ACOG Anti-Home Birth Response

The American College of Obstetricians and Gynecologists, ACOG, released a press statement on Wednesday, February 6th, about it's stance on home birth (ACOG 2008). Their statement epitomizes the position of ACOG as representors of their members, not the rights or needs of the women their members provide care for. The statement is riddled with propaganda, including sentences like, "Childbirth decisions should not be dictated or influenced by what's fashionable, trendy, or the latest cause célèbre," and "Choosing to deliver a baby at home is to place the process of giving birth over the goal of having a healthy baby." Allow me to paraphrase and address each paragraph in the statement.

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The first paragraph states that ACOG is opposed to home births, that childbirth is a normal process, that monitoring in a hospital or certified birth center is necessary due to the potential for quickly arising complications.

This seems like a reasonable enough set of statements, except that if a hospital is really the safest place for complications to be addressed, why is it that many hospitals across the country are not equipped to respond to an emergency in the 30 minutes commonly expressed as necessary for an emergency cesarean? Why are VBACs banned in many rural hospitals because of lack of adequate staff for an emergency cesarean when the chances of any other laboring woman needing an emergency cesarean are at similar rates? Why did the 2005 study of outcomes for planned, appropriately attended home births yield similar or better results for maternal and perinatal mortality than did hospital births in the same period (Johnson 2005)? Home births are just as safe or safer for low-risk women who are planning an attended home birth because an adequately trained home birth midwife is able to handle common health needs of childbirth and serves as a first-responder in true emergencies. Home birth midwives with adequate training can recognize the need for hospital transfer, usually long before any true emergency arises.

In Colorado, home births are required to occur within 30 minutes of a hospital. This would negate the worry of adequate access to hospital personnel and equipment, considering that in the event of an emergency transfer, an ambulance would be used and the hospital medical team would be informed of the incoming patient's needs. Hospitals typically take this long to prepare for an emergency anyhow. Considering this Colorado regulation, I fail to see the additional dangers associated with home births attended by trained midwives.

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ACOG "acknowledges" the rights of women to choose their health care providers, but does not support home birth providers or home birth advocates. ACOG also states that they only support midwives certified by ACNM or AMCB.

ACOG is blatently claiming that women should have limited rights to birth attendants and environments! What right have they to dictate what a woman can choose for the "normal physiological process that most women experience," as they state in their first paragraph? This statement should be drastically fought, considering its implied removal of a woman's rights to her body and to informed decisions. This statement might as well say, "Birth is only okay when We are in ultimate control of you. Don't listen to those crazy old granny-midwives. Only We know what is best for you."

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The next statement expresses ACOG's beliefs that home birth is a trend made popular by celebrities, that life-threatening complications can arise during birth, especially for VBACs, and that a woman puts herself and her child at unnecessary risk by giving birth anywhere except a hospital or accredited free-standing birth center. This paragraph contains the amazingly expressive sentence, "Childbirth decisions should not be dictated or influenced by what's fashionable, trendy, or the latest cause célèbre."

Considering that only 1% of U.S. births are at home, how could one call this a "trend" at all? What this statement is referring to is Ricki Lake's recent film The Business of Being Born. Ricki Lake has brought home birth to the public eye unlike anything in the past decades, showing America and the world that home birth is not only an option, but a safe and desireable option. This is threatening to ACOG because it may be a cornerstone to a shift in birth philosophies of many Americans. To speak fairly, the movie also increases the likelihood of people choosing home birth when it may not be a good option for them. Instead of better educating the public and expressing the means of making home birth safe for appropriate people, ACOG chooses to blast home birth altogether, implying they are more interested in representing their members than the public good.

Another issue to take up with this statement is that ACOG doesn't put out damning press releases when celebrities glorify elective primary cesareans, even though they are drastically more dangerous (three times the neonatal mortality rate) than home births, when applied to the same low-risk category of women (McDorman et. al. 2006). A low-risk first-time mother electing for an unnecessary primary cesarean versus a low-risk first-time mother electing for a CPM-attended home birth within 30 minutes of a hospital: which would you say is more deserving of a press release of condemnation? It seems the health of mothers and babies is not the only thing of concern to ACOG.

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ACOG applauds themselves for issuing a task force to analyze cesarean rates of physicians and hospitals and to assist said institutions in lowering their rates, if they deem it necessary. They go on to cite obesity, gestational diabetes, and maternal choice as important factors in the rising cesarean section rate, and state that it is impossible to determine a goal for cesarean rates.

I want to point out the irony of this: ACOG supports maternal choice in the cesarean epidemic, but not in home birth, which, as was previously mentioned, is safer than elective cesarean. The reasoning for this discrepancy is obvious: cesareans support ACOG's members, home birth does not. It is also appalling that ACOG would point blame at these groups of women for the cesarean rate, avoiding any statements inplying that their own practices might contrbute to said problems.

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ACOG next states that OB/GYN's may save lives and lower the chances of "bad outcomes" in emergency situations. They also say that they believe the safest place for labor, delivery, and postpartum are hospitals, accredited free-standing birth centers, or birth centers in hospital complexes.

All statements in this paragraph have previously been addressed in this essay.

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The next paragraph states, "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." Then ACOG states that midwives cannot perform cesareans or other procedures that would be best for mother and child.

As is obvious from my essay thus far, adequate studies have indeed occurred and have certainly been rigorous enough for change to be made and informed opinions to form. Home birth is at least as safe, if not safer, than hospital birth for low-risk women attended by adequately trained midwives.

