Anger Towards ACOG

I'm trying not to be angry about ACOG's (The American College of Obstetricians and Gynecologists) latest statement on home birth. I'm hoping Amie will weigh in here with some of her eloquence and humor, but in the meantime, a few quick excerpts and responses...

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.

This reminds me of the OB in The Business of Being Born who said her problem with home birth was, "What about monitoring? Do they do fetal monitoring?" In other words, ignorance of what midwives actually do at a home birth. And which complications are they concerned with, exactly? The medical community tends to use that ominous word without delving into what they mean by it. (They also like to say, "If you'd seen what I've seen...") Midwives are highly trained professionals who know how to deal with (rare) emergencies, and who will, if necessary, transport care to a hospital setting.

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.

So, basically ACOG doesn't support women's rights to make informed decisions regarding her delivery and choice of provider.

Childbirth decisions should not be dictated or influenced by what's fashionable, trendy, or the latest cause célèbre.

Because .5% of birth represents a fashionable trend. But I think really this is a dig at Rikki Lake.

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...Multiple factors are responsible for the current cesarean rate, but emerging contributors include maternal choice...

If ACOG is so interested in reducing the number of cesareans, then WHY do they keep harping on cesarean by "maternal request"? (See this great pdf from the Lamaze Institute for an excellent summary of the issue and references.) Especially when you consider the fact that most women aren't actually requesting them?

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.

And the BMJ study is what, chopped liver? I love how they use the term "lay midwife," to imply someone with little or no training. It takes time to prep an OR, even if you're in the hospital. Cesarean doesn't just happen by magic. Often a homebirth transport patient can have a cesarean as quickly as a patient in the hospital, since her midwife (a highly trained, competent professional) can alert the hospital to their impending arrival and need.

ACOG encourages all pregnant women to get prenatal care and to make a birth plan.

No one in the hospital will read your birthplan, but it's nice to know ACOG supports us having them! Oh, and midwives provide excellent prenatal (and postpartum!) care.

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.

Wait, homebirthers don't care about healthy babies?! I chose a home delivery the second time around largely because I felt it was safer than the hospital. But the second line is what I really want to address. The "process" is important. The "process" can be magical, empowering, and beautiful. The "process" can give birth to a stronger woman, can lead to a more satisfying breastfeeding relationship, and can make bonding so instant and intense that the mother won't hesitate to advocate for her child for the rest of its life. The "process" can also belittle, abuse, and devastate both mother and baby. If ACOG doesn't see the value in birth itself, then all the rest of this is beside the point. ACOG just doesn't get it.