The federal Centers for Medicare and Medicaid Services (CMS) released on April 9 the Medicare billing information for physician providers after decades of litigation by the American Medical Association (AMA) seeking to block the release. [http://www.reuters.com/article/2014/04/09/us-usa-medicare-data-idUSBREA3809H20140409] Some of the dollar figures for federal moneys paid to individual physicians have been shocking, but those of us who have studied the economics of maternity care should not be surprised. It is basic economics that markets in which consumer access to information is blocked, and also where real competition has been suppressed, will be characterized by high prices.
The Big Push for Midwives Campaign supports the release of provider billing information because it benefits women and their families. Consumers should have access to information that could affect decisions about their healthcare, including the choice of provider and the cost of a provider's services. An informed public is better equipped to exercise not only health care choices, but also political speech, especially now that private health plans are required to provide maternity coverage. This kind of data educates both citizens and policymakers about the direct and indirect costs related to healthcare and allows better informed decision making.
Why did the AMA fight to suppress this information for so long? The assumption that consumers are ignorant and need to be protected from information goes back to early American court cases from the 1700s. Back then even physicians did not understand what diseases were and how they spread. Most people could not read and had very limited education. Even if they could read, the information was stuck in books in far-off universities. This remained true even during much of the last century.
Today, most people can read and have access medical and health care information on the internet. They could have had access to this cost-related information if the AMA had not impeded access. Women and their families should have access to whatever information they need that could affect their health care decisions, including relative costs, so they can make intelligent decisions based on the evidence.
The heart of midwifery is educating women and their families so that they make informed decisions instead of keeping them ignorant and dependent on providers. Releasing information like this is a good first step. We need to make this information user-friendly and to educate both citizens and policymakers to compare many factors – costs, outcomes, consumer satisfaction – so they can understand and use the information effectively. Consumers need this information for health care decision, and policy makers should be looking at and comparing what the federal government pays for physician services versus the services of other health professionals, such as midwives.
For those playing along at home, as soon as The Big Push for Midwives announced the "Largest US Study to Date Finds Home Birth to Be a Safe Option for Most Women" based on newly released research (here and here), Big Medicine played a card from its dark deck.
Goliath reached up its sleeve to flip the Ace of Scaremongering at millions of mothers, families, and babies across the US, in its desperate attempt to try to shut/shout down the truth, citing numbers that are neither published nor peer reviewed, and based on birth certificate data.
The good news is that the truth about the safety of out-of-hospital birth as published in the Journal of Midwifery & Women's Health is still available even if Goliath is teetering from the stone that hit his exposed forehead.
While it is beyond pathetic to see the turf war that Big Medicine continues is waging, it is sadly not surprising. Goliath doesn't seem to care that:
- Rural, uninsured, and underinsured women need more maternity care options.
- States need to remove barriers that deny mothers, families, and babies access to high-quality, safe, and cost-effective midwifery care.
- The US needs to get it in gear to significantly reduce rates of prematurity and low-birth weigh that are critical to reducing racial and economic disparities in birth outcomes, and reducing unnecessary costs to our health care system.
- The US has one of the highest rates of both infant and maternal death among industrialized countries, and frankly, the US maternity care system is broken. Maternal and fetal mortality rates are worse than 40 other countries worldwide, and we spend more money than anyone else on maternity care. Where is almost all that care being delivered? The answer Goliath doesn't want you to see through his 30%-c-section-tinted glasses is HOSPITALS.
Big Medicine is NOT doing so great at birth in America, and Big Medicine's problem with out-of-hospital birth is not that it isn't safe. Rather, it's that it is a safe option for most women and thus presents a threat to the Big Medicine status quo and the trade associations and state medical societies who control it. Goliath is deeply dependent on maintaining the status quo … so dependent that Big Medicine will sometimes tell bald-faced lies about out-of-hospital birth research on national television and in other media outlets and hope that no one notices. Here are some other sensible voices on the matter:
- Here's an impressive statement from the American College of Nurse Midwives (ACNM)
- Here's a piece where Missy Cheyney refutes these new scaremongering numbers.
- Here's an item that points out more on the flaws in birth certificate data.
- Here's the response of the Reddit community to a recent diatribe from Big Medicine's biggest shill.
- Here's a commentary by sociologist Barbara Katz Rothman on "Home Birth In a Risk Society."
