ACOG Statement on Homebirth
By Danell Swim
February 6, 2008
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.
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The American College of Obstetricians and Gynecologists is the national medical organization representing over 52,000 members who provide health care for women.
Read the Response to ACOG Statement on Home Birth
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7 Responses to “ACOG Statement on Homebirth”
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“Choosing to deliver a baby at home, however, is to place the process of giving birth over the goal of having a healthy baby.”
The thing is the process is part of having a healthy baby. Midwifery lead care is safer and more satisfying for mothers than obstetric care. The sharp increase in medical intervention surrounding birth has not made any improvements on the neonatal morbidity front : Cerabral Palsy is remaining stable? A section rate of +40% is not right and can not be defended.
Where is the evidenced based practice?
Women and Birth are not an INDUSTRY for you to protect your access too.
I too found that statement interesting;
“Choosing to deliver a baby at home, however, is to place the process of giving birth over the goal of having a healthy baby”
From a bacteriological point of view, home birth is healthier for babies. A lot of research on infant gut health of late has found that environmental factors are indeed extremely important for the intestinal colonization. With 70% of our immune system existing within the gut, babies with impaired gut function can not be considered healthy.
Infants who were born vaginally at home and were breastfed exclusively seemed to have the most “beneficial” gut microbiota. On the other hand, it is demonstrated that abnormal development of the intestinal microbiota reported following caesarean section delivery may continue even beyond infancy. In addition to that other practices for managing birth in hospital contribute to poor gut and microbiota health and that is not even addressing the risk of nosocomial infection within hospital.
I wonder from how many aspects the ACOG is considering health and safety in relation to birth. Not enough it would seem as the current argument given is contradictory. Most women don’t have complications… BUT most women should birth in hospital. If one were to apply that to something else, it simply would not fly.
Where are the mass-media-seeded ACOG statements on C section deaths of mothers and babies, the epidemic of unnecessary inductions, supine positioning, coached pushing, vaginal examinations, birthrape, episiotomy?
Any place where physicians are standing by ready to intervene is NOT SAFE TO GIVE BIRTH. Far too many interventions are done for the convenience of surgeons and to “avoid litigation”, not for the genuine wellbeing of mother or child.
Perhaps the reason “homebirth advocates” are “so rosy” about homebirth is because the outcomes at a homebirth far surpass those of hospital births. Instead of asking ACOG for their opinions we should be asking the consumers, the women giving birth under the guidance of ACOG members everyday. I will personally guarantee that midwife attended home births have a far higher rate of satisfaction, lower rates of intervention, almost negligable rates of trauma/distress for both mother and baby, and they cost the state nothing in comparison to the outlandish costs of systematic, medicalised birth.
Birth needs to be demedicalised for it to be safe in hospitals and drug companies need to be denied the massive earnings provided by ACOG members.
typical scare tactics…….statements made that are unsupported by even a cursory glance at research that offers emphatic support to the assertion that homebirth is, at the very least, as safe an option as hospital birth for low-risk mothers. we see the same thing here in bermuda. clearly, GYN/OCIDE (the wanton destruction of the minds and bodies of women by the patriarchal medical establishment) is an offical policy that must be made visible, problematic and then eliminated as a debilitating influence on the well-being of women and babies.
I am a CNM and practice homebirth exclusively now. I’ve practiced in the hospital, and free-standing birth centers. There is no difference in monitoring in NAAC accredited birth centers than at homebirths. The same medical equipment and midwife skill is available at a homebirth as at a birth center birth.
The scientific literature shows over and over that homebirth is at least as safe as hosptial birth. It woudl be so much more fair if the culture of science and medicine would at least consistently base their position statements on the science and evidence they claim to subscribe to. But as it is, the recent ACOG position statement is not different than the usual witch hunts based on fear and superstition.
Trendy Birth: An Odd Dichotomy
Recently the American College of Obstetricians and Gynecologists (ACOG) released a statement against homebirth, calling it, among other things, a dangerous popular trend in modern times. Oddly enough the latest trend in birth truly isn’t homebirth (an occurrence that has existed since the beginning of time) but elective cesareans, or Too Posh to Push, as the media has dubbed it. A few years ago ACOG released a statement about elective cesareans, acknowledging the serious risks to choosing major abdominal surgery for birth, but stated that it was a choice that should be left up to the doctor and his patient.
