“The Perils of Journalism:” Ricki and Abby’s Response to the Today Show

We were aware that the Today Show was producing this segment for several months now, but we were shocked at the heading: “The Perils of Midwifery.” A historical section of our film The Business of Being Born documents the public smear campaign physicians groups launched against midwives in the early 1900’s from which the midwifery profession never fully recovered. It is so disheartening to see these old tactics at work again, especially at a time when our country is in the midst of healthcare reform which could finally give all women access to midwifery care in hospitals and increased options for birth center and home births. It’s getting harder to ignore the systematic assaults on women’s birth options that ACOG (American College of Obstetricians and Gynecologists) has been orchestrating since The Business of Being Born premiered two years ago.

ACOG’s first public response to BOBB came in June 2008, when they introduced a resolution to the American Medical Association (AMA) at their annual meeting which commits the AMA to "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." The second paragraph of the resolution read: “Whereas, There has been much attention in the media by celebrities having home deliveries, with recent Today Show headings such as “Ricki Lake takes on baby birthing industry: Actress and former talk show host shares her at-home delivery in new film.” The resolution did not offer any science-based information for the AMA's anti-midwife or anti-home birth position and after public backlash, ACOG wisely eliminated the specific reference to Ricki. (Read our initial response co-written with Jennifer Block: http://www.huffingtonpost.com/ricki-lake-jennifer-block-and-abby-ep... )

A few weeks ago, ACOG made a public plea asking its members to submit anecdotal, anonymous data about patients who planned out-of-hospital deliveries on their website. According to the request, which was originally linked from ACOG’s home page, they are “concerned” about the “problem” of growing numbers of women seeking out-of-hospital maternity care. Once again, this request was taken off the homepage and after public backlash and made accessible only by pass codes.

You may be wondering why women seeking expanded birthing options would be a “problem” for ACOG? “Just follow the money,” says Steff Hedenkamp of The Big Push for Midwives Campaign. “ACOG does not want to continue losing patients to Certified Professional Midwives and out-of-hospital birth, so they’re telling members to send in more of the same old tall tales that far too many OBs love to scare women with.” Analysts expect the group to use the anecdotal data collected from members to support its ongoing state and federal lobbying campaigns aimed at denying women access to out-of-hospital maternity care and Certified Professional Midwives.

Now of course we understand that ACOG is a trade organization representing the financial interests of its members but it’s still a wonder that with the United State’s unacceptably high infant mortality rate, skyrocketing c-section and premature birth rates and disappearance of options like VBAC, the physicians would waste so much money and energy waging a media campaign against out-of-hospital birth? As if home births, birth centers and midwives are the real “perils” out there. What about the perils of having no access to prenatal care? It’s also a wonder that the press doesn't expose the safety record of hospitals. But then again, most parents who have bad outcomes in hospitals are silenced by gap clauses with cases settled out of court. The fact that homebirth midwives demand transparency certainly conveys a more honorable stance towards letting the public evaluate the safety profile.

The Today Show should hold themselves to higher journalistic standards than playing up the tragedy of a stillborn baby born at home without explaining that this same phenomenon happens all the time in hospitals. Although our hearts go out to any couple who loses a child, it’s a shame to see a personal tragedy exploited to serve a political agenda. Yes, complications can arise at any birth and as we showed in the final climatic scenes of BOBB, it is essential that homebirth midwives work in collaboration with physicians and hospitals to ensure a safe outcome for their clients. But the Today Show failed to say that the midwife in question has an excellent safety record. They also chose not to mention the most recent study out from the Canadian Medical Association, which supports the safety of home birth for low-risk women. http://www.cmaj.ca/

On a positive note we’d like to point out that in contrast to the official position of ACOG, many of its members are not opposed to out-of-hospital birth and are embarrassed by the tactics ACOG is using to scare women into hospital births. Recently, we spoke off the record with the Chief of Obstetrics at a major New York Hospital about ACOG’s actions. This OB/GYN felt the public solicitations for anecdotes on ACOG’s website was a “huge mistake.” This OB/GYN, who attended a screening of BOBB at Weill Cornell Medical College last year, toured us through Labor & Delivery proudly sharing that he had banned the use of Cytotec, which he called a “toxic drug.” He said he has also placed strict limits on the use of Pitocin, which “drove everyone crazy” but had the direct effect of lowering the hospital’s c-section rate and drastically reducing the number of babies in the NICU. He recognizes the need for more evidence-based protocols in maternity care and was delighted to share his success with us. Like many physicians, he feels the solution is to make the hospital experience as “home-like” as possible. Apparently, he feels this is a more productive use of physician’s time and energy than trying to scare women out of home birth. Amen.

Tags: Homebirth, Lake, Midwives, Ricki, Show, Today

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thanks for the suggestions Lydia - we'll try to catch his show and see if he's interested!
abby
I've also been considering contacting journalist, Lisa Ling. In her words...

