Wednesday, January 26, 2011

ACOG Weighs in on Homebirth

ACOG issued a statement on homebirth on January 25, 2011.

Here is our "response".  Please feel free to give yours!

ACOG says: "It's important to remember that home births don't always go well, and the risk is higher if they are attended by inadequately trained attendants or in poorly selected patients with serious high-risk medical conditions such as hypertension, breech presentation, or prior cesarean deliveries." 

Childbirth Today: No, homebirths don't always go well but then neither do hospital or birth center births.  To think that location guarantees safety is not supported by the literature.  We do agree that high risk women should be attended by equally adequate providers.

ACOG says: absolute risk of planned home births is low.

Childbirth Today: True!

ACOG says: published medical evidence shows it does carry a two- to three-fold increase in the risk of newborn death compared with planned hospital births.

Childbirth Today: please cite the references.  

ACOG says: A review of the data also found that planned home births among low risk women are associated with fewer medical interventions than planned hospital births.

Childbirth Today: True.

ACOG says: Although The College does not support planned home births given the published medical data, it emphasizes that women who decide to deliver at home should be offered standard components of prenatal care.

Childbirth Today: There will ALWAYS be the population who will decided, through informed decision making that home birth is an option for them.  We hope that instead of putting up more roadblocks for these families, ACOG will work together with other care providers to create an educational and informational highway for families devoid of statements like this one, that could be construed as not presenting the entire picture plus discouraging families from seeking childbirth education, which strengthens their educational foundation.

ACOG says:  It also is important for women thinking about a planned home birth to consider whether they are healthy and considered low-risk and to work with a Certified Nurse Midwife, Certified Midwife, or physician that practices in an integrated and regulated health system; have ready access to consultation; and have a plan for safe and quick transportation to a nearby hospital in the event of an emergency.

Childbirth Today: Research shows that in countries with more midwifery care, maternal mortality/morbidity and infant morbidity/mortality rates are much lower, while our statistics grow worse in spite of rising intervention on births.  Have you read this 2005 study in the BMJ? What about Licensed Midwives or Certified Professional Midwives?  Why leave them out?  

ACOG Says: the risk is higher if they are attended by inadequately trained attendants or in poorly selected patients with serious high-risk medical conditions.

Childbirth Today: women should choose their care providers carefully and wisely, whether they are midwives or physicians.  Women should also choose their location to give birth wisely as well.  The Birth Survey can help!

While statements or opinions such as Committee Opinion #476, "Planned Home Birth," is published in the February 2011 issue of Obstetrics & Gynecology is perfectly fine as an opinion, the reader must be aware that it is only an opinion and only based on limited references...which are not given.  For expectant parents to make full use of informed consent, they should hear other opinions, read CDC statistics and make their own decisions.  After all, childbirth is not an illness.  It is a state of health.  And statistically speaking, few women actually need the care of an obstetrician (who is also a surgeon).  There are some that do and that is why we have obstetric care and hospitals.

The bottom line (no pun intended...well, ok maybe) is that the war between physician/midwife and hospital birth/home birth is not likely to end soon.  And this is one example of why.

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