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MANA Response to ACOG


A wave of disbelief and disgust traveled quickly across social media in response to a presentation given at the ACOG 2018 Annual Clinical and Scientific Meeting suggesting that using condoms to prevent pregnancy was ACOGs best advice for reducing the maternal mortality rate that is on the rise in the USA. As the only industrialized country to hold the dubious honor of having the most expensive system of maternity care while its outcomes are worsening, the profession who presides over the vast majority of those births seems to think that a cartoon condom holds the answers. Given that these statistics are three times worse for women of color, the sentiment takes on a racist tone to add to the misogynist attitude that is at the heart of the power dynamic identified as a leading contributor to obstetric violence. This is a dynamic that puts birthing people in a vulnerable position with an "expert" who expects compliance and does not allow for personal autonomy in decision making. Unnecessary interventions or undue influence, coercion and even threats are hallmarks of obstetrical violence whether perpetrated, knowingly or unknowingly, by institutions or practitioners. Read more about obstetric violence here.

To add insult to injury, ACOG apologized, not because they recognized that the magnitude of their statement was inherently violent, but simply because people had become upset. This apology was one that had the air of only being sorry because they got caught – an afterthought that felt disingenuous. Like so many of the words we hear from those who profit from manipulating us into doing what benefits them more than it does us, the apology didn’t go far enough to show sincerity.

So, what to do? If the words seem meaningless, then how will we know what is real? What tape measure can we use to know what to believe? What actions would we need to see before we can believe the words that we hear when ACOG tells us they care about maternal mortality and about the families they serve?

A few suggestions:
1. A dedication of resources toward dismantling institutional racism
2. Shared decision making with full informed choice of all options, including opt-out  
3. A willingness to listen to consumers about their perception of the birthing experience
4. No hospital VBAC bans
5. Improved education in physiologic birth and normal variation during obstetrical residencies
6. Legislative support for autonomous midwifery, especially CPMs
7. True collaborative support for home birth families
8. Decreased use of unnecessary interventions, including inductions and surgical birth
9. Quality improvement that looks for system breakdowns rather than blaming victims
10. Dedication to prioritizing the needs of families over the needs to satisfy liability insurance requirements

Each professional organization and credential has a responsibility to put the families we serve in the forefront of every decision we make. We expect that of MANA, and we expect no less from ACOG.

Sarita Bennett, DO, CPM

Sarita Bennett, DO, CPM

MANA Vice President

Sarita has listened to women’s stories all her life – stories about love and birth and healing and death. She grew up in a rural mountain culture that valued self-reliance and in which home birth was the norm. The birth of her first child brought an awareness of a calling to midwifery which she pursued through self-study and attending women in their homes. The births of her own four children taught her to listen to the power of her body and what it means to give birth in ecstasy. In the early 1980’s, she joined with other young midwives in her state to support one another and find sisterhood as they developed standards of care, risk factor guidelines and a well-honed peer review process. In 1994, Sarita found herself answering another calling and began her Osteopathic education at the West Virginia School of Osteopathic Medicine. After graduating with honors, she completed a family medicine residency with a strong maternity care program and “old-time” family practice approach to birth. In 2001, she returned to her rural home town, providing home birth and general family practice until 2013, when she relocated to begin a new adventure. Along with her passion for midwifery, she discovered her gift for mentoring and is actively involved in educating future midwives through The Academy of Experiential Midwifery Education. Sarita served as secretary for the MANA Board of Directors from October 2011 until being elected as vice president in 2014. From this perspective, she sees the interconnectedness of midwives and the need to work cooperatively if we are going to ensure that women and their families – not big business – are the ones who profit from our birth experiences.