"I want to raise consciousness about issues and stories that don't always make the headlines. I believe that global awareness makes a person smarter and ultimately more human. I'm grossed out by what some "news" outlets masquerade as news. It seems that so many of these outlets cover international stories only when there's catastrophe or war. It's a shame."

She's covered women's issues before, and I remember a specific remark she made during an Oprah episode. The story was on women in India who are paid to be surrogates for American couples, and because the Indian woman was impregnated with an embryo from very tall, Caucasian man and his wife, Lisa and Oprah joked that the Indian woman shoud automatically request a C-section (because obviously, this baby was going to be too big for this little, Indian woman to birth vaginally).

I was actually kinda shocked at Lisa's ignorance and thought Lisa would want to know the truth behind many of births long, upheld myths.

Just sharing aloud here...
Thank you for writing about this! I've written a post on the Today's Show embarrassing excuse for a report. I have tremendous faith that the movement is growing and we will be able to continue to expand safe childbirth options for women around the country with sites like this one and as many voices as possible speaking out!

What's So Scary About Home Birth?

Thanks,
Amie
Thank you for keeping an open dialogue on such important issues. I am a mother of four, with a fifth baby due in six weeks. After three hospital births, my fourth baby was born at home with two well-qualified midwives (both CPM) in attendance. I am planning a homebirth again with the same midwife group. However, I do not consider myself a “Homebirth Advocate”, but rather an advocate for women and babies. As much as I appreciate the midwifery standard of care for myself, I fear it sometimes goes too far in it’s assertions and alienates many women, causing them to feel guilty because they didn’t have the perfect birth or ended up with a c-section. On the flip side, conventional obstetric care has become a one-size-fits-all standard leaving the very important emotional significance of the event out of the equation along with eliminating true informed consent and choice.

The current advocacy for midwives and homebirth compares the practice in the United States to other westernized countries but fails to see the vast differences between the two. The ACOG on the other hand, does see those differences and uses them to frame their position, which ultimately hurts midwifery. There is no doubt that embracing midwifery care and integrating it into our current maternity system would be a boon for women and babies, producing better outcomes for both. Unfortunately, organizations like MANA will need to first step up and take responsibility for the negative reputation Certified Professional Midwives have among the medical community and the vast majority of Americans.

The current educational protocols for CPMs are severely lacking, and while many excellent midwives come from this system, so too do many poorly prepared midwives that dampen the landscape for everyone seeking to serve it or be served by it. All of the studies that are used to promote midwifery and homebirth are flawed in the American system because of this fact and it is time for MANA to truly protect midwifery by changing courses. Continually pointing to the Dutch system or the Canadian system or studies conducted in the United Kingdom will do nothing to promote the effectiveness of the midwifery model of care and homebirth for American women if we don’t also follow those countries’ lead and prepare ALL midwives to work within the established medical community, the way they do in Europe. A national approach to this will also be helpful over the current disjointed state by state regulations.

Yes, the Today Show was extremely irresponsible in reporting just one side of the homebirth story, but all of us who have had good homebirth outcomes don’t really have a leg to stand on when defending our beliefs as long as MANA hides their perinatal outcome studies and a simple search for the educational requirements for CPMs reveals two year courses in homeopathy and botanicals. The truth is, the McKenzie’s would never have been “allowed” to labor for four days at home anywhere else in the industrial world where midwives practice as part of an integrated maternity system that values women and babies. Here in the United States though, we are taking the idea of “birth is not an illness” to new heights and unfortunately the outcome will not always be a positive one.

Admittedly, there are no guarantees in life and poor outcomes can happen at home or in the hospital. But let’s be honest, the horror to the McKenzie loss is not that their baby died, but that it died after four days of labor. As advocates for women and babies, can we really defend this? If we are truly interested in changing the political culture for midwives and producing better outcomes for both mother and baby, then we must self-examine the state of affairs within the midwifery community and compare it to other countries where midwifery is widely accepted. The ACOG is not going to make it easy; they are protective of their “birth turf”. We are only at the forefront of this issue, but let’s not see it squashed because of sub-standard educational credentialing or over-zealous ideals that keep a woman at home for four days when the hospital, with ultrasound machines and higher-tech fetal monitoring, is only a minute away. Our fight for midwifery and natural childbirth must go beyond OB bashing and extolling the virtues of an intervention-free birth. If we are going to make any progress and see our daughters and granddaughters give birth in a nurturing and supportive system, then we must look inward before reaching across the divide to learn from the medical establishment how to properly assess risk and teach them how to appreciate the body’s ability to birth naturally.

