Docs gets defensive on home birth

Right on schedule, the American College of Obstetricians and Gynecologists has issued another pronouncement against home birth. It repeats the usual baseless charges that home birth isn’t safe (more on that below)—yawn. Same old racket the docs have been pushing for over a century. Can you blame a guild for defending its turf?

What’s more interesting is what’s new. For the first time, ACOG has altered its stance to accept as safe “accredited freestanding birthing centers.” This is a significant retreat, in the face of what I surmise must have been rising pressure from birth centers. I guess this means these entities are growing in influence and economic power. Midwives attending home births will have this kind of influence when hell freezes over, so the retreat doesn’t suggest it’s likely ACOG will surrender its last stand against home birth any time soon. Still, this retreat makes ACOG’s anti-home-birth stance even more threadbare, as freestanding birth centers offer nothing significant beyond what midwives practicing in the home can offer.

The other interesting new tidbit is this weirdly defensive and downright sneering line: "Childbirth decisions should not be dictated or influenced by what's fashionable, trendy, or the latest cause célèbre. "

“Fashionable”? “Trendy”? A “cause celebre”? Are we talking about home birth, practiced since the dawn of humanity but holding steady at about 1 percent of American births for many decades? People who choose home birth do so in the face of widespread hostility, because of deeply held beliefs, often religious ones. Go tell the Amish they’re being “trendy.” It seems hard to believe big bad ACOG has been scared by Ricki Lake’s new film, “The Business of Being Born.” The movie’s hot in my circles, but has yet to be released in theaters in most of America. A more plausible (and more fashionable) bogey is the favorable mention home birth got in Vogue a few months ago.

ACOG is also defensive about the soaring C-section rate, which it mentions home birth advocates cite as a justification for promoting home births. ACOG states vacuously that it’s “committed to reducing C-section rates," but “there is no scientific way to recommend an 'ideal' national cesarean rate as a target goal." Actually, after thorough review of the scientific literature, the World Health organization has set 15 percent as the upper limit of what C-section rates should be and under 12 percent as a better goal (the U.S.'s rate is currently over 30 percent). The European countries with the lowest infant and maternal mortality rates in the world have C-section rates under 10 percent. These seem like pretty obvious science-based goals.

Among ACOG’s reasons for claiming home birth is unsafe: “a seemingly normal labor and delivery can quickly become life-threatening for both the mother and baby.” In fact, fast-moving emergencies in childbirth are exceedingly rare, and in those cases when they do occur, you’re not much better off in a hospital. Few hospitals have surgeons and anesthesiologists on duty 24-7, and the typical time between the decision to do an emergency C-section and the first cut is thirty minutes—it takes time for on-call docs to arrive at the hospital and scrub up and for equipment to be readied. If you live within 30 minutes of a hospital, you’re just as well off at home—and perhaps better, since, if you have a midwife at home, you have one-on-one attention and the problem may be recognized faster.

Indeed, all well-designed studies have found that a midwife-attended home birth is as safe for low-risk births as hospital birth, and perhaps even safer. See Johnson et al in the British Medical Journal, Janssen et al in Birth, etc, etc. etc.

And get a load of ACOG’s snide and dishonest whack at midwives who attend home births: It refers to “lay or other midwives attending to home births.” “Other” must refer to the highly trained and licensed certified professional midwives who attend most planned home births—nothing lay about it.