ACOG statement on home birth - Mothering Forums

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Old 11-12-2006, 10:23 PM - Thread Starter
 
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This is making the rounds on some listservs, curious if anyone here had seen it. I know what my reaction was :

ACOG Statement of Policy
As issued by the ACOG Executive Board


OUT-OF-HOSPITAL BIRTHS IN THE UNITED STATES

Labor and delivery is a physiologic process that most women experience without complications. Ongoing surveillance of the mother and fetus is essential because serious intrapartum complications may arise with little or no warning, even in low risk pregnancies. In some of these instances, the availability of expertise and interventions on .an urgent or emergent basis may be life-saving for the mother, the fetus or the newborn and may reduce the likelihood of an adverse outcome. For these reasons, the American College of Obstetricians and Gynecologists (ACOG) believes that the hospital, including a birthing center within a hospital complex, that conforms to the standards outlined by American Academy of Pediatrics and ACOG,1 is the safest setting for labor, delivery, and the immediate postpartum period. ACOG also strongly supports providing conditions that will improve the birthing experience for women and their families without compromising safety.

Studies comparing the safety and outcome of U.S. births in the hospital with those occurring in other settings are limited and have not been scientifically rigorous. The development of well-designed research studies of sufficient size, prepared in consultation with obstetric departments and approved by institutional review boards, might clarify the comparative safety of births in different settings. Until the results of such studies are convincing, ACOG strongly opposes out-of-hospital births. Although ACOG acknowledges a woman's right to make informed decisions regarding her delivery, ACOG does not support programs or individuals that advocate for or who provide out-of-hospital births.

1American Academy of Pediatrics and /American College of Obstetricians and Gynecologists. Guidelines for Perinatal Care, 5th Edition. Elk Grove Village, IL, AAP/ACOG, 2002.

Approved by the Executive Board October 2006

The American College of Obstetricians and Gynecologists 409 12th Street, SW, PO Box 96920. Washington, DC 20090-6920 Telephone 202 6385577
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Old 11-12-2006, 10:32 PM
 
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ICK.

: is right!

~Marie : Mom to DS(11), DS(10), DD(8), DD(4), DD(2), & Happily Married to DH 12 yrs.!
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Old 11-12-2006, 10:39 PM
 
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to the aap

We are safest and happiest at home.

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Old 11-13-2006, 01:22 AM
 
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there's a big shock.
wouldn't change my mind in the least, andhopefully not my future clients either

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Old 11-13-2006, 01:25 AM
 
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What a bunch of BULL :
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Old 11-13-2006, 01:27 AM
 
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"Labor and delivery is a physiologic process that most women experience without complications. Ongoing surveillance of the mother and fetus is unnecessary and can even cause serious intrapartum complications, even in low risk pregnancies. In some of these instances, the availability of expertise and interventions on .an urgent or emergent basis may be life-saving for the mother, the fetus or the newborn and may reduce the likelihood of an adverse outcome."

Is how I'd phrase that. :
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Old 11-13-2006, 01:46 AM
 
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Gee, is anybody surprised here? Like they'd ever admit that they're not needed at births, and women are perfectly safe without them?

I like how they phrased the scientific studies: not "studies have been done that prove hospital birth is safer" but rather " We don't like the studies that show out of hospital births are safer, so we'll just phrase that to say you can't prove out-of-hospital births are safe."

Ruth, single mommy to Leah, 19, Hannah, 18 (commuting to college), and Jack, 13(homeschooled)
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Old 11-13-2006, 03:59 AM
 
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Whatever they can do to keep us down and keep the $$$ in their pockets.
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Old 11-13-2006, 04:00 AM
 
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Here is what I want to know...why does the ACOG think they have the right to make blanket statements regarding the safety of birth and set standards for maternity care? The ACOG is a TRADE UNION, people! That's it...why on earth do they think they are the end-all and be-all for all practitioners, hospitals, etc??? UGH!

Marilyn, married to my soulmate Jay and mommy to Elijah Blaze 08/04/2003 and Mila Soleil 10/02/2011 . 
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Old 11-13-2006, 04:04 AM
 
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Oh and they forgot to mention....that with all their wonderful technology the U.S. is ranked 29th in the world in maternal mortality (WHO 2000), and 27th in Infant Mortality (U.S. Dept. of Health and Human Services 2004). Of course they have fancy words to explain that aways too. Ya, that's the care that seems safest to me....
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Old 11-13-2006, 04:08 AM
 
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Quote:
Originally Posted by Marilyn82
Here is what I want to know...why does the ACOG think they have the right to make blanket statements regarding the safety of birth and set standards for maternity care? The ACOG is a TRADE UNION, people! That's it...why on earth do they think they are the end-all and be-all for all practitioners, hospitals, etc??? UGH!
:

I never actually thought about that until I read something along that lines in Marsden Wagner's book "Born in the USA". Very akin to the ACOG's guidelines on suspected fetal macrosomia with many of their recommendations being made "primarily on consensus and expert opinion" rather than on "good and consistet scientific evidence". Grrrr...
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Old 11-13-2006, 12:37 PM
 
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How utterly vague!