It is obvious that midwives, as well as family practitioners and other non-OB attendants, are not able to perform cesareans, but this statement also implies that such medical procedures, which only obstetricians can perform, are necessarily the best for mother and baby. One need only spend a few days on the ICAN email forum to realize that an inexcusable number of women and infants are the victims of unnecessary obstetrical procedures, performed for the "safeguarding" of obstetricians, not of mothers and children. Stories abound of women who were sectioned because their obstetricians had a social obligation, because nobody told them they could try something different, because a cesarean was presented as their only option, because they had a cesarean with the last baby, because the baby was getting "too big," because labor was taking "too long." This list goes on.

If this second statement were to be taken seriously, all hospitals without in-house obstetricians and anesthesiologists available 24-hours a day would have to shut down their maternity wards. This statement basically says that such hospitals are unsafe for labor, childbirth, and postpartum.

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ACOG summarizes their statement by supporting prenatal care and birth plans, hospital or birth center births, and CNMs working with physicians. They also state, "Choosing to deliver a baby at home, however, is to place the process of giving birth over the goal of having a healthy baby."

This statement, which implies that women do not care for the health of their babies if they choose to birth at home, is ludicrous and false. It also explicitly shows that ACOG does not care at all about the mother, the mother's health, the mother's desires, or what is best for mother and child. Even if the health of the baby were the only goal of ACOG, home births would be the method of choice for many babies.

ACOG is not interested in the health of mothers or babies, however. ACOG is interested in "representing over 52,000 members who provide health care for women." ACOG represents it's members by lying to the public, by attempting to bully people into choosing the more dangerous options, by putting mothers and babies at risk who would not otherwise be there, by allowing their members to perform unnecessary primary cesareans thus endangering the lives of mothers and babies, and by pushing propaganda instead of informing the public of scientifically based risks and benefits. ACOG is obviously not interested in providing health care for women, ACOG is interested in providing under-educated patients for their members to make money from.

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References

ACOG (2008) "ACOG Statement on Home Births" February 6, 2008. Washington, DC. <http://www.acog.org/from_home/publications/press_releases/nr02-06-08-2.cfm>.

Johnson, Kenneth C and Betty-Anne Daviss (2005) "Outcomes of planned home births with certified professional midwives: large prospective study in North America" British Medical Journal. 18 June 2005 330:1416. <http://www.bmj.com/cgi/content/abstract/330/7505/1416>.

McDorman, Marian F. PhD, Eugene Declercq PhD, Fay Menacker DrPHCPNP, Michael H. Malloy MDMS (2006) "Infant and Neonatal Mortality for Primary Cesarean and Vaginal Births to Women with 'No Indicated Risk,'" United States, 1998-2001 Birth Cohorts. Birth 33 (3), 175–182. <http://www.blackwell-synergy.com/doi/full/10.1111/j.1523-536X.2006.00102.x>.

Quick Reply - Avoiding Labor Induction

There are plenty of ways of avoiding induction.

1st - don't go in for the appointment. I know this seems flippant, but you really should keep in mind that all decisions are YOURS to make, with your doctor's advice. They are not your doctor's decisions, your doctor's body, your doctor's baby, etc.

Next, consider the reasons your doctor is recommending induction. If you have not yet reached 42 weeks and everything looks normal and healthy, there may be no medical reason to induce, in which case, inducing may be more dangerous than waiting. Even if you have passed 42 weeks, you still have the option of monitoring the baby and placenta to make sure things are doing well as you wait. If you are not interested in inducing except for when medically indicated, then let your doctor know this and work from there.

There are a number of natural induction methods that are not usually dangerous for you or the baby (consulting medical professional, of course), and certainly not as dangerous as chemical induction. Acupuncture can work (see link below) as can nipple stimulation.

I have only heard of nipple stimulation being dangerous if you continue doing it after a contraction has started... it's much safer than chemical induction though because when you stop stimulating the nipples, the contraction goes it's course and stops. This is unlike chemical induction methods, which can hyperstimulate the uterus to the point of distressing the baby and causing very bad things for the mother. "Hyperstimulation" is also possible with nipple stimulation, of course, but is not nearly as likely as with chemical induction and it is also avoidable simply be stopping the stimulation when a contraction starts. Nipple stimulation is also not as "efficient" as medical inducing agents, meaning that it could take longer to work (good, in my opinion). The other thing is that nipple stimulation isn't done with hospital monitoring, usually, so docs worry about that.

A good question to ask yourself and your doctor when thinking about induction (natural or unnatural) is how likely it is to succeed. If your cervix is not favorable (i.e. closed, hard, posterior), medical induction is more likely to fail and result in a cesarean and "natural" induction may succeed but will probably take a long time.

So the things to do to get your body ready for labor now are to have sex (to start effacing the cervix), walk (to get baby into a good position), and possibly take measures to start contractions (acupressure, nipple stimulation, etc).

While these are ultimately your choices to make, it is not advisable to do anything behind your doctor's back. Letting him/her know what you are thinking or doing is of utmost importance in helping them adequately do their job as your care provider. There may be medical reasons for you NOT to do something that a lay person suggests, and you may only know about these if you talk with your doctor about them. There are always risks to every intervention, and naturally inducing your labor is still an intervention.

You shouldn't necessarily be afraid of doing anything, but you should know the risks involved in all choices before you move forward.

Also... find out what your doctor would do to induce you. What drugs would s/he use. Learn about those drugs. I wouldn't wish a Cytotec/misoprostol induction on anyone in the world. Look into that drug and make your own choices.

http://acupuncture.rhizome.net.nz/Defaul... - acupuncture for pregnancy, childbirth, etc.