Friday, February 8, 2008

ACOG's Position Statement on Homebirth

Apparently, the American College of Obstetrics and Gynecology (ACOG) has taken notice of the rise in consumer awareness of the shortcomings of maternity care in the US (and other countries). As more and more documentaries, such as The Business of Being Born, Pregnant in America, and What Babies Want are being released, hopefully the birth pendulum will swing toward evidence-based care.

Or at least, that's what ACOG is afraid will happen...hence the sudden release of their reiterated position statement on homebirths:

Below is the text of their statement which can be read here with my comments appearing in red.

((rolls up sleeves)) Ready? Here we go...

ACOG Statement on Home Births

Washington, DC -- The American College of Obstetricians and Gynecologists (ACOG) reiterates its long-standing opposition to home births. [Of course they oppose it. If they supported homebirth, it would mean admitting their own shortcomings and handing over business to the competition. It would be a poor business decision. ACOG supporting homebirth would be akin to Walmart telling consumers that Target is better and to take their business there. In short, never going to happen.] 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. [Women who choose homebirth with a midwife are monitored more closely than those in a hospital. Fetal monitoring is available and used with homebirths attended by midwives. In addition, in a homebirth, there is one midwife caring for 1 woman. The mother is not left to the "care" of 1 nurse assigned to multiple women who will "monitor" her via EFM strip from the nurse's station. The midwife will observe all physical and emotional markers for signs of complication. In a hospital setting, the OB will typically not arrive until close to pushing time. In terms of continuous fetal monitoring, there is no research to support that it improves outcomes. ACOG needs to remember their own statements from the 2005 ACOG practice bulletin: Intrapartum fetal heart rate monitoring. Obstetrics and Gynecology, 106(6), 1453-1460 where continuous fetal monitoring is not recommended as it does not improve outcomes. ]

ACOG acknowledges a woman's right to make informed decisions regarding her delivery [but do they stress physician accountability for providing evidence-based information on both sides of the issues?] 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).

Childbirth decisions should not be dictated or influenced by what's fashionable, trendy, or the latest cause célèbre. [So, you're saying the Amish are trendy? They homebirth exclusively - it isn't practical to go to the hospital in the horse and buggy - but that must be another trend, right?] 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. [Especially true when the mother is tied down by monitors, jacked full of pitocin, strapped to a bed, denied food or drink, fingers and tools shoved repeatedly into her vagina, pushing flat on her back, poked with needles, exposed to bacteria, pumped full of drugs with her anxiety level through the roof.] 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. [A midwife providing constant care is better able to detect the first signs of a uterine rupture than a harried nurse watching a monitor strip.] 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. [And hospitals carry no risks, is that right? Funny, I hadn't noticed MRSA in my house or the other 25 strains of virus that are resistant to all known antibiotics. Where can they be found? In hospitals (where sick people go).]

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 [and what actions are you taking to suppress it? encouraging hospitals to ban VBAC?], but there is no scientific way to recommend an 'ideal' national cesarean rate as a target goal. [Check with the WHO (World Health Organization) on that one - their research supports a c-section rate of 10-15% as acceptable.] 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. [Fat lot of good that did - rates continue to climb.] 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. [Why are maternal choice primary c-section rates increasing? Because of fear - irrational, irrefutable fear. You know what I'm talking's the stuff you're so good at spreading...since you won't provide evidence-based care, then you'll scare women into thinking they can't birth without you. Unfortunately, it works.]

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 [although 75 years of homebirth research don't support this statement], 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. [So basically, only in the places where your power reigns supreme... what a surprise!]

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. [See BMJ study 2005. When you don't like the evidence, you instead choose to ignore it. Nice.] 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. [Hence, why a woman transfers to a hospital - if and only when complications arise.]

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. [Which can be achieved in either setting, but is assured in neither. However, the research supports that 93-95% of births are uncomplicated and low-risk. ] Choosing to deliver a baby at home, however, is to place the process of giving birth over the goal of having a healthy baby. [((censored)) Citation, please? Again, show me the studies that hold hospital birth safer than homebirth.] 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. [So you don't lose your power over birthing women because if they realized that OBs are not the only option, you'd be losing their business and their money...]

# # #

The American College of Obstetricians and Gynecologists is the national medical organization representing over 52,000 members who provide health care for women.

Hmmmm...let's talk about that. What is ACOG? To answer this question, let's turn to Dr. Marsden Wagner, a leader in the fight for evidence-based maternity care:

To understand the absolute monopoly ACOG has established in American maternity care, it is helpful to look more closely at this organization. The American College of Obstetricians and Gynecologists is not a "college" in the usual sense: it is not an institution of higher learning. Nor is it a scientific body. With few exceptions, its members and leaders are not scientists but medical practitioners, and there is nothing in ACOG's mission statement about science. The ultimate proof that ACOG is not a scientific body? Too many of its policies and recommendations are not based on real science. . . .

In truth, ACOG is a "professional organization," which amounts to a trade union. Like every trade union, ACOG has two goals--to promote the interests of its members and to promote a better product, in this case, the well-being of women. But if there is a conflict between these two goals, the interests of its members come first. . . .

American maternity care, then, is under the control of tribal obstetrics. A small group, most of them men, are controlling birth in such a way as to preserve their own power and wealth while robbing women and families of control over one of the most important events in their lives. . . .

Power without wisdom is tyranny. There are plenty of intelligent obstetricians who have lots of knowledge, but intelligence and knowledge do not guarantee wisdom. I have known wise individual American obstetricians, but I see no evidence of wisdom in organized obstetrics in the United States. The maternity care we have in what we like to believe is our free country is obstetric tyranny.

Excerpted from Born in the USA by Dr. Marsden Wagner.

In short, ACOG is a business, plain and simple. And why do businesses exist? To make money. Period. If quality of care and maternal and infant safety were truly their chief concerns, it would be reflected in their policy, practice and procedures. Until then, the only consumers they're serving are themselves.


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