And speaking of opinions....

Quote:
For these reasons, the American College of Obstetricians and Gynecologists (ACOG) believes that the hospital, including a birthing center within a hospital complex, that conforms to the standards outlined by American Academy of Pediatrics and ACOG,1 is the safest setting for labor, delivery, and the immediate postpartum period.
They simply cannot say that is it safer because it is not. All they can say is that they BELIEVE that it is safest. Well, I believe it is! So there! Let's just throw opinions back and forth. What do the facts say?

Quote:
Studies comparing the safety and outcome of U.S. births in the hospital with those occurring in other settings are limited and have not been scientifically rigorous.
Um, that is just not true.

I didn't realize they are a trade organization. What does that mean exactly? I always refer to them as a professional organization but now I realize I don't know what I'm talking about.

Jamie, DW to Jeff, birth and postpartum doula and Hypnobabies instructor.
4 years and 5 IVF cycles in the making, Elliott was born at home in water on 2/2/11.
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Old 11-13-2006, 12:39 PM
 
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The Surgeons will do just about anything to put $$$ in thier pocket now won't they??????

This makes me soooo MAD!!!!!

Heather
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Old 11-13-2006, 03:24 PM
I think the new policy statement is a good sign, especially given the fact that it follows on the heels of their most recent statement on "lay midwifery," which I've copied below. The two statements are somewhat contradictory in that the midwifery statement validates the CNM and CM credentials, thereby acknowledging the value of midwifery care. And the fact that the statement mentions "lay midwives" is a backhanded way of acknowledging out-of-hospital midwifery care. In other words, the statement basically says, if you're going to choose a homebirth midwife (because where else do "lay midwives" practice?) then we think you should choose a CNM or a CM (and how many CMs even have hospital privileges?)

Then this new statement comes out and says, oh by the way, we don't think homebirth is such a good idea and we don't support anyone who practices or advocates for it. So what about those CNMs and CMs you just told us are more qualified than "lay midwives" to attend OOH births? Do you support them or not? Or did you just throw them to the curb?

And what I especially love about both statements is that they acknowledge a mother's right to choose her maternity care provider and even the setting where she gives birth. It's a far cry from their earlier statements that referred to homebirth as "child abuse" and that opposed all forms of midwifery. Plus I think it's a sign that they've realized they're losing the battle against legislative advances that CPMs have been making in recent years, where one of the strongest arguments on our behalf has been pointing out that some women will always choose homebirth regardless of what ACOG has to say about it. The fact that they've finally been forced to concede that point is huge, IMO, and a sign of real progress.

Katie Prown
Legislative Chair
Wisconsin Guild of Midwives

ACOG Statement of Policy
As issued by the ACOG Executive Board

LAY MIDWIFERY

The American College of Obstetricians and Gynecologists (ACOG) is the representative organization of physicians who are qualified specialists in providing health services to women. ACOG is committed to facilitating access to women's health care that is both safe and high quality. One method of attaining this goal is to assure that providers of care meet educational and professional standards of a certification process. ACOG recognizes the educational and professional standards currently used by the American Midwifery Certification Board (AMCB)* to evaluate and certify midwives. While ACOG supports women having a choice in determining their providers of care, ACOG does not support the provision of care by lay midwives or other midwives who are not certified by the AMCB.

*The American Midwifery Certification Board (AMCB), formerly known as the ACNM Certification Council (ACC), was incorporated in 1991. The AMCB develops and administers the national certification examination for Certified Nurse-Midwives (CNMs) and Certified Midwives (CMs). CNMs are registered nurses who have graduated from a midwifery education program accredited by the American College of Nurse Midwives Division of Accreditation and have passed a national certification examination administered by AMCB. Certified midwives have also graduated from a midwifery education program accredited by the American College of Nurse Midwives Division of Accreditation, have successfully completed the same requirements, have passed the same AMCB national certification examination as certified nurse-midwives and adhere to the same professional standards as certified nurse-midwives.

Approval by the Executive Board February 2006
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Old 11-13-2006, 04:37 PM
 
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Quote:
Originally Posted by sapphire_chan View Post
"Labor and delivery is a physiologic process that most women experience without complications. Ongoing surveillance of the mother and fetus is unnecessary and can even cause serious intrapartum complications, even in low risk pregnancies. In some of these instances, the availability of expertise and interventions on .an urgent or emergent basis may be life-saving for the mother, the fetus or the newborn and may reduce the likelihood of an adverse outcome."

