Midwife: Lobbying Program the Objective

Midwife: Lobbying Program

The objective of this work is to identify three special interest groups and to discuss the agenda of each special interest group including economic and political incentives including socioeconomic biases and ethical dilemmas and to discuss whether or not each group is a private interest group or public interest group and why. This work will further discuss successful lobbying strategies for each group and will discuss failed lobbying strategies. Finally this work will discuss one professional topic of importance and why could be done to lobby for or against that issue.

Between 1990 and 2006 in the U.S. It is reported that nurse-midwife attended births "rose from 3.4% to 7.4% of all births while non-nurse midwife attended births account for an additional 0.4%." (Heimann, 2009) Boards of Nursing regulate nurse-midwives in 26 U.S. states. Non-nurse midwives are reported to work traditionally without any type of regulation although it is reported that a "national campaign led to the establishment of accreditation for their training and regulation in 24 states." (Heimann, 2009)

Three special interest groups in the discussion on midwifery include those of: (1) the American Medical Association (AMA); (2) the American College of Obstetricians and Gynecologists (ACOG); and (3) Citizens for Midwifery (CFM).

I. Citizens for Midwifery (CFM)

Citizens for Midwifery (CFM) states that the groups core values include those as follows:

(1) Pregnancy and childbirth are normal, healthy processes.

(2) Access to midwives and the Midwives Model of Care is vital to normal childbirth.

(3) the Midwives Model of Care outlines a type of care and is not limited to the education or any specific category of provider.

(4) Respect is at the core of the Midwives Model of Care. Every woman should be treated with respect in every phase of her care from pregnancy through postpartum. Respect includes, but is not limited to complete information about tests, treatments, and procedures, fully informed consent, preservation of privacy, and polite respectful communications by all involved with her care.

(5) Pregnancy and childbirth effect the physical, mental, and psycho-social well-being of mothers, babies, and families, therefore maternity care should not only avoid harm, but also provide benefits to them.

(6) Maternity care should be grounded in evidence, and care providers should be accountable to the mother and family for the mental and physical outcomes resulting from their actions or inactions.

(7) Clinical decisions in maternity care should be focused on promoting the overall health and well-being of the mother-baby dyad; these decisions should never be influenced or determined by economic considerations or legal fears.

(8) the use of practices, medications, and medical procedures should be based on the needs of each individual woman, her baby, and the circumstances of her pregnancy, labor, birth, and postpartum experiences with her full understanding and consent and based on the best evidence available. Routine protocols not based on research evidence should be avoided.

(9) Maternity care is an important aspect of health care in the United States and must be included in all discussions of health care policy.

(10) the quality and cost of maternity care and its outcomes directly or indirectly affect every U.S. citizen. (CFM, 2010)

Naturally, these facts are the basis upon which CFM directs its lobbying efforts and to some extent these have been effective strategies as evidenced in the laws and regulations that acknowledge and govern these individuals and their respective organizations.

II. The American Medical Association (AMA)

The American Medical Association (AMA) is "not accountable to the public" and as well "fits the dictionary definition of a professional organization -- "an organization by and for members of the profession"..." (CFM, 2010) in other words the primary purpose of the AMA is "to advance the interests of physicians and advance legislation and public policy that is favorable to its members." (CFM, 2010)

The AMA is reported to have formed "the Scope of Practice Partnership, a national effort to restrict the scope of practice of allied health professionals, including midwives at the state level. This effort is not based on any evidence but serves to promote the interests of the AMA membership. SOPP includes virtually all of the medical specialties, is well-funded, and has been active in attempts to prevent certified professional midwives from achieving licensing, and works to restrict what nurse-midwives may and may not do in their practices." (CFM, 2010)

III. The American College of Obstetricians and Gynecologists (ACOG

The American College of Obstetricians and Gynecologists (ACOG) was founded in Chicago, Illinois in 1951 and has more than 52,000 members and is reported to be the "nation's leading group of professionals providing health care for women." (CFM, 2010)

The American College of Obstetricians and Gynecologists, is reported to be "...the pre-eminent authority on women's health, is a professional membership organization dedicated to advancing women's health by building and sustaining the obstetric and gynecologic community and actively supporting its members." (CFM, 2010) the ACOG mission statement is as follows: "The College pursues this mission through education, practice, research, and advocacy. ACOG will emphasize life-long learning, incorporate new knowledge and information technology, and evolve its governance structure. To achieve its strategic goals, ACOG will develop an operational plan that includes appropriate metrics." (CFM, 2010)

It is the belief of ACOG that the safest setting for labor, delivery and the immediate postpartum period "is in the hospital, or a birthing center" however, ACOG states this without providing information to support this belief. The reality is, according to CFM that "...a large collection of studies over many years and in a number of countries has consistently shown that a planned homebirth with a trained midwife is as safe as the hospital, with far fewer interventions and less morbidity for mothers and babies.

ACOG's statement includes incorrect information and contradictory statements. For example: "ACOG acknowledges a woman's right to make informed decisions regarding her delivery and to have a choice in choosing her health care provider, but ACOG does not support programs that advocate for, or individuals who provide, home births." If ACOG does not support home birth providers, then it is not supporting a woman's right to make her own informed decisions about her maternity care." (CFM, 2010) ACOG has identified the following strategies in their effort to 'advocate' for women's health:

(1) Promotion of women's reproductive rights,

(2) Equity, nondiscrimination and cultural sensitivity;

(3) Partnerships and alliances with women, women's groups and others,

(4) Advocacy education and training; and (5) Research, research funding and evidence-based practice. (CFM, 2010)

IV. Lobbying Efforts on the part of CFM, ACOG, and AMA

Lobbying efforts on the part of ACOG and the AMA are based upon marketing considerations and this is apparent when analysis is conducted on the basis of the arguments presented by these organizations. For example, obstetricians are in reality surgeons who are trailed in coping with childbirth complications. These individuals are not trained in the area of the requirements for a normal and natural physiological childbirth process. In addition, obstetricians "apparently cannot attend births without using major abdominal surgery on more than 30% of pregnant women, without using drugs for pain (86%) of births, drugs to stimulate labor (47% of births), and medical induction of labor 41% of the time." (CFM, 2010) in addition, obstetricians have "no understanding of how common and routine birth practices, protocols and interventions interfere with labor and increase risks of complications for mothers and babies." (CFM, 2010) it is apparent that midwifery offers to birthing mothers accommodations that the obstetrician and gynecologist cannot offer therefore giving rise to these individuals and their organizations binding together to move the authoritative bodies toward decisions that will be in their favor. CFM reports in the work of Hodges (2008) entitled: " "...that is the Roe v. Wade case "the Supreme Court ruled that the right to privacy is not absolute; in the third trimester, when the fetus is considered viable, the government interest in the fetus may override the mother's rights to control her body (although, where the mother's life or health are at risk the balance shifts back to the mother). " (Hodges, 2008) CFM understands that this means that the woman giving birth can be forced to have a c-section as this has been the case in past cases where a c-section was at issue. Therefore, CFM should rightly advocate for the Roe v. Wade ruling to be changed to reflect the rights of women to choose the method of childbirth that they desire with safety of the mother and child as guiding ethics.

V. Analysis