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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