Is how I'd phrase that. :
I agree completley. The way hospital staff moniters a laboring woman compared with the way a competent midwife observes is 1000 times different.

Quote:
Originally Posted by Ruthla View Post
Gee, is anybody surprised here? Like they'd ever admit that they're not needed at births, and women are perfectly safe without them?

I like how they phrased the scientific studies: not "studies have been done that prove hospital birth is safer" but rather " We don't like the studies that show out of hospital births are safer, so we'll just phrase that to say you can't prove out-of-hospital births are safe."
What they don't mention is WHAT study they used! They used a study, which used natural miscarriages done at home as birth outcomes!!!!

(and for some reason, I can't seem to come up with a link to that study!)

~Autumn~   Mama to whistling.gif (2001) and hearts.gif(2005) partners.gif madly in love since '99 
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Old 11-13-2006, 04:46 PM
 
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Originally Posted by [email protected] View Post
Plus I think it's a sign that they've realized they're losing the battle against legislative advances that CPMs have been making in recent years, where one of the strongest arguments on our behalf has been pointing out that some women will always choose homebirth regardless of what ACOG has to say about it. The fact that they've finally been forced to concede that point is huge, IMO, and a sign of real progress.
I agree. If they didn't see us as a threat, they wouldn't be making statements against us. In the past we've been totally ignored by them.

I do worry, however, about those of us in states that require OB "backup." I may be in the only state in the union that requires OB backup...I'm not sure. But statements by ACOG against what I do make it very hard for even the best OB to support me. If we could just get rid of the darned backup law, but alas, we've tried and it's not going well...

Charlotte, midwife to some awesome women, wife to Jason, and no longer a mama to all boys S reading.gif('01), A nut.gif ('03) S lol.gif ('08) and L love.gif ('10).
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Old 11-13-2006, 05:22 PM
 
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Old 11-13-2006, 05:23 PM
 
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The back up physician is quickly becoming a joke in PA! No one will touch a direct entry or CPM midwife with a ten foot pole! We only have birthing centers staffede by CNM's and even those are quickly fading into the past. CNM's that were once hired by the hospital are being let go, reduced to part time, or reduced to doing the gyn care and not doing births.
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Old 11-13-2006, 06:40 PM
 
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Originally Posted by Ruthla View Post
I like how they phrased the scientific studies: not "studies have been done that prove hospital birth is safer" but rather " We don't like the studies that show out of hospital births are safer, so we'll just phrase that to say you can't prove out-of-hospital births are safe."

Totally! Gah!

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Old 11-13-2006, 06:59 PM
 
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ACOG does not support programs or individuals that advocate for or who provide out-of-hospital births.
So back-up OBs have to go against ACOG, right? That is sad for so many midwives.

Jamie, DW to Jeff, birth and postpartum doula and Hypnobabies instructor.
4 years and 5 IVF cycles in the making, Elliott was born at home in water on 2/2/11.
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Old 11-13-2006, 07:00 PM
 
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Interesting that they lumped OOH birth centers in here. Those CNM's who rely on OB's for their birth centers to be legal may now be screwed. I would expect some backlash from ACNM, but so far no statement that I can find. And I do think that this statement is in direct response to the BJM published CPM study.
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Old 11-13-2006, 07:00 PM
 
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So back-up OBs have to go against ACOG, right? That is sad for so many midwives.
EXACTLY.

Charlotte, midwife to some awesome women, wife to Jason, and no longer a mama to all boys S reading.gif('01), A nut.gif ('03) S lol.gif ('08) and L love.gif ('10).
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Old 11-13-2006, 09:05 PM
 
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I suggest that we take this opportunity not to rant and rave like the righteously angry women that we are, thus giving them the opportunity to dismiss us, but be calm and rational and send communication to ACOG respectfully requesting that until such time as they do get "convincing" evidence on the safety or unsafety of homebirth that they decline having an "official statement of policy" because to do so would be to make an uninformed conclusion that they themselves admit they have no basis on which to make.

Mom of three spunktastic kiddos, supported by super-partner while dabbling in midwifery and organic farming. Biting off more than I can chew since '03.
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Old 11-13-2006, 09:19 PM
 
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Yea, well, maybe when they come up with a set procedure other than the fact it is completely 100% OK not to inform a patient about a potential pregnancy complication I will believe this.

