Sunday, June 16, 2024

Opinion | The U.S. needs better birthing policies

Opinion | The U.S. needs better birthing policies


I read the Nov. 19 front-page article “A midwife faces scrutiny after a baby dies” with tears in my eyes. This tragic story began with the midwife’s experience of a traumatic birth: a Caesarean section for breech presentation in which she “had no say in the matter.” Unfortunately, as research has shown, this story of feeling coerced into Caesarean for breech presentation is not unique.

Even though major obstetric organizations consider vaginal breech birth a “reasonable option” for appropriately screened candidates that can be “nearly as safe” as cephalic (head down) birth, care for planned vaginal breech birth in the United States is often extremely difficult if not impossible to obtain. With no choice other than Caesarean in the hospital system, some people, such as Air Force Lt. Col. Tom Timmerman’s wife, choose to have a breech birth at home to avoid surgery, putting themselves and their baby at increased risk.

A recent report from the National Academies of Sciences, Engineering, and Medicine said hospitals have “a clear and urgent responsibility to make available forms of care that appear to be safest in the hospital setting (for example, planned vaginal breech birth).”

We need reform of hospital policies to support vaginal breech birth and to respect the autonomy of pregnant women and birthing people and their right to decline surgery. We need more doctors and midwives who are skilled in vaginal breech birth to provide that care. Without these changes, I fear this heartbreaking story might be doomed to repeat itself.

Robyn Schafer, New Brunswick, N.J.

The writer is an assistant professor in the school of nursing, division of advanced nursing practice at Rutgers University and at Robert Wood Johnson Medical School department of obstetrics, gynecology and reproductive sciences.

The Nov. 19 article on midwifery highlighted both the strengths and weaknesses of our statutory health-care licensing agencies. On one hand, they offer consumers a valuable resource to screen potential health-care providers. In Virginia and Maryland, you can easily and quickly check on practitioners to determine if they are licensed and if any disciplinary action has been enforced in the recent past.

At a time when health-care extenders are being encouraged to meet an unmet need, educational standards and requirements are also being adjusted legislatively to accommodate these changes. As a result, it is even more important for consumers to ensure the competence of their chosen practitioner.

In contrast, monitoring the disciplinary activity of health-care boards provides the consumer with disconcerting insight regarding oversight. In many cases, a practitioner who ultimately has their license revoked can practice for years while the case wends its way through the statutory process. Additionally, practitioners who commit egregious offenses can continue to practice as the result of legal stays, reprimands or financial fines.

Attending to the disciplinary action of your state health regulatory entity is an extremely valuable resource and should be used by consumers as an essential vetting process.

Cynthia Favret, Williamsburg, Va.



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