When I started looking into existing research on both issues I was quite fascinated to note that, contrary to ACOG’s opinion, there was quite a bit of good research showing the safety of homebirth. In fact the one study used as the reason to restrict homebirth was actually flawed to the point of uselessness, due to, among other things, poor controls. Other than that one flawed study, used as the basis for ACOG’s opinion, I could find no other studies that showed homebirth to be riskier than hospital birth for low risk women. In addition to the latest large study on homebirth published in the British Medical Journal in 2005, I also found over ten years worth pervious studies that showed the safety of homebirth for low risk women attended by Midwives.
Conversely one of the sad benefits of the latest trend toward elective cesareans is that we now have enough of a population to determine the pros and cons of an extreme choice like elective cesarean. The results show some very extreme negative risks that are punctuated by increases in maternal and infant mortality.
So why, if there is this laundry list of serious risks to elective cesarean, but no real studies showing serious risks for low risk moms having homebirth, is ACOG coming out full force against homebirth, but not against elective cesarean? Very strange, and very scary.
Amy V. Haas, BA, BCCE
Community Resource Coordinator
Rochester Birth Network
http://www.rochesterbirthnetwork.com
Certified Childbirth Educator
http://www.healthybirth.net
(References available upon request)
References:
American College of Obstetricians and Gynecologists, News Release, February 6, 2008, ACOG statement on homebirths; Office of communications, communications@acog.org 201-484-3321.
American College of Obstetricians and Gynecologists (ACOG). (2000). Planning your pregnancy and birth. Washington, DC: ACOG.
Bernstein, P. S.; “Elective Cesarean Section: An Acceptable Alternative to Vaginal Delivery?” Field Notes in Obstetrics and Maternal-Fetal Medicine
Medscape Ob/Gyn & Women’s Health 7(2), 2002
Citizens for Midwifery; “Out-Of- Hospital Midwifery care: Much Lower Rates of Cesarean sections for Low Risk Women”.; http://www.cfmidwifery.org/pdf/cesarean2.pdf
Johnson, KC; Daviss, BA; “Outcomes of planned homebirths with certified professional midwives: large prospective study in North America”; British Medical Journal,; 330:1416; 2005.
Johanson R, et al; “Has the medicalization of childbirth gone too far?” British Medical Journal 324:892-895 (April 2002)
Kolas, T. , et. al, , “Neonatal Outcomes Worse With Planned Cesarean Than Planned Vaginal Deliveries” Innlandet Hospital Trust, Lillehammer, Norway
,Am J Obstet Gynecol 2006;195:1538-1543
MacDorman MF, et al; “Infant and neonatal mortality for primary cesarean and vaginal births to women with “no indicated risk,” United States, 1998-2001 birth cohorts, Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland 20782, USA. PMID: 16948717
Martin J., et al ; , “Births: Final Data for 2004”; National Vital Statistics Report; Center for Disease Control Volume 55 # 1, September 29th, 2006, http://www.cdc.gov/nchs/data/nvsr/nvsr55/nvsr55_01.pdf
Pang, JWY, et al; “Outcomes of Planned Home Births in Washington State” Obstetrics and Gynecology Volume100:#2;253-259 (August 2002)
Schlenska, P F; “Safety of Alternative Approaches To Childbirth” Doctoral Dissertation; Stanford University, California, http://www.vbfree.org/docs/meadsum.html.
Weaver, J. J., Statham, H., & Richards, M. (2007). ” Are there “unnecessary” cesarean sections? Perceptions of women and obstetricians about cesarean sections for nonclinical indications.” Birth, 34(1), 32-41.
Weigers, TA, et al; “Outcome of planned home and planned hospital births in low risk pregnancies: prospective study in midwifery practices in Netherlands” British Medical Journal 313: 1309-1313 ( November 1996)
“For Low-Risk Women, Risk of Death May Be Higher for Babies Delivered by Cesarean”, Birth: Issues in Perinatal Care. Black Well Publishing, August 29, 2006; professionalnews@bos.blackwellpublishing.net.
Amy V. Haas©2008
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“I agree completely with the excellent article by Amy Haas on the
ACOG position on home birth and on elective C section. The simple
explanation for both these ACOG positions is the same—MONEY. ACOG
is against home birth because it takes clients away from them and they
are in favor of elective C section because they get more money with C
section than with a vaginal birth “Marsden Wagner, MD
(Former head of the committee on maternal child health for the World Health Organization)
2/14/08