- Here's a Facebook post by Rebecca Dekker, PhD, RN, APRN of EvidenceBasedBirth.com.
- Here's a Throwback Thursday treat by Wendy Gordon, CPM, LM, MPH, MANA Division of Research, Assistant Professor, Bastyr University Dept of Midwifery in Science & Sensibility.
- Here's another Throwback Thursday treat by Miriam Pérez of radicaldoula.com published in RH Reality Check.
Here at The Big Push for Midwives, we are ALL IN to knocking Goliath down. The powerful and strong are not always what they seem. David had only a stone and a slingshot to bring down the greatest warrior of his time. The Big Push has only the truth, courage, faith, and the amazing grassroots uprising of the PushStates who fight the good fight every day from where they are with what they have. To see more on these dueling studies, visit the PushHeadlines page today.
Submit your question to the Big Push.
QUESTION #4: Home birth legislation seems to be a true non-partisan issue, with Republicans politicians showing support from the right, as well as feminists from the left. Has this been the experience of the Big Push? Is there any instance from state to state that the Big Push knows of where pro-midwife legislation has been split legislators along party lines?
ANSWER: In every state the support for CPM legislation has been roughly 50/50 between Republicans and Democrats—in fact, another comment we frequently hear is how unusual our list of co-sponsors is and how they've never seen certain far right and far left legislators on the same bill together. And that is one of our primary strengths as a movement, that supporting access to out-of-hospital maternity care and midwives who are specially trained to provide it is naturally bipartisan.
In fact, the only people who oppose expanding maternity care options and choices are the special interest groups with a financial stake in maintaining and the legislators who are beholden to them.
What's inspiring about our movement, though, is that we're such a refreshing example of how politics is supposed to work. Many of the legislators we try to recruit have been "bought" by medical industry money, but if enough of their constituents speak up, votes often trump special interest money. And we're able to mobilize a significant number of voters in every state, not only via outreach to legislators and staff, but also through the campaign work we do in support of our friends and, sometimes, against our opponents. Midwifery supporters in a number of states have played a significant role in influencing the outcome of state legislative races—in Wisconsin, we even mobilized the Amish to turn out and vote.
Submit your question to the Big Push.
QUESTION #3: What type of opposition have you encountered during your work for the Big Push? Can you note a prominent incident or situation?
ANSWER: In virtually every state we generate fierce opposition from professional associations, such as ACOG and state medical societies, with a vested financial interest in maintaining what amounts to a near monopoly on the provision of maternity care in the U.S. Opponent groups, of course, deny that their objections to legislation authorizing Certified Professional Midwives to practice has anything to do with money or turf because out-of-hospital birth represents such a small corner of the maternity care market.
But what they aren’t saying is that out-of-hospital maternity care is a market that is poised for growth and has, in fact, been growing at a noticeable pace since the economic downturn began. As more families are losing their health insurance and as more women are finding the high-cost of maternity care riders and deductibles to be beyond their means, more women are seeking out alternatives to hospital-based maternity care. And this is another reason why our media outreach efforts have been so successful—more women are learning that about those alternatives.
Certified Professional Midwives all over the country are reporting unprecedented demand for their services, and a North Carolina study recently found a 50 percent increase in the demand over the course of one year alone. No single incident stands out, but we have noticed an interesting pattern in many states. Early on in the process, the legislators who support us expect to have an easy road ahead of them and often think we're exaggerating when we tell them how strong the opposition to our bill is going to be, since they consider our issue to be a pretty small one, a no-brainer that will sail right through both houses in no time.
But once they see the unusual procedural roadblocks that typically get thrown our way, the unorthodox committee assignments used to try to kill our bills, and the extreme level of "dirty" politicking that we typically have to overcome, the comment we hear over and over is, "Wow—I have never seen that happen before in all my years in the statehouse." We can’t tell you how many times we’ve heard comments to that effect from legislators who are shocked by how opponent groups will stop at nothing to kill CPM legislation, often employing desperate and heavy-handed tactics.
Submit your question to the Big Push.
QUESTION #1: The American Medical Association (AMA) (along with other doctor trade organizations) has taken a stance diametrically opposed to home birth and Certified Professional Midwives (CPMs). Activist midwives and consumers who are involved in statewide legislative efforts across the US have cited the AMA's stance as a main motivator in their activism: they want to get legislation passed before the anti home birth lobby can. To what degree is the Big Push for Midwives a reaction to the stance of the AMA and other doctor's groups at the state and national levels?
