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Wednesday, February 6, 2008

Time to Deal with ACOG

My comments in red to this new ACOG statement.

For Release: February 6, 2008
Contact: ACOG Office of Communications
(202) 484-3321

ACOG Statement on Home Births

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. Monitoring of of both mother and the unborn do occur at home. Complications are more likely to arise following the medical interventions introduced by the medical team in the hospital.

ACOG acknowledges a woman's right to make informed decisions regarding her delivery oh, really... 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. Hospital birth is trendy. Babies have been born at home and in fields with and without midwives long before hospitals and physicians participation in birth. 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. following intervention, that is. 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. Attempting a VBAC, immobile, tied down to monitors and receiving pharmaceuticals is far more dangerous. Surgical birth is almost always more dangerous than vaginal birth. 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. Why won't OBs just cooperate and back up homebirth midwives?

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, What are you doing to reduce it? Nothing that I can see.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 My age has nothing to do with it. Why are young women having so many cesareans, then? , overweight, obesity and diabetes what is ACOG doing to help women with nutrition. NOTHING. Most women tell me their OB never mentioned nutrition except for prescribing vitamins. Most women tell me, I am the first physician to mention pregnancy nutrition and referral to the Brewer Diet.

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 hospitalof course, it does!, or a birthing center (So kind of ACOG to extend their support to a birth 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. Most OBs in America would have not been able to deliver my third son feet first safely in my own bed.

ACOG encourages all pregnant women to get prenatal care and to make a birth plan Most OBS don't look at birth plans. . 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. I'd like to know what ACOG member has attended a homebirth, ever? 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.
# # #
The American College of Obstetricians and Gynecologists is the national medical organization representing over 52,000 members who provide health care for women.

I am so glad I am not an OG/GYN.

More responses from the natural birth community can be read at The True Face of Birth


Wife to the Rockstar said...

YOU GO GIRL!! Glad you are my doctor.

Jen said...

After reading this article it is obvious to me now why it was probably so difficult to find this information (aside from not really knowing any other women locally pregnant or with children who might have shared this info. at the time).
After a horrible birth experience in a hospital with essentially no one to guide me or help me - what I would have given for a doula at the least!!! - (even with my husband by my side it was a very scary, helpless, and lonely experience!), followed by breastfeeding difficulties that possibly could have been prevented with the proper guidance and education earlier on (of course I mean pre-Dr. Punger) it has compelled me to want to educate others who probably have NO CLUE of what IS available.
And just as a side note: The woman has a choice!?!?! I was given an episiotomy without being told... and then I was given NO assistance during the actual birthing process so I completely tore anyway!!!... I mean literally the doctors and nurses could have played a game of poker standing around while I pushed the baby out with no assistance whatsoever (even though there was a room full of nurses/two doctors/etc).
I have even considered handing out info. flyers to every pregnant woman I see (and they are everywhere these days) because if I had known then what I know now OH how different things could have been! Even just to know about LLL would have been one step into a many other avenues of education. You would think my "breastfeeding class" would have mentioned these!?!
I look back and realize that if I never was as lucky as I ended up when it came to finding the right guidance and information I would still be just as clueless and would probably have to endure yet another miserable birthing experience because I thought that was all that was available.

Now that I am off my soap box I do have one question...

After about 12 hours of labor my water broke and there was meconium. Of course this fueled concerns so when Luke was born there was a whole "team" of people ready to whisk him away for x-rays etc. In fact the nurse said I was lucky I even got to hold him before they took him away!!! So much for my birth plan of wanting to nurse immediately following birth! In a homebirth situation how is something like this (meconium) handled?

pearly1979 said...

I personally think it's all about money. These people don't want there to be options for us, options to take our money elsewhere. There was no way in hell my OB who does not attend VBACs was ever going to say I was a candidate for a VBAC. She is a business woman. Why would she knowingly and willingly send me else where for a birth she wouldn't give me. She wanted my business so she made my options tailored to what she had to offer so she would get my money. (Or my insurance companies anyways.)

