HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

Thursday, June 19, 2008

AMA - Home Births Resolution

The AMA passed a resolution to introduce legislation to regulate home births.  Women's Health News provides some background on the resolution and states,

 The AMA did recommend for adoption an amended resolution (205) on home birth, as follows:

“That our AMA support state legislation that helps ensure safe deliveries and healthy babies by acknowledging 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.”

Aren’t they just saying that certain types of trained professionals should be the only ones to attend home births?

Not exactly. There were also two resolutions on the table (204 & 239) that were combined and adopted as amended. They stated that the AMA should “support state legislation regarding appropriate physician and regulatory oversight of midwifery practice, under the jurisdiction of either state nursing and/or medical boards.” . .

The resolution also asks that the “American Medical Association only advocate in legislative and regulatory arenas for the for the licensing of midwives who are certified by the American College of Nurse-Midwives.”  In other words, the AMA is formalizing in the form of a resolution the notion that CNMs and CMs recognized by the ACNM should be the only legally practicing midwives, and that “lay” midwives (there is a lot of term confusion here, but CPMs, direct-entry, that type of thing) who are not regulated by a nursing/medical board (because they are not doctors or nurses by training/certification) should not be allowed to be licensed to practice under state regulations. . . .

In effect, encouraging states to explicitly make non-ACNM-certified midwives illegal would probably reduce the pool of available homebirth providers in a given state considerably, even though this particular resolution doesn’t specifically address home births. . . .

Midwives and some lay health care providers groups are quite concerned by the resolution as seen in this article at RH Reality Check.  Amie Newman writes,   


In an unmistakably insecure and aggressive move, the American Medical Association (AMA) adopted a resolution at its annual meeting last weekend to introduce legislation outlawing home birth - according to The Big Push for Midwives. . . .

"It's unclear what penalties the AMA will seek to impose on women who choose to give birth at home, either for religious, cultural or financial reasons-or just because they didn't make it to the hospital in time," said Susan Jenkins, Legal Counsel for The Big Push for Midwives 2008 campaign. "What we do know, however, is that any state that enacts such a law will immediately find itself in court, since a law dictating where a woman must give birth would be a clear violation of fundamental rights to privacy and other freedoms currently protected by the U.S. Constitution." . . . .

What the AMA's resolution and these other kinds of potential and actual legislation do is to open the door to penalizing motherhood, in effect. Because most of these legislative attempts do not directly address the issue, they leave the door dangerously open to criminalizing women for making the decisions they feel are best for themselves, their fetuses and their families.

Proposing this kind of legislation would also force women to birth in government-approved settings, a scenario that seems almost unbelievable. According to the Big Push for MIdwives:

Until the AMA proposed ‘Resolution 205 on Home Deliveries,' no state had considered legislation forcing women to deliver their babies in the hospital or limiting the choice of birth setting. Instead, states have regulated the types of midwives that may legally provide care. Currently, 22 states already license and regulate CPMs, who specialize in out-of-hospital maternity care and have received extensive training to qualify as experts in the types of risk assessment and preventive care necessary for safe and high-quality care for women who choose give birth at home. Certified Nurse Midwives (CNMs), who are trained primarily as hospital-based providers, are licensed in all 50 states and the District of Columbia.

The resolution did not offer any science-based information for the AMA's anti-midwife or anti-home birth position.  Steff Hedenkamp, Communications Coordinator for The Big Push for Midwives says, "Maternity care is a multi-billion dollar industry in the United States. So it's no surprise to see the AMA join the American College of Obstetricians and Gynecologists in its ongoing fight to corner the market and ensure that the only midwives able to practice legally are hospital-based midwives forced to practice under physician control. I will say, though, that I'm shocked to learn that the AMA is taking this turf battle to the next level by setting the stage for outlawing home birth itself-a direct attack on those families who choose home birth, who could be subject to criminal prosecution if the AMA has its way." . . . .

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