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New ACOG Policy on Out-of-Hospital Births
The Executive Board of the American College of Obstetricians and Gynecologists (ACOG) in October issued a new "Statement of Policy" regarding out-of-hospital births in the US. The statement in its entirety is included below. You will note that there is no URL for this new policy statement. ACOG chose to make this policy statement available on-line only to their members, and did not provide any press release about it.

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.


(1) American 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
Now, I didn't expect the ACOG to be pro-homebirth. But the first part that I bolded about there being no evidence that out of hospital births are safer...isn't that incorrect? Even if there hasn't been an "official" study, don't the statistics of many homebirth midwives prove that statement to be wrong? And the United States has the 2nd highest infant mortality rate of the industrialized nations -- doesn't that right there say that the hospital method isn't the best? The countries with the lowest infant mortality numbers also have the highest use of midwives and non-hospital births, I remember reading.

Anyway, that made me a bit
: to read...
 

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Even if there hasn't been an "official" study, don't the statistics of many homebirth midwives prove that statement to be wrong?
Statistically, homebirth midwvies statistics themselves don't prove anything because you don't know if doctors are attending more high-risk births than midwives. If you adjusted for that, you may come up with a different number. (Although we all know from commen sense that it appears that are safer or at least as safe.) I do believe there was a study called the CPM2000 or something that proved that they were "as safe" once the numbers were adjusted to account for high-risk patients that doctors attend.

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And the United States has the 2nd highest infant mortality rate of the industrialized nations -- doesn't that right there say that the hospital method isn't the best? The countries with the lowest infant mortality numbers also have the highest use of midwives and non-hospital births, I remember reading.
Statistically, when two number are correlated, that doesn't mean that one number causes the other to be the way it is. So that still doesn't prove anything. (Again, we can deduce from common sense that the two ARE related but hasn't been proven via a controlled study)
 

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http://bmj.bmjjournals.com/cgi/conte...7505/1416?ehom
This link will take you to a recent homebirth study done in North America. Since ACOG is basing its "official statement" against homebirth on the fact that there are not enough "rigorous" studies on homebirth, this one is pretty relevant. The facts are all there, normal, healthy pregnancies are much more likely to end in positive outcomes through birthing at home, than in the hospital.
 

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The problem I have with this is the hypocrisy. U/s, cefm, arom, induction, c/s, etc etc etc have not shown to increase positive outcomes and in some cases actually causes more problems (like episitomies causing more extensive tears and cefm) and there have been well controled studies done on those that prove that. Do I see obs and the ACOG standing by those studies? No, they do whatever they want despite the studies.

Of course by their standards: studies of sufficient size, prepared in consultation with obstetric departments and approved by institutional review boards - This will never happen. Because there will never be enough hbers included in the study because there aren't that many to begin with. Plenty I think but there will never be enough for them and it will never be in consultation with ob depts because ob depts will never go for it. If they did then women and mws would never have a problem getting a back up.

I just see this as a way that the medical profession is trying to get hbs made illegal or as close to it as possible. Basically making it impossible by imposing impossible standards.
 

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Discussion Starter · #6 ·
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Originally Posted by StacyL View Post
Not like ACOG will be putting up any money for an objective, rigorous study of the comparative data anytime soon.
Ya, definitely not expecting that!

Thank you for the input! gemasita, those are good points that I didn't think of. kathan12904, thanks for the link!

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I just see this as a way that the medical profession is trying to get hbs made illegal or as close to it as possible. Basically making it impossible by imposing impossible standards.
That's what I was thinking, too...if the studies aren't ever done, then it can't be proven that homebirths are better, so of course they just won't DO the studies...it is not right. But in the past two years-ish that I've really gotten into homebirthing (and had my own HB!) and alternative health, I've come to see how much it can be attacked by the mainstream...
 

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Actually, it's not a statement about home birth AT ALL. Follow the conversation at OB/***net and you'll see the ultimate goal that ACOG has is to hinder legislative efforts of legalizing midwives. I was told as much by one of the doctors who wrote it AND another one pretty much told me to shut up and trying to stand up to doctors because it's annoying habit of mid-level practitioners.

If you are a group of doctors and you write a statement denouncing the safety of home birth, then what the heck is the state wasting its time legalizing midwives to practice dangerous acts? It's about midwives, not home birth.
 

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Argh! Is there any sort of movement to support more research like the BMJ study? (Note that the BMJ study doesn't say that homebirth is really safer, but it does say that homebirth is as safe for low risk pregnancies. Given that it's also cheaper, this could be a great boon to a government looking to decrease its skyrocketing medical costs. Assuming one could get past the politics, of course.) I really think that if there were multiple studies by respected organizations showing the true comparative safety of homebirth, legislators would be forced to stand up and take some notice. But they'll never listen to homebirth supporters unless we can get a whole lot of reproduceable results. Scientifically speaking, this doesn't require an enormous number of homebirths, just a number of studes with well-matched samples.

Anyone know of anything we can do to support such research by relatively unbiased organizations?
 

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MANA (Midwives Alliance of North America) collects stats voluntarily from its members and I believe the numbers can be used for future studies. The authors of the BMJ study are in the process of compiling statistics for a follow-up that will include more data.
 

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In Wisconsin we found that the BMJ study was an extremely effective tool for educating legislators about the safety of OOH birth--the fact that it was a prospective cohort study and that CPMs were required to submit their stats that year as a condition of recertification made it clear, as well, that it was a well-conducted, rigorous study.

That said, we also found--and I think this has been the case in other states as well--that the most effective argument to use with legislators had to do with public protection. We would point out the fact that families are always going to choose home birth for religious, financial, cultural or philosophical reasons and that it was their duty to make sure that these families have access to well-trained midwives.

ACOG may believe that home birth is unsafe, but that doesn't mean women are going to stop choosing it--legislators here very much responded to that point.

Katie Prown
Legislative Chair
Wisconsin Guild of Midwives
 
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