Thursday, February 7, 2008

ACOG's loose cog on homebirth and Gail's comments

I got an email from my friend Debra Pascali Bonaro today. She's always up to date. She sent along the following statement from American College of Obtetricians and Gynecologists.

Wow, see ACOG's news release below against Home Birth... ACOG must be feeling
threatened from all the discussion about Home birth...The Business of Being
Born
and more movies in the pike that are creating awareness and discussion.
I can't wait till we release Orgasmic Birth this spring. [Premiers in Minneapolis, September 25th, 2008]

As Christine Morton wrote: "interesting way they discount research showing
safety of home birth with trained midwives in attendance and end up
accounting for the rise in cesareans in terms of women¹s desires and
bodies. Hmmm."

I hope some of our groups will be responding to this... From a PR
perspective this is great... It shows they are threatened and this will
keep the dialogue going I hope.
Hugs
--
Debra Pascali-Bonaro
www.orgasmicbirth.com


Here's the statement:


ACOG NEWS RELEASE
For Release:
February 6, 2008
Contact:
ACOG Office of Communications
(202) 484-3321
communications@acog.org
ACOG Statement on Home Births

Paragraph 1.) 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.

2.) 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).

3.) 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.

4.) 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.

5.) 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.

6.) 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.

7.) 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.

# # #

The American College of Obstetricians and Gynecologists is the national
medical organization representing over 52,000 members who provide health
care for women.


Gail's Reactions

ACOG's statement includes misleading projections, emotionally-based opinions, fear, and just plain self serving PR. I'd be nice, but ACOG has been promoting its position with false and jilted accusations against non OB birth attendants for decades and it gets tiresome.

First of all, Mehl in the 70s and, currently, Daviss and Johnson in this decade have constructed excellent research on the safety of homebirth with non-nurse midwives. CPM2000 research outcomes have been available for plenty of time now for a fellow of ACOG to read it. Canada and Britain embrace the quality job done by Betty-Anne Daviss and Ken Johnson, though, like the doula studies, its rare that an American physician doesn't block, obscure and resist evidence-based innovations that would require them to share care in the birthing room.

Gail's rebutal:

1st paragraph
"No warning" --?! Trained homebirth Midwives handle birth emergencies very well. Ken Johnson shared that though homebirth midwives may experience higher numbers of shoulder dystocia [presumably due to higher average birth weights among homebirth families] there were no deaths and fewer adverse outcomes when compared to
shoulder dystocia in hospital birth statistics. I'm waiting for specifics on that finding from Ken. I mention it here as an example.

2nd paragraph and Gail's comments:
"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, ACOG acknowledges that women are choosing homebirth providers, but doesn't support homebirth programs or providers. Thats a relief. I wouldn't trust an ACOG based homebirth service. The transport rate would likely be 100%, eh?

3rd paragraph and rebuttal:
"Childbirth decisions should not be dictated or influenced by what's
fashionable, trendy, or the latest cause célèbre."
Will ACOG rebut the cesarean fashion raging in Hollywood?

"Despite the rosy picture
painted by home birth advocates, [Again, I'm loving living in the Light and Color as a homebirth midwife. Inside joke, and reference to Susan Sarback's School of Light and Color.] a seemingly normal labor and delivery can
quickly become life-threatening for both the mother and baby. "
We covered this in paragraph 1.


"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."

My friends who work as hospital employees on Labor and Delivery tell me of mistakes that cost lives and ruptures. Mistakes such as attempting to flush the uterus of meconium or increase amniotic fluid by replacing the natural fluid with a saline solution-only not to notice that the solution is blocked by the baby's head and can't exit. The fluid builds up until the uterus ruptures. Then, there is the continued use of cytotec for induction and its causal increase in uterine rupture, and a subsequent rise in amniotic fluid embolism of over 200%. Amniotic fluid embolism is almost always fatal to the mother, and that is also true against the healthy mother, and she doesn't have to have had a uterine scar for a cytotec rupture.

Let's address the speed of surgery necessary for saving a baby after a catastrophic rupture. Another friend spoke of an induced VBAC mother on an epidural complaining of uterine and shoulder pain. She was told repeatedly that the epidural wasn't taking fully and that she was fine. That is, until the baby died. Then the doctors discovered that her uterus had been ruptured for some time- time enough to have done surgery hours before and save her baby.

Homebirth midwives tend to listen to mothers. Homebirth mothers do not have epidurals which can confuse symptoms. Other problems may occur with home VBAC, and rarely they will, but lets not confuse location of birth with the illusion that death happens in one place and not another. Facts, irrefutable data, exist to show the safety of homebirth.