(I recognize that the midwife responsible for the McKenzie’s care is a CNM with an excellent reputation and safety record and do not judge the unknown circumstances of this case. I contend that because of the diverse backgrounds in training, midwives in general are lumped into the same category in the eyes of the medical establishment, and this is one of the factors keeping midwifery from being fully integrated into the mainstream).
This is exactly how I feel about our system. It is very disjointed. I know many CM would love to stay out of the system, but it leaves them (and the public) with varying ideas about how much education is really needed. I am all for women's choices, but I think we absolutely need to look at why Canada and Europe have such good home birth outcomes. It's because their midwifes are a part of the system and are trained for that. Not only do their clients know that they are trained, but the doctors, hospitals and other medical staff know they are trained.
I love that this story is being shared with everyone viewing this website. I have felt it to be a mission of mine since my first child was born via c-section in August 2008 (Las Vegas, NV), to get the word out about midwifery c-sections, ICAN, and information in general about womens options to friends, family, people online etc... I applaud "mybestbirth.com" for being so vigilent on the issues and media coverage of birth topics!
I don't watch TV so I wouldn't know...has the TODAY Show responded at all to comments on this segment? I'm curious what kind of response they got.

Dr Oz would be a great channel, especially if he looks at and present the evidence IN SUPPORT of home birth. He seems the type who'd appreciate the data.

~casey
I believe a monopoly on birth is a figurative mistake we ourselves have made. The people who have power - acog, obs', hospital protocols etc. were given, are given and will continue to be given the green light for control as long as we continue to allow it.

BOBB has gone a LONG way in getting mainstream to consider where the power of their birthing belongs, after all it is the mainstream that is responsible for this river of figurative control.


acog can not take a thing from someone who will not give it to them, even on their own turf.
SPEAK UP campaign www.jointcommission.org/PatientSafety/SpeakUp and our patient rights fully guarantee every choice is ours, even to leave, to fire a nurse or doc who is behaving in a manner that makes a Mom uncomfortable. Informed consent and Refusal is another back up system. I do not know a single provider in hospital setting who is NOT aware, keenly, of these safeguards for Mom-equally, I do not know a single provider who will TELL any Mom these safeguards, including about their PA (patient advocate) in their own facility.

The truth of this is part of the reason home and out of hospital birthing is on the rise. There is a general professional (medical) dishonesty about birth and birthing and to whom birthing belongs in our nation.

Midwives will always have families to serve and legislation will support them more and more. For those customers who choose the hospital however, and their will always be plenty.
Truth of their birthing, their power, their right to be respected in ALL areas of their care will continue to be diminished, obfuscated and that is the way many care providers want it....unless they know better, internalize it and accept nothing less. A VERY difficult proposition based on my 15 years of experience serving hosp., home and birth center births.

A local hospital doc group is about to banish all birth plans, if you are a customer who thinks you will be well taken care of this is ok. If you are not, you figure hmmmm........next visit to my ob, I will have it put in my chart before I see the doc because you understand your doc can not alter that record and has to, by law, support your true wishes if they do not want to be held accountable.

There is no way to go but Evidence Based. EB

Unless we the birthing demand it (EB), we will remain just after Costa Rica on infant and maternal mortality rates.
I am sensitive here because I live in a county with the highest rate of infant mortality in the nation.

We are the single most lucrative industry for our nations docs and hospitals. All of them prefer to work
9-5 m-th, weekends off. hm....WE are letting this happen.

More mainstream education like BOBB NOW please. The viewing parties around the nation have made a huge difference. As a doula and Hypnobaies Instructor, I speak from experience here.

Thank you and pretty please, more film covering the topics left out in the nasty Today show segment.

How about -"How to get an Evidence Based Birth if you DO choose a hospital???"

I see it often in customers who internalize and are empowered to trust themselves rather than distrust others.

Thank you again,
KathyO
As the birth community seeks to build bridges and collaborate the medical community in general resists and in fact seeks to tear down. Sensational angles are what make "good" news stories and I learned long ago not to put much stock in such so called reporting. I find it so unfortunate but typical that the Today show which is so well respected would take such a slanted point of view and use a family tragedy to highlight the point.
I have never found midwifery to take that tack and in fact midwifery advocates take the high road, the moderate road and the truthful and honest road. I have yet to see scare tactics regarding OB care and hospital care promoted by midwifery in an effort to make a case for themselves. Midwives, unlike ACOG, do not color truths and try to scare off women from using OB care or hospital care. Rather midwives are advocates for informed consent and personal responsibility. They practice evidence based care. I am so saddened by the backbiting,fearmongering, paternalistic approach taken by ACOG. I know there are physicians out there that are not in agreement with this stand by ACOG and how nice for the women who seek them out and how sad that these physicians will have to endure the backlash from their own organization. One other thing that I would like to add is we recognize there are no absolutes in this issue regarding the skills of the various practioners meaning there are some midwives that are less skilled or prudent in their care. Also, there are some that are more MEDwife than MIDwife. Just as there are some physicians that give excellent, family centered care with an open mind and respectful of of women's right to have birth options. I have been educated in the medical model as a registered nurse. But as an RN we are taught to be patient advocates and I have found that by far the midwifery model of care excels in every area and therefore as a patient or in more dignifying terms, client advocate, I continue to support that model and work to inform and educate women about this wonderful option.

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