ACOG Strikes Again

Just when I think I have nothing else to write about, they go and issue an "opinion." They is ACOG (American Congress of Obstetricians and Gynecologists) and the opinion is on home birth no less. Here is a link to the "opinion" so you can read it in full. (As an aside, did you know that this group, that has paved the way for a 30%+ c-section rate actually,

"strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women's health care."

Yes, it actually says that in their description of themselves. Deep breath. )

Lets begin at the beginning, shall we?

although the absolute risk of planned home births is low, published medical evidence shows it does carry a two- to three-fold increase in the risk of newborn death compared with planned hospital births."

Well, I can get behind the whole absolute risk of planned home birth is low, but it carries a two to three- fold increase in the risk of newborn death? Is this true? Lets check the sources for these studies cited in the "opinion".....

Wait, they didn't cite their sources. Are we dealing with a physicians group or not? Maybe they got called away to an emergency birth and didn't have time to cite their sources. That's fine, I can go see if I can find some with the handy dandy Internet. I have no doctorate so we shall see how it goes.

Wait! Here is one, from Canada but a nice big study. And I quote:

Results: The rate of perinatal death per 1000 births was 0.35 (95% confidence interval [CI] 0.00–1.03) in the group of planned home births; the rate in the group of planned hospital births was 0.57 (95% CI 0.00–1.43) among women attended by a midwife and 0.64 (95% CI 0.00–1.56) among those attended by a physician. "

That looks suspiciously like the rate of death in the physician attended hospital group was 0.64 but was 0.35 in the midwife attended home birth group, almost half! No, this can not be the study they were referring too, the data is switched, more people are dying WITH the doctors. I must keep searching.

Here is another study. They found that:

"CONCLUSIONS: The perinatal hazard associated with planned home birth in the few women who exercised this option was low and mostly unavoidable."

This must not be the study that ACOG was thinking of either, it seems to indicate that sometimes, things just go wrong.

Ahh, this just might be it. A study in Washington done by looking at birth records which found that home birth was less safe than hospital birth. Here is Henci Goer tearing it apart for bad research practices and including pre-term and unplanned or unattended home birth in their data. This might be the famous "home birth kills" study that appears to be deeply flawed.

Lets move on though.

A review of the data also found that planned home births among low risk women are associated with fewer medical interventions than planned hospital births."

Ahh, interesting. This is on of the big reasons why women choose to birth outside of the hospital and far far away from anybody associated with ACOG. Yes, even they admit (because maybe they don't realize that interventions are a BAD thing?) that home birth tends to result in much lower intervention rates.

I am getting tired but I am going to keep trudging through this "opinion" paper. Lets just skip to the end.

The recommendations state that a prior cesarean delivery is an absolute contraindication to planning a home birth due to the risks, including uterine rupture. Women who want to try for a vaginal birth after cesarean are advised to do so only in a hospital where emergency care is immediately available. Attempting a home birth also is not advised for women who are postterm (greater than 42 weeks gestation), carrying twins, or have a breech presentation because all carry a greater risk of perinatal death."

Oh yeah, I almost forgot about the dangers of birth for women who have already been literally cut by a prior hospital intervention, or were crazy enough to go post dates or have twins. They need to be in a hospital where interventions they are trying to avoid are readily available.

I am not even going to take the time to look up studies to contradict this. In fact, I have no doubt that there are higher risks with VBAC, twins or post date pregnancies. Instead of trying to prove ACOG wrong with studies, lets just look at something that they themselves stated just a few months ago when they came out with a new VBAC statement. (TOLAC refers to trial of labor after cesarean.)

most women with one previous cesarean delivery with a low-transverse incision are candidates for and should be counseled about VBAC and offered a TOLAC. In addition, "The College guidelines now clearly say that women with two previous low-transverse cesarean incisions, women carrying twins, and women with an unknown type of uterine scar are considered appropriate candidates for a TOLAC,"

Nowhere do they say that they endorse home birth, but they do admit that women should be "allowed" to labor even if they have had more than one c-section or if they are carrying twins AFTER a previous c-section.

They also go on to admit some of the problems that can be avoided if a woman is able to VBAC rather than have a repeat cesarean.

A VBAC avoids major abdominal surgery, lowers a woman's risk of hemorrhage and infection, and shortens postpartum recovery. It may also help women avoid the possible future risks of having multiple cesareans such as hysterectomy, bowel and bladder injury, transfusion, infection, and abnormal placenta conditions (placenta previa and placenta accreta)."

Lets end with a sentence from ACOG's new opinion.

"A review of the data also found that planned home births among low risk women are associated with fewer medical interventions than planned hospital births."