4th paragraph and rebuttal:
ACOG is looking to see if a reduction in the cesarean rate is necessary? Would a plumber seriously tell the building commission one toilet per house is all that is really necessary? No offense to plumbers, please note, who do not, mind you, in any way imply that homeowners should install a toilet for every person in the house to protect them from the effects of incontinence. Nor do plumbers advocate studies to see how many feet of pipes American cities and towns could bear before the public noticed adverse effects, such as soil erosion, or problems with laying streets, and raise an alarm that would outweigh the monetary benefits to their profession. However, ACOG and many OBs talk of cesarean studies to see how many medically unnecessary cesareans could be done before the public complained of loss of mothers, injuries to too many mothers and children, etc. Right now, obstetrics supposes that the corresponding higher maternal death rate is acceptable at a 30+% cesarean rate.


Gail's comment on paragraph 5:
Women risk the increased injury of having an Obstetrician care for them rather then a Family Practice doctor or Midwife. Non medically trained midwives have been shown to have the lowest injury rates of trained birth attendants. (Mehl)Link


Paragraph 6:
References that refute ACOG's claim that homebirth hasn't been adequately studied is aptly addressed at the following links:
British Medical Journal, CPM2000 http://www.bmj.com/cgi/content/full/330/7505/1416
Midwives Alliance Homebirth References
Ronnie Falcoa's posting of Homebirth and Out-of-Hospital Birth, Is it safe?
Excerpts from Experts on homebirth safety at Heritage Homebirth
From Mothering Magazine and Pam England There's No Place Like Home.

Paragraph 7:
Thomas Strong, MD succinctly challenges the ACOG and medical prenatal care system in his book, Expecting Trouble. Women come to homebirth midwives sometimes just to get the superior prenatal care. We often spend 45 minutes to an hour with families. Nutritionally based prevention is limited in clinic settings. However, many homebirth midwives give extensive nutritional counseling to prevent anemia, preeclampsia, postpartum hemorrhage, to enhance the health of the baby and mother and postpartum recovery.

ACOG says, "Choosing to deliver a baby at home, however, is to place the process
of giving birth over the goal of having a healthy baby. "
Let me share an excerpt of an email I sent to a grandmother who works with infant loss in her occupation. She was worried about her daughter's upcoming homebirth:

"Remember the risks of birth are three, " Gail wrote,
  1. "Those we have no control over and will happen no matter home or hospital;
  2. Those that are due to interference or neglect by well meaning caregivers that misunderstand the physiology of birth (again, no matter where they are or got their training and in spite of intent);
  3. And last and least often, by delay in emergency help.

There are uncommon events that can make a lovely home birth turn sour or tragic. I acknowledge that.

But there are common and standard events that interrupt bonding, breastfeeding and a mother's perception of her ability to parent and succeed as a woman, mother, wife and community contributor that happen with every hospital birth. Yes, I mean to say every. Even those rare, good hospital births with wonderful, skilled and intuitive care providers like [your daughter's Family Physican used for her first child's birth].
These interruptions in the physiology of human birth come from birthing outside of a woman's own environment. These interruptions can not be made up, but they can be compensated for. We now have generations of human mothers compensating for poor birth environments and the subsequent adverse effect on mothering and self. We are the walking wounded.
[Your daughter], along with other home birth mothers, just doesn't think that accepting some harm, the certain harm of disrupting the physiology of childbirth, is worth accepting to avoid the very small risk of harm due to the location of a home birth. Most emergency cesareans take 20 minutes or longer to begin, did you know that? You may find the CPM study useful."



ACOG concedes:
"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."

CNMs offer a wonderful service to American women. And CNMs will remember when ACOG was against their profession. Birth Center advocates will remember when they were attacked by ACOG.
Let's not fall into the pattern of the recently oppressed once raised now turning on those below them in the hierarchy of (supposed) power. Midwives must stand together. Submission of midwives under physicians may have a similar dynamic of how a battered wife will submit and stand by her man as she and her children are lost or emotionally distorted beyond recognition.
Professor Shelley E. Taylor, PhD on Womens' Stress Response


We have to speak up for homebirth. Our future depends on safe and gentle, physiologically centered birth care. Not only from midwives, but doctors, nurses and family members, is physiological and kind care needed.


Here is an email sent to me about this entry:


"Great response as I too, was going to add, they should practice what
they preach. "Childbirth decisions should not be dictated or influenced
by what's fashionable, trendy, or the latest cause célèbre." I can't
tell you how often dr.s I have asked about the increase in C birth reply,
"My hands are tied as women come in asking for it at their first
prenatal visit." Sounds like the woman is blamed again rather than the
dr. giving reassurance a vaginal birth is safer and natural.

Since I am the 'grandmother' you speak of, it was great! I'll forward
this to [her] sister who is having a home birth in five weeks. Keep up
the good work!

Joann"

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