If Ob's backed up homebirth midwives more people would go to hb mw's and less people would come to the Ob. So why would they shoot themselves in the foot like that? That's like Burger King running a commercial telling you how much better Subway is for you, but if you don't really like it you can still come get a whopper. It's so not going to happen.

A healthy pregnant woman doesn't make as much money for an OB as an unhealthy one. The more testing you need and the more monitoring and intervention a woman needs, the more money they make. Think of a cash register, high blood pressure-cha ching, over-weight-cha ching, diabetes-cha ching. Pediatricians that support and promote formula are guilty of the same thing. Do they really want you newborn to be as healthy as possible on breastmilk so that they will only see them at well child visits and never make a dime off you all the rest of the year? Some do, I know this. Many do not. Many are in the pocket of formula companies and it's in the best interest of their pocket as well if a baby is on formula.

As much as I hate it and as unfair as it is to say to the few doctors there are like Denise who truly care, medicine is a huge business and to expect it to be anything else is like beating your head against a wall. I don't see it changing. If people are not sick, doctors do not make any money.

ACOG has to continue to see birth and promote birth as an illness to keep their jobs. This piece is all about job security. I hope there is a homebirth organization that will respond to this and you'll post it. The way to deal with the ACOG is to write some thing like you have, that counter acts their fight for job security.

In our area there has been a huge campaign to raise money to build a children't hospital. A state of the art, best in the area, ideal care facility for children. Every where you turn they are looking for donations from the community to build this thing. Telethons, little ballon posters you can buy with your groceries, etc. I often wonder how they get away with it. They want me to give them money so that they can build a place where they can turn around and charge my insurance thousands and thousands of dollars if my child ever ends up there and providers can then take home a nice chunk of it for themselves???

Anyone want to donate to the daycare I want to build so I can start making me some good money?

Jen said...

It is unfortunate that the world has come to it but "money makes the world go round" in most people's eyes.
It is very re-freshing to see blogs and comments from so many people who are still trying to uphold a wholesome and happy home for themselves and their children.
My husband and I were beginning to loose hope!

labortrials said...

Thank you thank you for this post! I'll be HBACing for the first time in September, so I admit that this statement threw me off a bit. You're right - what OB has any experience with homebirth? Since they only deal with HB transfers (which they call "train wrecks"), of course they are going to be critical of homebirth and homebirth midwives.

~ Kimberly

Permission to Mother said...

Re: Meconium

The homebirth midwifes carry the the suction apparatus for meconium and they carry oxygen and emergency equipment. A great question to ask a midwife upfront is how she handles meconium, just in case it varies from midwife to midwife.

Meconium is often a result of medical interference. Pharmaceuticals stress a baby, as well as labor herbs (and probably the 5 week herbal labor preps). I discourage the use of castor oil. If it makes mom bowels empty... it should affect the baby in a similar way. There is a lot that can be done to minimize the chances of meconium.

Heather said...

I wish, oh, how I wish, that I had known about your practice in September of 06! :( (Ok, actually, BEFORE September, but y'know. Semantics.)

We were living in PSL then, and I allowed myself to be swayed into the medical-mode of thinking by a variety of people. Namely, my mother, who was an L&D RN for years, who told me that, "ACOG says its dangerous! They know what they're talking about!"

And now, on my unfortunate journey post-cesarean, I know better. Much better. And now I know the struggle that I am facing with any future children, and the fight I am in for to get the VBAC I deserve.

L said...

Sing it Sister!Can you send the letter with those red comments right back to ACOG...please!

Love reading your comments!

Permission to Mother said...

I sent my response in red to ACOG just now.


Wani said...

I'm going to forward this post to my friend who is having a hard time getting her husband on board to have a homebirth.
I was looking for blogs related to homebirth and thats how I found you. I had an unnecessary cesarean in July of '05 and then a CNM attended HBAC in March of '07. What a healing experience our homebirth was!
I love to share my birth stories so feel free to contact me if interested!

Permission to Mother said...

Congratulations on your HBAC. Send me the story, or post the link here.


nyjlm said...

wow, I had not heard about this statement (I came to check out your book after your post on FLCA). One certainly has to wonder if this was put out due to Rikki Lake's film.

I guess I should never be surprised at the arrogance of ACOG.

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