Unpacking and bringing some sort of order to our new house has taken precedence over blogging, but this morning I feel compelled to blog. Recently I have had several conversations with my beloved midwife about licensing. She is against licensing, I support it (a recent switch for me, more on that later). My midwife believes many people choose licensing because they crave legitimacy and recognition but she argues that in fact licensing encourages the targeting of midwives. I can't prove this but I sense that if licensing encourages the targeting of midwives it is because licensing increases the number of home births in an area (or at least puts home birth on the physicians' radar screen) which then makes the local Board of Medicine very nervous about infringement on their territory and leads to the targeting of midwives. In other words, it is not the licensing but the fear of lost dollars in their pockets, that leads to the targeting of midwives. I just read an article that for me, sums up exactly why the American Medical Association (AMA) would like to outlaw home birth.
The article "AMA Scope of Practice Initiative Advances" is about the Scope of Practice Partnership (SOPP) project. The SOPP program was "developed in part to curtail growth in advanced practice nursing and in new 'alternative health care' disciplines, according to the AOA* Advocacy group."1 In other words, the AMA has an entire initiative whose goal is to keep more dollars in their members' pockets. Even more worrisome is that the American Medical Association's (AMA) litigation center is lending its support to the SOPP program, and with much success.
As evidence of the AMA Litigation Center's success, the presentation cites a March 14, 2008, Texas appeals court ruling (link is mine) that found the Texas State Board of Podiatric Medical Examiners had overstepped its authority by defining podiatrists' practice scope beyond the foot to include the ankle and leg.2
Why not include the ankle and leg (many states do)? Does the foot exist in a vacuum? Is the mother not connected to the child in her womb? But this reminds me of the tendency of OBs to look at a small piece of the picture (the foot) to the detriment of the whole (the foot and related leg structures). For example, once the baby is out, the cord is quickly clamped (separating mom/baby) and the responsibility of the baby is handed over to over to the pediatrician, even though delayed cord clamping is usually best for mom and baby. Or if mom is past her due date, they discuss induction rather then focusing on the emotional health throughout pregnancy and thoroughly exploring issues (fear of the pain of labor, fear that a first child will not adjust well to a sibling, fear of "failure" if a woman is planning a vaginal birth after cesarean, etc. etc.) that might influence the start of labor. But I digress. I worry that SOPP members may argue that just as podiatrists in Texas should focus only on the foot, midwives, once labor begins, should focus on mom. This would allow them to argue that midwives can only provide care in a hospital setting where a pediatrician is present to attend to the newborn, thus preventing encroachment on the pediatrician's "territory." Until OBs agree to subscribe fully to the midwives model of care, a model which looks at the whole picture, and attend women in their chosen setting, SOPP needs to find another project. In South Carolina, podiatrists seem to understand that the foot does not exist in a vacuum. Perhaps the American Medical Association can learn a thing or two from them.
1American Optometric Association News Association, News Online, AMA Scope of Practice Initiative Advances, June 2008, http://www.aoanews.org/x7856.xml?AOAMember accessed November 11, 2008.
*AOA American Optometric Association.