Stakeholders for the Homebirth Summit

Stand and Deliver posted more information about the upcoming Homebirth Summit called by the ACNM.  Have a look at Rixa’s post and my previous post if you haven’t already (additional links on my previous post).

Geraldine Simkins, president of MANA, sent out a message with more information regarding this “work team.”  I’d like to further break down the point that addresses “stakeholders.”

The stakeholders are NOT ANY ORGANIZATION but rather are individuals who are defined as belonging in these nine stakeholder groups:

    • Consumers (from a variety of perspectives)
    • Consumer advocates (doulas, childbirth educators, childbirth and women’s healthcare activist)
    • Home Birth midwives (CPM, CNM, LM, Amish, traditional, whatever)
    • Obstetricians and OB family practice
    • Collaborating MCH providers (nursing: L&D, neonatal, pediatrics; CNMs who provide backup)
    • Health insurers and liability insurers
    • Health policy, legislators, legal, ethics
    • Research and education: Public Health, epidemiology
    • Health models, systems, administrators

In this way, the WHOLE SYSTEM is at the table. Otherwise, we will not be able to seriously come to consensus.

Here are my thoughts on each identified group of stakeholders:

  • Consumers from a variety of perspectives – why would they invite consumers who have no understanding of or appreciation for home birth to the table?  How would an anti-homebirth consumer help improve home birth?  How are these people being chosen?
  • Consumer advocates – are these all people who currently (or have a history of) support families who desire or choose home birth?  Doulas, CBEs, and activists are not necessarily supportive of or educated about home birth.  How are these people being chosen?
  • Homebirth midwives – ok good, hopefully they will select some midwives (with solid experience & reputations) who have chosen NOT to be certified.
  • OBs and FPOBs – aside from receiving transfers in a hospital setting, what experience do they have with homebirth?  It is possible that an FPOB would be more supportive of home birth, but puh-leez, how many OBs have actually attended home births???  Additionally, how forceful will a FP be in an arena over-represented by “first class” medical participants or will they be subverted by their more ‘highly esteemed’ colleagues?
  • Collaborating MCH providers – other than practitioners who willingly back up homebirth midwives and their families, what business do these other people have weighing in on homebirth?  I have yet to meet a nurse who thinks home birth is a good idea.  This is now the second category of stakeholders that I place within the larger category of ‘back up.’
  • Health insurers and liability insurers – at this point in time, I think it will be useful to have this group participate in the discussion.  They need to “face the music” and know that women and their families expect home birth to be a viable option.  Insurance is often a barrier for people who desire home birth.  Additionally, liability insurers have stuck their big fat toes into every crevice of maternal-fetal care, so they need to know what a huge obstacle they are providing for families searching for the best options that suit their needs.  (The fact that my OB couldn’t/wouldn’t deliver a breech baby because of his stinkin’ malpractice insurance drives me INSANE to this day!)  This group should listen and learn.
  • Health policy, legislators, legal, ethics – what in the HELL kind of catch all category is this?  I can’t make sense of it.  However, representatives from state-level governing/licensing boards, like Montana’s Alternative Health Care Board, should participate.
  • Research and education: Public Health, epidemiology – please add medical anthropology to this group!
  • Health models, systems, administrators – again, too vague for my comfort.  And it is premature to invite this group to the table.

Which of these stakeholder groups are rooted in public health and/or naturopathic (including midwifery) perspectives?

  • Consumers (??!!) – maybe, but again, it depends on the “variety of perspectives” invited . . .
  • Consumer advocates (??!!) – see above
  • Homebirth midwives

Which of these stakeholder groups are rooted in allopathic tradition?

  • OBs and FPOBs
  • Collaborating MCH providers
  • Health insurers, liability providers
  • Health policy, etc. (??!!)
  • Research and education – some of these folks might have training in non-allopathic perspectives
  • Health models, systems, etc.

So SIX groups (already with institutionalized POWER) interacting with THREE groups (with hardly any power when it comes to institutional change) with two-thirds of its representation from somewhat questionable backgrounds . . .

And people involved wonder why women (like me) are so concerned?

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8 responses to “Stakeholders for the Homebirth Summit

  1. My reply in another forum still stands:
    Regarding the Homebirth Summit and “stakeholders”:
    Something Geradine said at the ICAN conference really resounds with me. Midwives believe they ARE the voices of the mothers. She said that a CPM (not a midwife, mind you) is the ideal provider for women.