Boys, let me get this strait- you admit that home birth has fewer interventions than hospital birth. You also admit that attempting a VBAC is safe as is twin delivery. You admit to the high success rates of VBAC. You also claim to advocate for patient safety and education.

Ladies and gentlemen, the reason so many women birth at home, in PARTICULAR when they are attempting VBAC or are higher risk for some reason, is that they WANT to avoid those higher hospital intervention rates. They know that they will be fighting an uphill battle if they dare gestate for longer than 40 weeks. They know that they are simply less likely to be interfered with if they birth at home.

I am not saying that ACOG is totally off base. There is some truth in their statement. I wholeheartedly agree that you must choose your birth attendant carefully and have plans in place for transfer or possible emergencies. Planning a home birth is NOT fool proof. Things can go wrong. Educate yourself. Know what is safe and legal. Know what your attendant is capable of and how well trained he or she is. Do everything you can to prepare for good outcome.

But I do hope that women will continue choose birth that is safe, beautiful, and natural and not be scared off by this ridiculous statement unbacked by any research notes.

What speaks louder than anything to me is that ACOG takes the time to even comment on home birth. They must know that only about one percent of women in America choose to birth this way. And yet, they are worried about it.

I think the reason that the powers that be care at all about home birth is not that they are worried about yours or my safety, it is because they realize on some level, that birth can be much more than they will ever be able to offer in their hospitals. They don't want the word to get out. That, could hurt their bottom line.

Birth safe.


Birth Smart said…
i love the way they say they don't reccommend homebirth . . . but if you do it, be sure and do it their way - with the gbs screen, etc. ok sure. just a reality check: women planning a homebirth are past the point of viewing you as an authority.
Cherylyn said…
Awesome post! Thank you for such a swift response to the new statement.
Love this post. It just reiterates several thing: that ACOG has no balls whatsoever. That when ACOG insists that something is dangerous, every doctor gets on board and talks about it, but when they say something that's *perceived* as dangerous is really *safe* NO physician in the world adheres to their "guidelines." What a joke.
Anonymous said…
As a c-section mom (due to rigid birth center protocols with ticking clocks and ROM, thanks again, ACOG), I have to wonder if the 30-40% c-section rate and the "HBAC is SO DANGEROUS! YOU MIGHT EXPLODE!" nonsense just serves to ensure there are lots of mothers who feel they have to be in a hospital to give birth safely. They are trying to ensure repeat business. I feel lucky to have gotten out of that hospital alive, with my baby healthy. They put us in (apparently) grave danger because of some statistical risk of infection. That is a terrible way to practice "medicine". I now think OBs are a bunch of quacks who I wouldn't trust to neuter my dog.
As a pregnant mom with twins...I am home birthing because of the hospitals and doctors. I do not know why ACOG even bothers giving an opinion; the docs and hospitals ignore them.

The TOLAC thing is hilarious. Yes, VBAC'ing mothers would probably benefit from VBACing in a hospital 'just in case' for their first VBAC. Tell me, then, why most docs and hospitals do not allow this?

For me, twin home birth is a big no no. However, if I were to have my twins in the hospital, I would be forced to labor in the OR, flat on my back with an epidural. Now, I don't know about you, but that doesn't sound like a great way to 'attempt a natural twin birth'.

ACOG is just a mouthpiece. That's all they are. They haven power to affect change in the medical field. They are used to tell the public..."look! Now you can trust your doctor...look at all of these things we just said!". But until there is a way to MAKE docs and hospitals adhere to their guidelines, I just consider it all putrified air blowing out the wrong hole.
I think you really hit the nail on the head when you questioned why ACOG even takes the time to continue releasing opinions on homebirth, given that less than 1% of American women choose to give birth at home.

ACOG is nothing but a mouthpiece for the big businesses of hospitals and insurance companies who thrive with high intervention and c/s rates.

Homebirth isn't good for profits.
Kara Dudley said…
Thank you for this wonderful post! Many people DO think that birth in a hospital is safer; it makes sense until you delve deeper into the information and really look at what a hospital birth entails. I had a wonderful out of hospital birth (at a freestanding birth center) with a direct entry midwife. My next baby will be born at home. I couldn't imagine birthing in a hospital unless something was REALLY wrong.
erinmidwife said…
The battle of interpretation -- or misinterpretation -- of the statistics will continue. ACOG loves to sling mud! Here is my reply to the PR release:
Ktietje85 said…
Just found your blog -- love it. :) Of course this is all true and common sense. I'll be having my second baby at home this summer (third baby; first was born in a hospital and then I said "never again").
reannan said…
Nice post mama birth. I love the tone of your writing.