ANSWER: When it comes to Resolutions the AMA passes in opposition to home birth, these are adopted in response to the growing success of the grassroots movement in support of expanding access to Certified Professional Midwives and out-of-hospital maternity care. Since midwifery activists began organizing across states in 2005—an effort that culminated in the launch of the Big Push for Midwives Campaign in 2007—UT, VA, WI, MO, ME, ID, and IN passed laws authorizing legal practice for Certified Professional Midwives, while bills that had been effectively dead for many years in states such as IL, NC, MA, AL, SD, and AL suddenly began to make significant progress.
Once such item, Resolution 205, was brought to the AMA on behalf of the American College of Obstetricians and Gynecologists (ACOG), which had issued alerts to its members about the Big Push’s legislative successes and the need to increase the resources dedicated to fighting CPM legislation (these alerts are titled "ACOG 2007 Midwifery Year In Review" and "ACOG 2008 Midwifery Year In Review").
So clearly they are concerned about the progress we’ve been making and they've made defeating our bills their second most urgent state legislative priority, ahead of issues such as medical liability reform, access to contraception, and reducing perinatal HIV.
Another such item, Resolution 814, sought to limit the scope of practice for allied health care providers, though it predates the Big Push and doesn't specifically mention Certified Professional Midwives (which physician groups love to try to malign by using the oxymoron, "lay midwives"), it was brought to the table by the Texas Association of Anesthesiologists, which had fought quite forcefully, though unsuccessfully, to repeal their state law authorizing CPMs to practice. (If you're interested in learning more about that battle, we can put you in touch with the lobbyist who helped the Texas midwives defeat the TAA, but it’s a safe bet that it was one of the primary catalysts for Resolution 814.)
At its November 2005 Interim Meeting, the American Medical Association (AMA) House of Delegates adopted Resolution 814 titled, “Limited Licensure Health Care Provider Training and Certification Standards.” The resolution states:
RESOLVED, That our AMA, through the Scope of Practice Partnership, immediately embark on a campaign to identify and have elected or appointed to state medical boards physicians (MDs or DOs) who are committed to asserting and exercising their full authority to regulate the practice of medicine by all persons within a state notwithstanding efforts by boards of nursing or other entities that seek to unilaterally redefine their scope of practice into areas that are true medical practice. (Directive to Take Action)
Resolution 814 emerged from the Scope of Practice Partnership (SOPP), which was formed by the leadership of the AMA and other physician trade organizations to obstruct expansion and to restrict the licensed scope of practice of other healthcare professionals. These actions by organized medicine limit access to providers who have the education, expertise and experience to offer safe, quality health care services to the public, particularly for rural, uninsured and other underserved populations.
The Big Push for Midwives Campaign objects to the misleading and divisive language used in the AMA SOPP resolution, which needlessly pits medical doctors against other healthcare professionals at a time when the American public is faced with unprecedented healthcare shortages and millions of uninsured children and adults. The healthcare professionals that have been targeted by SOPP, which include nurse practitioners, physician assistants, podiatrists, optometrists, psychologists, chiropractors, and midwives, are the solution to this crisis, not the problem. The erroneous claim that SOPP can or should determine what is best for the patients of other healthcare professionals represents an outdated and patronizing line of thinking that cannot possibly serve the needs of today's patients—particularly childbearing women and their babies. Therefore, The Big Push for Midwives opposes SOPP and its efforts to restrict the scope of practice of our allied healthcare partners and to obstruct legislative initiatives that would increase access to licensed Certified Professional Midwives.
Father Knows Best Meets Big Brother Is Watching:
"The SOPP also is overseeing the completion of the AMA Scope of Practice Data Series, a compendium of information and resources for medical associations on 10 non-physician providers, and the creation of a geographic mapping tool that will allow Federation partners the ability to map, on a state-by-state basis and by specialty, the practice location of not only allopathic and osteopathic physicians but also various non-physician providers."
"From the President" by Ronald M. Davis, MD http://elephantcircle.net/?p=429
Following this AMA directive, several state medical boards have targeted more than a dozen midwives in states where CPM licensure is not yet available, leaving hundreds of pregnant women without care.
