Monday, July 21, 2008

The AMA on home births

The American Medical Association has issued a statement against home births (original Word doc converted to HTML by Google). To me this provides further evidence that, at the very least, the AMA does not have the best interests of the general public at heart.

One concern is their apparent disregard for quality of life issues. Their focus is narrow, defining success as survival of mother and child:

"An apparently uncomplicated pregnancy or delivery can quickly become very complicated in the setting of maternal hemorrhage, shoulder dystocia, eclampsia or other obstetric emergencies, necessitating the need for rigorous standards, appropriate oversight of obstetric providers, and the availability of emergency care, for the health of both the mother and the baby during a delivery..."

It is safer to never go on a boat. It is safer to avoid travel. It is safer to never drink more than a couple bottles of beer. Safety is not a goal to be achieved to the exclusion of all else. Of course we want the mother and child to survive, but in many cases medical interventions do nothing to improve survival rates.

Hospital births are unpleasant. The medical staff wants to get a live baby out. It matters little to them whether the mother has a 3 month recovery or a 4-week recovery. They don't care if you go home exhausted and stressed out. Many OBs seem to see their patients as unruly children who must be told what to do. They often seek control and predictability where a less predictable and more organic birth would be better for everyone involved.

Pitocin, epidurals, Caesarean sections, and other interventions all have legitimate and justified applications in some pregnancies. Like much of American health care, however, pregnancy and birth suffer from an excess of medical intervention. OBs certainly have their reasons. Our society is litigious. The financial incentives are perverse, rewarding the amount of work regardless of appropriateness. The staff doesn't have to suffer through a recovery made excessively difficult by unnecessary interventions. That their behavior is understandable doesn't mean it's in the best interests of all families.

Medicine is, ideally, an empirical discipline. However, the AMA cites no medical studies in support of their statement. That makes sense, because those research studies don't exist. There are studies suggesting that home births are not worse in terms of mortality, while being superior in reducing medical interventions. I am not the AMA, so I can't say what their motives are. However, the AMA is a powerful lobby with many characteristics of a guild. It seems reasonable that their motivation is to maintain control of a significant health area. That preserves their prestige as well as their livelihoods. Their efforts have the effect of reducing competition. That is so obvious a consequence that it cannot be accidental. Perhaps I am too cynical, and they make these efforts only with reluctance. Regardless, they consider the costs acceptable, which is suspect because they bear few costs and yield only benefits.

The final and most egregious part of this statement comes at the end:

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...

They want to use the law to restrict individual freedom and force their methods on everyone. Their methods are often what's best. It's not often enough. The best data we have are clear, and the AMA offers little in rebuttal. Rather than prove the superiority of their care, and rely on individuals to make the right decision, they would rather use their prestige and political power to try to eliminate alternatives. That frees them of the burden of demonstrating their superiority, as well as eliminating much of the incentive to improve what is clearly not good enough.

This, among other issues, has led me to conclude that part of the dysfunction of the American medical system can be blamed on the AMA and similar organizations. They can be truly excellent in a number of areas, but they seem to believe that their expertise is broader than it is. Everyone make mistakes, even with the best of intentions. However, the AMA is a political entity as well, and those politics have tainted what they do. We have excessive respect for doctors in our society, and that reverence is hurting us all.

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Blogger John Paul said...

Do any doctors still make house calls for home delivery, or is that only the domain of midwives in Austin? What about elsewhere? Is the insurance too hight?

July 21, 2008 at 11:35 AM  
Blogger Ketan said...

I don't know for fact, but I would be very, very surprised if any doctors did that anywhere in this country.

July 22, 2008 at 11:38 AM  

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