After my daughter's stillbirth, and the fact that 1) They completely failed to inform my husband and myself of the fact she had a 2 vessel cord; and 2) the fact that given my history of very fast labor they allowed me to walk around for 3+ weeks breech with the "we will see what happens when you go into labor" is perfectly acceptable standard of practice, I have decided from now on I will 100% be homebirth. That I no longer trust a medical professional with my care or my child's care.
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Old 11-13-2006, 10:36 PM - Thread Starter
 
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Originally Posted by mom2seven View Post
Interesting that they lumped OOH birth centers in here. Those CNM's who rely on OB's for their birth centers to be legal may now be screwed. I would expect some backlash from ACNM, but so far no statement that I can find. And I do think that this statement is in direct response to the BJM published CPM study.
ACNM is preparing a statement, it hasn't been released yet. They are trying to team with other associations like the APHA to strengthen the response. I will suggest that the AABC be approached, too. I think you are absolutely right that FSBC's are at risk here as well.
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Old 11-13-2006, 10:55 PM
 
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Originally Posted by Ruthla View Post
Gee, is anybody surprised here? Like they'd ever admit that they're not needed at births, and women are perfectly safe without them?

I like how they phrased the scientific studies: not "studies have been done that prove hospital birth is safer" but rather " We don't like the studies that show out of hospital births are safer, so we'll just phrase that to say you can't prove out-of-hospital births are safe."
Have you guys seen the movie/read the book Thank You for Smoking ? Even though it's fictional (based on life) it provided interesting insight into the workings of such interest groups as ACOG.

Quote:
Originally Posted by Marilyn82 View Post
Here is what I want to know...why does the ACOG think they have the right to make blanket statements regarding the safety of birth and set standards for maternity care? The ACOG is a TRADE UNION, people! That's it...why on earth do they think they are the end-all and be-all for all practitioners, hospitals, etc??? UGH!
Because anyone can make blanket statements. They say "look we're doctors this is what we say". Most people aren't going to question it. Heck, I even use most doctor organization statements as jumping off points (but that's all)

Quote:
Originally Posted by nurnur View Post
Oh and they forgot to mention....that with all their wonderful technology the U.S. is ranked 29th in the world in maternal mortality (WHO 2000), and 27th in Infant Mortality (U.S. Dept. of Health and Human Services 2004). Of course they have fancy words to explain that aways too. Ya, that's the care that seems safest to me....
Here here! I just LOOOOOVe how no OB care people ever point that out. That data is available thru Mothers’ Index and State of the World’s Mothers 2006 report too, but the way the healthy mother initiative thing is written you see how dangerous birth *can* be, but you have to really dig and think to discover that the US is pitiful compared to most other developed nations. We need an indepth report exclusive of developed nations to really advance and streamline women's care. The healthy mother initiatve is great for what it does, but it won't help us.
http://www.savethechildren.org/publi...2006_final.pdf
We get ranked #10 tied with the UK because they take into account the following:
lifetime risk of maternal mortality
percent of women using modern contraception
percent of births attended by skilled personnel
percent of pregnant women with anemia
adult female literacy rate
participation of women in national government

infant mortality rate
gross primary enrollment rate
percent of population with access to safe water, and
percent of children under age 5 suffering from moderate to severe nutritional wasting

Emphasis mine- our ranking of perinatal safety is skewed )

Quote:
Originally Posted by BeckiCNM View Post
ACNM is preparing a statement, it hasn't been released yet. They are trying to team with other associations like the APHA to strengthen the response. I will suggest that the AABC be approached, too. I think you are absolutely right that FSBC's are at risk here as well.
Can't wait to read it!

~laura
and planning to eat it again
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Old 11-13-2006, 11:13 PM
 
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yeah yeah, the world wrong and the ACOG is right, they are as non partisan as the FDA :

How many hospitals are actually equiped to perform a section within minutes? Hm?
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Old 11-14-2006, 12:18 PM
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Old 11-14-2006, 12:33 PM
 
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That is just so sad!!!!

Here in Canada we pay taxes to cover healthcare and the government covers the care of a midwife...and they are allowed to have homebirths (with certain restrictions and guidelines).

Our government and OB's seem to feel homebirth is perfectly safe....

The only reason OB's in the U.S are against birthing outside a hospital is because they cannot profit from it.....they don't really give a care about women/infant healthcare....if they did they wouldn't give the poor care that they do during normal childbirth....

Our government regulates how many midwives are able to work....therefore they can stack the deck in favour of OB's and clients (our OB's had to many clients to handle anyways...so, the few that go to midwives actually helps them)...we also have certain restictions and once a mom fits into a certain criteria she has to be taken over under OB care...

I love the way our system works (except for the restrictions on homebirths/midwives...which is why I went unassisted)...but, just like in the U.S...it really does feel like OB's run the show...



~Charlene~
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Old 11-14-2006, 12:57 PM
 
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requesting that until such time as they do get "convincing" evidence on the safety or unsafety of homebirth that they decline having an "official statement of policy" because to do so would be to make an uninformed conclusion that they themselves admit they have no basis on which to make.
Wow, that is powerful. And right on!

Jamie, DW to Jeff, birth and postpartum doula and Hypnobabies instructor.
4 years and 5 IVF cycles in the making, Elliott was born at home in water on 2/2/11.
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