    There is a change that comes over women as they train to become a professional and sometimes, I think that we forget that we have crossed that line. Once you become a gatekeeper, you can no longer say you are the voice of women. You may be the voice for yourself, but you are also the voice of a provider, a licensee, or whatever else you take on in order to become a midwife, doula, childbirth educator, lactation consultant. You take on an education that changes your perspective and forces you to make different choices about birth from a different perspective.

    And I don’t think that many midwives realize that so they stop asking women what they want. They assume they KNOW.

    • Thanks, Shannon. I was hoping you’d repost that here. This is why I would hope they’d invite DEMs/LayMs who are decidedly NOT CPMs to the table.

  2. ” I have yet to meet a nurse who thinks home birth is a good idea.”

    Now you have met ONE! And actually there are several more of us out there believe it or not :-) But whether any of us are asked to participate in the summit is the real unknown at this point isn’t it?

    Please invite me….please invite me….please invite me…..

    • Nice! Hi!!

      I suppose I should qualify that statement – nurses I have met here are not supportive of home birth.

  3. The question isn’t whether providers support/believe in home birth for me. I know a lot of nurses who have crossed into acceptance and even some who participate in home birth and some small percentage who just believe in birth. The subset of people in medical professions who truly BELIEVE in home birth is so small, who believe in non-interfered with birth, who think its ok to simply trust the process and be watchful…that those people are generally already known in the birth world and dismissed in the medical fields as being kind of “odd” in a lot of cases. How do they come to the table with any power to change and are we trying to build a bridge to more medicalized homebirth so its acceptable or less medicalized hospital birth? If so, neither one of those is a “homebirth” summit.

    My true concern about this idea of stakeholders is still obvious. What would an OB have to gain with being involved with a homebirth movement when they do not attend homebirths, and don’t intend to attend homebirths. When we talk about birth issues, we often hear people say, “follow the money” when it comes to modern obstetrical/medical care. If we are experiencing the beginning of a paradigm shift, what does that even look like? Does it look like compromising some points on the homebirth front in order to get more support from the medical societies? If so, I think that many homebirth advocates are missing a HUGE selling point of the homebirth movement: that women are fleeing from the medical solutions and medical attitudes. That many women are harmed by the obstetrical system as it stands and making homebirth more licensed, regulated, controlled is taking the decisions out of the hands of the women and the midwives, both.

    Imposing arbitrary standards that meet ACOG or other organizations’, no matter what their original intent, imposes controls that have nothing to do with quality of care and everything to do with checklist, non-intuitive, non-responsive, individualized care designed to “protect the provider” from legal action. A friend of mine had to sign a binding arbitration agreement to be seen by her OB this week. This is the climate of obstetrics in this country. As we drag our midwifery community and homebirth community further and further towards licensure and controls, this is what we are dragging them towards. I’m extremely concerned about who is considered stakeholders in this because it defines the direction. And somewhere between the lines, I think we saw that stakeholders for this will be people who are already agreeing on a lot under the table.

    Shannon Mitchell,
    Director, BirthAction.org

    • …those people are generally already known in the birth world and dismissed in the medical fields as being kind of “odd” in a lot of cases. How do they come to the table with any power to change and are we trying to build a bridge to more medicalized homebirth so its acceptable or less medicalized hospital birth? If so, neither one of those is a “homebirth” summit.

      Mmm, very good points, Shannon. I tried to hit on the ‘power’ inequality, but you’ve phrased it much more powerfully. Thank you!

      Please keep up the pressure via BirthAction. I’m with ya, of course.

  4. ” How do they come to the table with any power to change”

    That is the million dollar question isn’t it, but I would rather have a voice than not if given the opportunity.

    ” What would an OB have to gain with being involved with a homebirth movement when they do not attend homebirths, and don’t intend to attend homebirths.”

    We cannot exclude them from the process because even with planned homebirths, a small percentage of women will need their expertise and skills and for the best outcomes of mothers and babies, a collaborative environment by all who surround them is beneficial.

    I’m not sure if you are saying that L&D nurses also should not be involved, but they play a critical role in women’s labors, births, and experiences in the hospital environment and they too need to be part of the collaborative team when it comes to caring for a family transported in from a homebirth.

    I also, like you, think It is vitally important for the women themselves to be represented and think the consumer stakeholders group should not be hand selected from within the “group”.

    As a previous L&D nurse, an advocate, and a “consumer” (not a good term for homebirth women) I see constitutional rights and ethics playing a huge role in all aspects of homebirth and hope those subjects are covered just as much (or more) than legal and insurance issues.

    Does anyone know if all of the participants have been chosen or are they still in the process?

    Lisa

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