminist Breeder!

This week the National Institutes of Health held a consensus conference on the topic of Vaginal Birth After Cesarean (VBAC.)  The purpose of this conference is to present and explore the current available information about the risks and benefits of both a vaginal delivery, and a repeat cesarean delivery, whereby the panel may ultimately present a consensus statement on the safety, efficacy, and availability of VBAC.

With the current national cesarean rate of 31.8 percent, a VBAC rate of only 7.8 percent, and nearly 40 percent of US hospitals banning vaginal birth after cesarean, many women are finding they have no choice but to undergo major abdominal surgeries for the delivery of their children. However, many women, alongside providers and educators, have stood in opposition to this forced surgery as a fundamental violation of the mother’s right to choose what happens to her body and her baby.  When the NIH announced the VBAC conference, many activists, mothers, and providers, felt this was an opportunity to beseech the researchers to look at the information available and see how this lack of choice has been harming mothers, their families, and even their providers.  In a show of solidarity, birth activists from all over the world came to witness the conference, ask questions, and share their stories about the ways that forced cesareans have affected their lives or their practice.

Much to the surprise and delight of the concerned activists, the resonating tone throughout the NIH VBAC conference was that of: maternal choice, patient autonomy, and informed consent or refusal.  While in recent years the relatively small risks associated with VBAC labor have driven providers to restrict access to VBAC, the NIH speakers presented clear evidence that there are serious risks associated with repeat cesarean delivery as well.  Dr. Howard Minkoff even pointed to the 2002 Smith study showing the risk to the baby in a VBAC labor is about the same as any other full term, normal vaginal delivery.   Consistently, the speakers stated that VBAC is a reasonable option, elective repeat cesarean is not a risk-free delivery, and that ultimately, it is the mother’s choice which of those risks to accept.  None of this is new information to anyone interested in maternal and fetal health, but these revelations in this type of forum validate the feelings of the many mothers and activists who have spent years pleading for supported access to VBAC.

Though most of the conference speakers focused on the statistical medical data on vaginal or cesarean birth, one speaker illustrated the more personal side of the story.  USA Today reporter Rita Rubin, brought the audience on an emotional journey as she presented stories of families across the country who have picketed, battled, or even birthed unassisted in the name of preventing an unwanted and unnecessary cesarean.  Throughout the conference, speakers and audience members made the NIH panel aware that many mothers demand access to vaginal birth, and that the VBAC issue will remain a contentious topic until hospitals and providers start respecting, and honoring, the mother’s right to choose.

Unfortunately, the language about informed consent and patient autonomy did not make it into the final NIH consensus statement, and when panelists were pressed on the issue, they failed to recognize that pregnant women have the same right to choose their course of care as any non-pregnant person. Says Susan Jenkins, legal counsel for The Big Push For Midwives, "the panel refused to take a position on whether a pregnant woman has the same constitutional right to informed refusal as any other adult in the U.S. This is unconscionable and I wonder what this administration’s take is on an HHS panel questioning whether pregnant women are entitled to the full benefits of U.S. citizenship in regard to patient autonomy."

Time will only tell if the NIH consensus will have a positive impact on VBAC access in this country.  From a birth activist’s point of view, the statements made during the conference were a huge leap in the right direction. However, our cesarean and VBAC rates will not be reversed overnight, and in the interim, scores of women are left without a choice but to either fight the system for their VBAC, or submit to a surgical birth.  To these women and their families, this is really no choice at all.

Home Births Rise in U.S. And It’s Not Because of Ricki Lake

6:40 am in Uncategorized by RH Reality Check

Written by Amie Newman for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

For women who choose to go through pregnancy and childbirth, the freedom to choose where and with whom to birth is not always immediately accessible. Before childbirth in hospitals became the norm, women birthed at home, under the care of a midwife. It wasn’t until the 1950s that childbirth care shifted significantly from midwives and homebirth to physicians and hospital birth. However, birth for healthy mothers and their babies does not necessarily have to be medicalized.  And because it was becoming increasingly clear that birth was drifting, quickly, from the hearts and hands of women to the more medicalized, economic model put forth by hospitals, women’s health advocates interested in natural birth created a movement.

There is nothing inherently wrong with hospital birthing, of course (written from the heart of a mother who birthed two beautiful children in a hospital birthing center). It is the focus on economics, while having lost our sense of what birth is all about by straying far away from trusting women and women’s bodies, that is the "wrong." We now have a cesarean section rate in this country of 30 percent – one out of every three births in this country is via c-section -  that dangerously exceeds the World Health Organization’s recommended rate of 5 to 10 percent of all births. With a cesarean rate of over 15 percent, the WHO says, we’re in the realm of doing "more harm than good."

We are not providing women with the optimal enivornments for birthing, or giving women the chance to choose where they wish to birth and with whom. There are of course many reasons for this, not the least of which is access. Women who have no health insurance are not in a position to "choose." Pregnant women who live in a small town with one hospital that forces c-sections upon women who have had a previous c-section are not in a position to "choose." Women who live in a state where midwifery, essentially homebirth, is illegal are not in a position to "choose."

This cannot be what our mothers want or what we want for our mothers.

Things are looking up. According to a new report by the Centers for Disease Control (CDC) released this week, more women in the United States are opting to birth at home or out-of-hospital, when they are able, mostly out of a desire for a low-intervention birth or because of cultural or religious reasons, and sometimes because of lack of transportation.  

The report also identifies reduced costs associated with out-of-hospital maternity care as a factor in the increased demand. 

Over the last five years, out-of-hospital births (which includes home birth and birthing at a free-standing birth center) rose 3 percent and home births rose 5 percent after having sharply declined between 1940 and 1969 and then remaining static over the last few decades.

Approximately 17 percent of these home births recorded were unplanned – either because of transportation issues for women who live in rural areas or emergency scenarios.

The report acknowledges that home births were "less likely than hospital births to be preterm, low birthweight, or multiple deliveries."

Out-of-hospital birth and home birth has been treated with more than a raised eyebrow by the media as well as some professional medical associations (specifically the American Medical Association (AMA) and American Congress of Obstetricians and Gynecologists (ACOG)) over the last few years.

The AMA passed a resolution in opposition to home birth stating that hospital births are the safest route for mothers and babies.

In a poorly reported segment on The Today Show a few months ago home birth was treated as a perilous fad spurred on by celebrities who birth at home with hordes of pregnant women clamoring to "do what Ricki Lake did."

However, the report makes a point to note that in contrast to the AMA and ACOG, the organizations that represent physicians who facilitate birth in hospitals, "the World Health Organization, the American College of Nurse Midwives, and the American Public Health Association all support home and out-of-hospital birth options for low-risk women."

As for midwives who attend home births and birth center births around the country?

The Big Push for Midwives Campaign Manager, Katie Prown, says, “Those of us who have been advocating for increased access to Certified Professional Midwives and out-of-hospital maternity care have long known that the research shows that AMA and ACOG statements about the safety of home birth and the reasons why women choose out-of-hospital delivery have no basis in the evidence,“ said Prown. “It’s great to be able to cite even more research on the safety of out-of-hospital birth and to be able to point to data showing that women in the United States do not, in fact, make decisions about where to have their babies for frivolous, selfish, or trendy reasons.”