PushNews from The Big Push for Midwives Campaign
CONTACT: Katherine Prown, (414) 550-8025, email@example.com
FOR IMMEDIATE RELEASE: August 15, 2011
Study: Two-Thirds of OB-GYN Clinical Guidelines Have No Basis in Science
Majority of ACOG Recommendations for Patient Care Found to Be Based on Opinion and Inconsistent Evidence
WASHINGTON, D.C. (August 15, 2011)—A study published this month in Obstetrics & Gynecology, the journal of the American College of Obstetricians and Gynecologists, found that barely one-third of the organization’s clinical guidelines for OB/GYN practice meet the Level A standard of "good and consistent scientific evidence." The authors of the study found instead that the majority of ACOG recommendations for patient care rank at Levels B and C, based on research that relies on "limited or inconsistent evidence" and on "expert opinion," both of which are known to be inadequate predictors of safety or efficacy.
"The fact that so few of the guidelines that govern routine OB/GYN care in this country are supported by solid scientific evidence—and worse, are far more likely to be based on anecdote and opinion—is a sobering reminder that our maternity care system is in urgent need of reform," said Katherine Prown, PhD, Campaign Manager of The Big Push for Midwives. "As the authors of the study remind us, guidelines are only as good as the evidence that supports them."
ACOG Practice Bulletin No. 22 on the management of fetal macrosomia—infants weighing roughly 8 ½ lbs or more at birth—illustrates the possible risks to mothers and babies of relying on unscientific clinical guidelines. The only Level A evidence-based recommendation on the delivery of large-sized babies the Bulletin makes is to caution providers that the methods for detection are imprecise and unreliable. Yet at the same time, the Bulletin makes a Level C opinion-based recommendation that, despite the lack of a reliable diagnosis, women with "suspected" large babies should be offered potentially unnecessary cesarean sections as a precaution, putting mothers at risk of surgical complications and babies at risk of being born too early.
"It’s no wonder that the cesarean rate is going through the roof and women are seeking alternatives to hospital-based OB/GYN care in unprecedented numbers," said Susan M. Jenkins, Legal Counsel of The Big Push for Midwives. "ACOG’s very own recommendations give its members permission to follow opinion-based practice guidelines that have far more to do with avoiding litigation than with adhering to scientific, evidence-based principles about what’s best for mothers and babies."
The Big Push for Midwives Campaign represents tens of thousands of grassroots advocates in the United States 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, firstname.lastname@example.org
(FULL STUDY is available in PDF format on this page)
The Big Push for Midwives Campaign is pushing hard to ensure that Certified Professional Midwives are legally authorized to practice in all 50 states, D.C., Puerto Rico, and Guam.
And we're proud to push hard, since our opponents, ACOG and OBGYN PAC, are working so fiercely together, raising and spending money big hand over closed fist on ads, telemarketing calls, and direct contributions to legislators' campaign chests, all to protect the specific interests of its member OB/GYNs.
In 2010, ACOG's PAC raised nearly $900K and spent more than $680K of it (a 10-fold increase over what they raised for their honeypot just 8 years ago), and it's interesting to consider ACOG boasts that its PAC can raise as much as $30,000 in a single month and that hundreds of OBs from across the country donate to the PAC at the President's Club level of $5,000 each.
No wonder then that they achieved a 60% increase in the number of physicians elected to Congress in 2010, and no surprise that these OB-legislators have hit Capitol Hill pre-programmed with the messages put forth by recently-stepped-down ACOG President Richard N. Waldman, MD, whose focus for the 112th Congress was on "keeping our specialty safe from those would transform it," in other words, from those who advocate for access to midwives and out-of-hospital maternity care.
Heck, if you can't beat the high-quality, low-cost competition that Certified Professional Midwives bring to the maternity-care marketplace, just make your focus the absolute elimination of these nationally certified providers of out-of-hospital maternity care. (For those of you watching gobsmacked from home, you may not realize that working behind the scene, ACOG's lobbyists have already systematically stripped CPMs out of various Health Care bills – with nary an objection from the other maternity-care groups around the table that ACOG has already pushed down into submission.)
Give Hope to Mothers and Families
Please make a recurring monthly donation of $10 dollars to the Big Push for Midwives Campaign for the U.S. States and Territories that are pushing together for a nation of CPM birth options.
Goliath is well-financed, and the Big Push for Midwives Campaign needs your support this month and every month so that we may continue to provide vital "labor" support (in the form of legal counsel, media and general advocacy support, education and outreach) to the courageous mothers and families who sacrifice so much in order to push the CPM birth options movement ahead.
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