Being Pregnant
ACOG Issues Statement On Home Birth Safety
The American College of Obstetricians and Gynecologists (ACOG) issued a committee opinion yesterday about home birth safety. Not many surprises here: It’s pretty much what you’d expect from a medical organization that has, heretofore, not been too hot on the idea of home birth.
In concordance with the highly criticized “Wax paper” (a big home birth study published last summer), the College states that while home birth for low risk mothers is associated with fewer medical interventions (and attendant risks) than hospital births, the risk for newborn death is higher. While the “absolute risk of planned home births is low,” the statement reads, hospitals and birth centers are the safest locations for labor and delivery.
Still, ACOG is edging a tiny bit closer to what one might consider “support” for home birth; the paper encourages women to make their own decision about where to give birth, based on the best evidence.
The College offers some specific guidance, too: Women who give birth at home should have excellent prenatal care, they should work with certified nurse midwives or certified midwives or doctors participating in “integrated care.” Easy and fast access to hospital back-up care is essential. The College is adamantly against HBACs (home births after cesareans) and believe that home birth is not a safe option for high-risk pregnancies, postdate (42 weeks+) pregnancies, multiples or breech babies.
The risks of home birth go up, says Richard N. Waldman, MD, president of the College, with “inadequately trained attendants or in poorly selected patients with serious high-risk medical conditions such as hypertension, breech presentation, or prior cesarean deliveries.”
The Big Push For Midwives– an organization I support– posted a link to this report on Facebook last night with the optimistic update that the emphasis on a woman’s choice might be a step in the right direction. Most of the midwives and home birth advocates who commented, however, seemed to view the news as same old, same old. One woman wrote, “The usual BS, based on a misguided attempt to maintain dominion over their perceived turf, and based on flawed ‘evidence’ (Wax et al., 2010).”
It is my believe that home birth safety absolutely must be considered in light of each woman’s personal health, care and circumstances. Having looked extremely closely at the risks and benefits, and taking into account my own circumstances– low risk and across the street from a major city hospital– I decided to try for a home birth in 2008. All went well. What do you guys think of these recommendations? How do you make your decisions about where to give birth when the evidence about various risks and benefits is so often clouded by controversy?
photo: Chris and Jen/Flickr
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[...] they do give a small amount of leeway to women who want a home birth, giving them recommendations on how to find a good midwife. They’ve got a long way to go, but this is a huge [...]
February Favorites « Birth a Miracle Services commented on Feb 08 11 at 2:00 pmDanielle625 commented on Jan 21 11 at 2:06 pmI am not surprised by this, although I am happy they said that women have a choice in how they give birth, because that is a step in the right direction, especially with women being robbed of their birth choices all over the country and forced into unwanted surgical procedures!
Amy commented on Jan 21 11 at 6:23 pmI believe home birth is a valid choice and should be made more available than it currently is (though I agree it should only be chosen by women experiencing low-risk pregnancies and be attended by midwives who are well-trained to handle emergencies). I can say that Dr. Waldman, current president of ACOG, has been my doctor for nearly ten years and delivered my daughter two years ago. He has always been very supportive of midwifery, natural birth, the use of birth centers over traditional hospital environments, and natural family planning. I can’t speak for the rest of the committee charged with issuing this statement, of course, but I did feel compelled to comment based on my own experiences with him.
ceridwen commented on Jan 21 11 at 6:28 pmAmy, Thanks for your comment. It always makes me happy to know about doctors supporting midwives and the other way around. That’s really the way forward!
Au Coeur commented on Jan 22 11 at 1:22 pmI agree that this is a step in the right direction. I think it’s important that they were able and willing to acknowledge that planned home births led to fewer interventions than hospital births. Hopefully they will act on that recognition to try to reduce the unnecessary interventions rampant so common in hospitals…
Emily commented on Jan 23 11 at 2:02 pmIn Ontario, where we have publicly funded midwifery, there are very specific scenarios where home birth is allowed (uncomplicated pregnancy, head down, a maximum of 25 minutes from a hospital, etc…). It seems to me that if those guidelines were followed more widely, it would satisfy the concerns of the ob/gyns as well as providing women with a real choice. In general, the midwives here have very good working relationships with the OBs. There seems to be mutual professional respect that is lacking in other jurisdictions.
