ACNM Responds to AMA Resolutions on Homebirth and Physician Oversight of Midwives

In an August 1 letter to the American Medical Association, ACNM President Kitty Ernst asserts ACNM’s strong support for a woman’s right to choose her site of birth and voices strong opposition to AMA’s call for greater physician oversight in midwifery.

• ACNM, AMA, and ACOG Leaders Meet as Follow-up to 2008 Resolutions.
• Letter to AMA on Resolutions 204 and 205
  • Addenda to letter
• Letter to AMA on Resolution 214
  

“This response represents input from many members for content, composition and review but I want to especially acknowledge the contributions of Saraswathi Vedam, Chair of the Home Birth Section of the Division of Standards and Practice, the writing and editorial skills of ACNM Executive Director Lorrie Kline Kaplan, and the ACNM Board of Directors and Fellows for their support for making a strong statement of the ACNM position.”

--ACNM President Kitty Ernst

More about the 2008 AMA Resolutions and ACNM's Response

The American Medical Association’s 2008 resolutions included Resolution 204, which opposes the creation of boards of midwifery and calls for greater physician oversight in midwifery practice; Resolution 205, in which AMA declares its intention to support state legislation to promote hospital and birth center birth over home birth; and Resolution 214, which declares that nurses who are Doctors of Nursing Practice only be able to practice under the supervision of a physician and as part of a medical team with the final authority and responsibility for the patient under the supervision of a licensed physician.

On August 1, ACNM President Kitty Ernst sent a letter voicing ACNM’s opposition to Resolutions 204 and 205.  “CNMs and CMs are autonomous health care professionals,” said Ernst.  “ACNM considers it vital to ensure proper CNM/CM representation on regulatory boards overseeing our practice to ensure appropriate and well-informed decision-making on scope of practice and other issues.  An appropriately configured board of midwifery could meet this need.” 

Ernst described Resolution 205 as an intrusion on women’s right to choose home birth.  “We strongly oppose efforts to legislate site-of-birth choices for women and their families,” she declared, adding that “the scientific evidence strongly supports that planned home birth under established selection criteria is a safe alternative to hospital birth.”

The letter includes a number of addenda summarizing this evidence, exploring the drivers behind the home birth choice and recommending specific strategies to improve the continuity of care for the small proportion of women and families choosing home birth.

At least one health plan has already used AMA Resolution to issue a new policy denying reimbursement for home birth.

In the addenda to the AMA letter, ACNM also calls on AMA to support its policy agenda to ensure a qualified midwifery workforce, and calls for AMA work with ACNM and other stakeholders to prioritize a focus on the larger issues plaguing our nation’s maternity care system that are affecting a significant proportion of childbearing families in the US.

Resolution 204, “Midwifery Scope of Practice and Licensure”

In this resolution, introduced by the American College of Obstetricians and Gynecologists (ACOG), AMA graciously resolved that “AMA only advocate in legislative and regulatory arenas for the licensing of midwives who are certified by the American College of Nurse-Midwives.” However AMA also resolved to:

• Support state legislation that only authorizes regulatory oversight of midwifery by a board of nursing and/or medicine;
• “Continue to monitor state legislative activities regarding the licensure and scope of practice of midwives;” and
• “Work with state medical societies and interested specialty societies to advocate in the interest of safeguarding maternal and neonatal health regarding the licensure and the scope of practice of midwives.”

The stated rationale for this resolution is proposed legislation in Massachusetts that would create a Board of Midwifery and grant licenses to Certified Professional Midwives (CPMs).   It would also grant licenses to CMs who are currently not recognized in Massachusetts.  The creation of a Board of Midwifery would remove CNMs from the current oversight exercised by the Massachusetts Board of Registration in Nursing.

Resolution 205, “Home Deliveries” 

In this resolution, also introduced by ACOG, the AMA resolved to:

• Support the recent American College of Obstetricians and Gynecologists (ACOG) statement 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 American Academy of Pediatrics (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”(1) and
• Support legislation in support 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.”

The AMA cites the growing number of states recognizing Certified Professional Midwives and recent media attention on celebrity home births as the primary rationales for Resolution 205. The Resolution also implies that home birth is inherently unsafe.

Resolution 214, "Physician Supervision of DNPs"

In this resolution, AMA resolved to:

• Institute a policy that nurses with Doctor of Nursing Practice (DNP) degrees be allowed to practice only under physician supervision. 

For more about the AMA and the resolutions, visit the AMA website.

1. www.acog.org/from_home/publications press_releases/nr02-06-06-2.cfm, accessed March 18,2008