Tuesday, March 10, 2009

When You Can't Have It Your Way, Legislate!

A news story aired on TV recently about a woman who had a dispute with a fast food restaurant over chicken nuggets (I think). So infuriated, she called 911.

Now it appears that a few physicians feel like the walls are closing in on their practices as "allied professionals" offer similar services. Instead of calling 911, they are calling lawyers and law makers, siting practicing outside of their scope.

While I am not educated on all of the complaints, the few I do know about midwifery.

But this is not the first time midwifery has been a target. According to the "History of Midwifery" written by the University of Texas Southwest Medical Center in Dallas:

Obstetricians began to identify a difference not only in the practices of the two professionals, but also in the neonatal/maternal outcomes between births attended by physicians and those by midwives. Statistics regarding maternal deaths and neonatal deaths which were available, sometimes suggested that midwifery attended births had poorer statistical outcomes than physician attended deliveries. It must be noted that any discrepancy may have been influenced by other factors. For example, as physicians became the provider of choice for the affluent woman, midwives cared for an increasing number of poor women. These midwifery clients usually lived either in rural areas of the country, or in immigrant areas of large urban cities where poor nutrition and poor sanitation were the norm. (Even with that consideration, sometimes midwifery statistics were equal or better.)The discrepancy between care of the two groups of providers was not as apparent in Europe, for it was during the 19th century that formalization of midwifery education had occurred in that continent, and statistical outcomes of midwifery practices were comparable to that of physicians in the same countries. Regardless of etiology, the difference between statistical outcomes of midwives and physicians in the United States precipitated a perception characterized as the "midwifery problem".

Current research is showing a difference in outcomes between physician and midwifery care ~ and in some instances, midwifery statistics are better. In the March 16, 2009 issue of American Medical Association News, midwifery again becomes the target.

And I have recently learned that several states, including Ohio, are beginning to legislate what childbirth educators should include in their curriculum (Ohio Revised Code 3701.63). This section of the Ohio Revised Code has to do with the dissemination of materials to educate on Shaken Baby Syndrome and I DO NOT HAVE AN ISSUE WITH THE TOPIC. What I do have an issue with is legislation mandating what childbirth educators teach in their classes.

To me, this is a dangerous precedent to set.

When childbirth education classes were "moved" out of the community and into the hospital (co-optation in the 1980s), I warned the CBE community of the dilution of curriculums to what the hospitals and staff wanted covered ~ which may or may not always be the evidence-based research.

I guess once again I am sounding an alarm. Take a good hard look at what is happening today and how that will impact tomorrow.

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