On Feb. 6 the American College of Obstetricians and Gynecologists issued the statement below on how the group is opposed to home birth. What is interesting to me is why they are issuing the statement now. A clue comes in the paragraph that begins: "Childbirth decisions should not be dictated or influenced by what's fashionable, trendy, or the latest cause célèbre." Does this mean ACOG ackowledges that home birth is suddenly trendy? Did you all see the article in Vogue a couple months ago, a favorable essay by a New York City mom who gave birth at home? Perhaps the people at ACOG saw that and got worried... home birth was literally in Vogue...Then of course there is also the Ricki Lake documentary, "The Business of Being Born," which comes out this month on Netflix! I would be worried if I were ACOG, too, as the film makes a compelling case against The System.
The statement goes on to say: "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..." (SO WHY DOES THE RATE KEEP GOING UP, NOW EXCEEDING 30 PERCENT, WHEN THE WORLD HEALTH ORGANIZATION ESTIMATES THAT ANY RATE ABOVE 10-15 PERCENT IS DOING MORE HARM THAN GOOD?)..."Multiple factors are responsible for the current cesarean rate, but emerging contributors include maternal choice" (THIS IS A SMALL PERCENT BUT GROWING AS DOCTORS BOTH ALLOW AND ENCOURAGE SECTIONS FOR NO MEDICAL REASON; SCARE THE DAYLIGHTS OUT OF WOMEN WHO THEN THINK THEY MUST HAVE A SECTION; AND REFUSE TO ATTEND VBACS) "and the rising tide of high-risk pregnancies due to maternal age, overweight, obesity and diabetes." (SO BLAME THE MOM). Nowhere in this statement is there any mention of malpractice fears among OBs, how overly managed labor is resulting in countless iatrogenic problems, leading to even more sections, etc.
Finally, where ACOG questions studies about the safety of home birth (there have been many large-scale ones, recognized around the globe as being well done)it is important to note that in the UK, the government there is actually advocating for MORE home birth, precisely because it is safe and because they recognize that birth in the hospital will almost always end up being more complicated because it is made so by the people who work there. Period.
Anyway, here is the ACOG statement in full. Feel free to write a letter. The address is at the bottom.
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).
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.
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.
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.
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.
ACOG Office of Communications