This spring, the American Medical Association decided to support a legislation "that
helps ensure safe deliveries and healthy babies by acknowledging that the safest setting for labor, delivery, and the immediate post-partum period is in the hospital" or accredited birth center.
So the AMA is against ANY women choosing to give birth at home. This appears to be based more on turf management than evidence.
(The issue erupted following the release of the documentary, "The Business of Being Born," by former talk show host Ricki Lake in which she haves her baby at home. The American College of Obstetricians and Gynecologists and AMA publicly criticized Lake, who wrote about the ordeal last month for the Huffington Post.)
Given that the human species requires birth as a requirement for
survival, and given that for the vast majority of our existence, said
births did not occur in a hospital, it seems a little far-fetched to me
that the birthing process is a medical condition requiring the full
resources of a hospital, especially when evidence exists that the
process is safe for low-risk mothers and on the flip side, use of fetal
monitoring has been shown to increase surgical procedures in low-risk
pregnancies, without showing improvements in outcome.
This highlights the issues we face in helping consumers make
appropriate health decisions. Under the guise of guidelines and
professional expertise, we see all kinds of interest groups making
broad statements that push their own agendas, rather than helping
individuals determine the best course of action for them (will your
doctor give you a personal risk vs. side effect analysis prior to
putting you on a medication?)
Until we understand risks to the patients at the margins of the
studies we’ve done, its irresponsible to default to more action/expense
against the wishes of patients. Simply taking results in high-risk
populations and generalizing benefits to lower risk is junk science and
further reduces the credibility of our once proud profession.
Vijay Goel is a doctor and former McKinsey & Co. consultant based in Los Angeles. He blogs regularly at Consumer-focused Healthcare.