Susan Jenkins commented on Jan 23 11 at 2:34 pmHI Ceridwen,
While it is certainly nice to see ACOG acknowledging a woman’s right to choose the setting where she will give birth, as the Big Push pointed out on facebook, you are absolutely right that the rest of this press release is just more of the same old monopolistic nonsense. If ACOG truly believed that home birth should be integrated into the system so that smooth transitions could occur from home to hospital, it would stop opposing state regulation of Certified Professional Midwives, the only midwife group that is specifically educated to provide out-of-hospital birth. The first step toward integration of home birth must be state regulation of ALL midwives, not just Certified Nurse-Midwives (CNMs) and Certified Midwives (CMs).
Interestingly, many people who read ACOG’s press release mistakenly believed that ACOG was referring to Certified Professional Midwives but, unfortunately, we are sure that the reference is the the small group (no more than 125 or so) of direct-entry midwives who have educated in hospitals like CNMs and certified by the same entity that certifies nurse-midwives.
ACOG is still refusing to acknowledge the one category of US midwives that specializes exclusively in out-of-hospital birth in homes and birth centers.
Actually, Ceridwen, I am hearing an interesting new buzz. People are noting that ACOG calls for providing women with accurate informed consent for home or hospital birth, and they are saying that this means OB/GYNs should warn their patients of the risks women who plan a hospital birth need to know about, such as the risk of nosocomial (hospital-acquired) infection, or the risk that she may be subjected to interventions that not only are not evidence-based, but have been demonstrated as possibly causing harm. For example, the connection between induction or electronic fetal monitoring and c-section.
For women to have complete informed consent, they need to have a better picture of the risks of harm to themselves and their babies associated with hospital delivery.
Meagan @ The Happiest Mom commented on Jan 25 11 at 10:22 amI’m torn. I do think it’s a step in the right direction that ACOG even acknowledges homebirth as a valid choice (or seems to) but the laundry list of prerequisistves is troubling to me. Particularly because I know quite a few mothers who have HB’ed precisely to avoid an essentially forced repeat c-section, or because the one hospital in their area is notorious for being mother-unfriendly or even unsafe.
I have five children and have had five births. One (the first) was an OK, but not great hospital birth. The second a homebirth. The third and fourth, fantastic low-intervention birth center births. The fifth, a less-satisfying homebirth (wasn’t crazy about my midwife when push (ha ha) came to shove.) Still, I was educated and informed enough by that point that I knew what I had to do for myself and she was more a highly educated supervisor.
Here’s what no birth choice does to somebody like me, though: if I were pregnant now, in the small, semi-rural town in which I live, I don’t know what my options would be. The local hospital is a joke. (literally, it’s a joke among the people who live here that the only reason you’d go there is if you face imminent death otherwise and are willing to risk infection or malpractice.) The hospital all my friends go to to have their babies is an hour away…not a great option for somebody whose last labor was about 2 hours long start to finish. Same with the only freestanding birth center I know of. Maybe if homebirth were more acceptable, profitable for the provider, supported and available, there would be some great midwives around here to choose from. But as it stands? I’d be choosing from a handful of non-options.
Kelly commented on Jan 25 11 at 11:07 pmI find it interesting that they state the risk of newborn death in a home birth is higher – doesn’t the US supposedly have some of the highest infant mortality (and mother death) rates in the developed world? And I would say that as of now MOST of those births are taking place in hospitals…so where is that risk highest again?
Lorette Lavine commented on Jan 25 11 at 11:08 pmI am a former Labor and Delivery nurse at a large medical center. Needless to say I have seen many complications during labor. It is my belief that a mother should have a choice but that this choice should be made very carefully. When something does happen it is essential to have all the supportive team available for both mother and baby.
If the medical care is good during the pre-natal period and there are no complicating factors then the mother can make an educated decision as to where she would like to deliver. For me it would be in a hospital and a GOOD hospital where there would be support for me and my baby if needed.
It is my belief that you want to have the best outcome possible and that may be in a medical facility.
I am not at all surprised at the ACOG statement…these are physicians who dedicate their practice to women’s health and they believe that home births do not offer the safest environment for mother and baby if something unforeseen and unpredictable happens. I tend to agree with them based on my personal experience…I have witnessed a maternal death and more than my share of emergencies with newborns all of which affects my opinion on this controversial subject.
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