Friday, February 8, 2008

ACOG Position Statement

I found this post at another blog and thought I'd share it.

The American College of Obstetricians and Gynecologists reiterated their statement on home births today. I’ve highlighted some of the statement I found interesting:

Washington, DC — The American College of Obstetricians and Gynecologists (ACOG) reiterates its long-standing opposition to home births. While childbirth is a normal physiologic process that most women experience without problems, monitoring of both the woman and the fetus during labor and delivery in a hospital or accredited birthing center is essential because complications can arise with little or no warning even among women with low-risk pregnancies.

ACOG acknowledges a woman’s right to make informed decisions regarding her delivery and to have a choice in choosing her health care provider, but ACOG does not support programs that advocate for, or individuals who provide, home births. Nor does ACOG support the provision of care by midwives who are not certified by the American College of Nurse-Midwives (ACNM) or the American Midwifery Certification Board (AMCB).

[For clarity: ACOG supports women to make their own choices, but does not support them making their own choices. Good. Let’s go on: ACOG does not support the Certified Nurse-Midwife who attends home births, but does support her in the freestanding birth center. ACOG does not support programs that advocate home births… which presumably includes health insurance and state health insurance programs that routinely, and often gladly, reimburse the CNM and CPM for providing this low-cost option to their subscribers.]

Childbirth decisions should not be dictated or influenced by what’s fashionable, trendy, or the latest cause célèbre. Despite the rosy picture painted by home birth advocates, a seemingly normal labor and delivery can quickly become life-threatening for both the mother and baby. Attempting a vaginal birth after cesarean (VBAC) at home is especially dangerous because if the uterus ruptures during labor, both the mother and baby face an emergency situation with potentially catastrophic consequences, including death. Unless a woman is in a hospital, an accredited freestanding birthing center, or a birthing center within a hospital complex, with physicians ready to intervene quickly if necessary, she puts herself and her baby’s health and life at unnecessary risk.

[Well! It looks like the home birth committee at ACOG has finally screened their copy of The Business of Being Born! It is very reassuring to see ACOG supporting freestanding birthing centers as a safe facility in which to give birth by VBAC. It may inspire the American Association of Birth Centers to rethink their stance on the subject as they currently do not recommend it. Additionally I wonder if ACOG realizes that a properly accredited birthing center is just like a home and not at all close to a hospital? Emergencies and other complications of varying degrees will have to be transferred out to a hospital just as they would a home birth.]

Advocates cite the high US cesarean rate as one justification for promoting home births. The cesarean delivery rate has concerned ACOG for the past several decades and ACOG remains committed to reducing it, but there is no scientific way to recommend an ‘ideal’ national cesarean rate as a target goal. In 2000, ACOG issued its Task Force Report Evaluation of Cesarean Delivery to assist physicians and institutions in assessing and reducing, if necessary, their cesarean delivery rates. Multiple factors are responsible for the current cesarean rate, but emerging contributors include maternal choice and the rising tide of high-risk pregnancies due to maternal age, overweight, obesity and diabetes.

[Does this say something closer to, If you women would just have babies at a reasonable age, start taking care of your health, and stop asking for cesareans, we would have a lower cesarean rate!? It would have been a nice addition to the paragraph to see how exactly they are helping physicians and institutions lower their cesarean rate because it doesn’t seem to be working.]

The availability of an obstetrician-gynecologist to provide expertise and intervention in an emergency during labor and/or delivery may be life-saving for the mother or newborn and lower the likelihood of a bad outcome. ACOG believes that the safest setting for labor, delivery, and the immediate postpartum period is in the hospital, or a birthing center within a hospital complex, that meets the standards jointly outlined by the American Academy of Pediatrics (AAP) and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers.

It should be emphasized that studies comparing the safety and outcome of births in hospitals with those occurring in other settings in the US are limited and have not been scientifically rigorous. Moreover, lay or other midwives attending to home births are unable to perform live-saving emergency cesarean deliveries and other surgical and medical procedures that would best safeguard the mother and child.

[To that I say to every home birth midwife of every credential: participate with MANA Statistics Project and continue to give ACOG numbers to reject as insignificant. Further, I wonder if ACOG has any clue that Certified Nurse-Midwives all over the US are attending home births? In my area they are pretty close to being the majority provider of such service. For the record, CNMs do not do cesarean surgeries just as “lay or other midwives” (licensed Certified Professional Midwives they meant to say) do not. I haven’t yet seen or heard anything a CNM would do that a CPM wouldn’t or couldn’t at a home birth.]

ACOG encourages all pregnant women to get prenatal care and to make a birth plan. The main goal should be a healthy and safe outcome for both mother and baby. Choosing to deliver a baby at home, however, is to place the process of giving birth over the goal of having a healthy baby. For women who choose a midwife to help deliver their baby, it is critical that they choose only ACNM-certified or AMCB-certified midwives that collaborate with a physician to deliver their baby in a hospital, hospital-based birthing center, or properly accredited freestanding birth center.

[It’s rather insulting to the families who choose home birth and the midwives who provide the service to state that the experience is being chosen over safety. If the experience were the most important thing, why do I get so many questions on my current neonatal resuscitation provider status, if I have medication to stop a hemorrhage, how fast can I start an IV, and more? If that wasn’t important I’d spend most of my time sprinkling good wishes over women instead of arranging for their ACOG recommended prenatal care and screening!]

So, we all understand this right ladies? WE are not capable of making informed decisions about our labors (unless of course we choose an OB in a hospital). WE are selfish because we chose to give birth at home. WE are not important in the birth process, the baby is the only one who matters. WE are responsible for the high cesarean rates. WE are following the "trends".

Exactly which trend is this? I, for one, have been aware of and witnessing home births since I was 13. Yes, long before Ricki Lake ever thought of giving birth, let alone making a documentary about the broken maternity care system in the US. A friend of mine was born at home 27 years ago (as were her subsequent three siblings). Another friend has been having her babies at home for the past 9 years. So, whose example are we following? Oh, that's right we're doing what we're instinctively meant to do. We're doing what has been done for thousands of years. We're controlling ourselves and giving birth the way we see fit, the way we work best. No, home birth is not for everyone ~ but neither is hospital birth.

No comments: