We used a mid-wife who went with us to the hospital. It was the most amazing experience, yet not very respected in the rural South. I can not recommend mid-wifery enough. It was truely one the most amazing the experiences of my life (and I am not only referencing birth-- I mean the months spent with our midwife).

Great post and I agree ACOG is getting "nervous" about the dissatisfaction women are having giving birth in hospitals.

I am not sure what they expected- they encouraged doctors not to perform breech births, forcing women to have C-sections- which in turn put their health and their baby's health in greater jeopardy than having a breech vaginal birth.

Breech delivery isn't even taught in medical schools anymore! The only group of providers who DO know how to deliver breech babies is midwives. Is it any wonder women who don't want an automatic C-section are rejecting OB's and hospitals and opting for homebirths?

What about the ban most hospitals have on VBAC's? Studies show that VBAC's are safer than repeat C-sections both in the short term and long term for the majority of women, and yet most hospitals won't allow them. If ACOG is so concerned with women’s health, why are these two procedures not offered as options?

This whole situation reminds me of what happened in the 70's- my mom and step mom who each had four children in the 1970's told me how awful it was to give birth in hospitals. They both told me stories about nurses immediately taking the baby away to the nursery after birth, and given bottles, even if the mother wanted to breastfeed. They would only bring the baby back every 4 hours.

Father's were not allowed to be present for the birth. My dad didn't even get to hold my brother until 2 days AFTER he was born. My dad said the first time he got to hold my brother was in the car, after my mom had been discharged from the hospital on the way home. He couldn't even hold his first-born in the hospital.

My step-mother told me how she kept "sneaking" out of her room to go to the nursery to get her baby. The nurses actually tried to restrain her! My step-mom had to fight with the nurses after giving birth so she could hold and breastfeed her baby. She finally told them she was going to sue them if she was not allowed to hold her baby. After that, they finally relented and "let" my stepmom take her baby back to her room to breastfeed.

After having her first two kids (my brother and I) in the hospital, my mother, as well as millions of other mothers, who had such bad experiences giving birth in hospitals decided "No more," and opted for home birth with midwives! There was an explosion of home birth in the 70's for the above reasons.

The hospitals reaction: they made birth more "baby and mom friendly”, finally allowing fathers to be present during the birth, allowing father’s to hold their baby in the hospital, allowing the baby to stay in the room with mom, and encouraging breastfeeding. This wasn't done out of the goodness of their hearts- they did it because they were losing millions and millions of dollars to homebirth. In the meantime, a lot of the organizations were working to discredit midwives and promote the idea that homebirth isn't safe. Sadly, that hasn't stopped and from ACOG's recent statement, it is only getting worse.

Now it has almost come full circle, 30+ years later, with women rejecting hospital births. Women are staring to say "No more," and opting for homebirths, so they can have the birth that they desire for themselves and their babies.

I predict as this trend keeps growing, we will see a shift in the hospitals, policies, allowing more breech deliveries and VBAC's-only because they will be forced to, if they want to survive- just like they changed their policies in the 70's.

ACOG's ridiculous claim that homebirth is more dangerous can only go so far, and I believe a lot of women already know better than that. Hospitals will eventually realize their bottom lines are suffering and be forced to offer women the types of births they desire.

ACOG is shooting themselves in the foot with this statement. They have reversed themselves before, and they would be crazy not to immediately retract this statement, and apologize to every woman for issuing such a foolish statement, insulting the intelligence of every woman in this country.

With “scare tactics” like this, and the unnecessary birth restrictions they encourage, no wonder women want home births. ACOG is reaping what they have sowed.

There are so many factual errors in this piece that it is difficult to know where to begin, but I will try to address the most egregious ones.

"According to Citizens for Midwifery, a number of rigorous scientific studies published in leading medical journals have found that for a healthy woman having a normal pregnancy, a planned, midwife-attended home birth is as safe as a hospital birth and with far lower rates of medical interventions."

That statement is false. To date there are NO studies that show that homebirth is as safe as hospital birth. Sure there are studies that CLAIM to show that homebirth is as safe as hospital birth, but they do that by comparing homebirth with low risk women to hospital birth with high risk women or with hospital birth many years before the homebirths.

"The most recent is also the largest study - with 5418 women participating - based on prospective reporting for all the births attended by Certified Professional Midwives in 2000, published in 2005 in the British Medical Journal. ("Outcomes of planned home births with certified professional midwives: large prospective study in North America." Kenneth C Johnson, senior epidemiologist, Betty-Anne Daviss, project manager. BMJ 2005;330:1416 (18 June)."

That study ACTUALLY shows that homebirth with a midwife in 2000 had a neonatal death rate almost 3 times HIGHER than hospital birth for low risk women in 2000. The authors simply "neglected" to mention the neonatal death rate for hospital birth in 2000. Instead they compared homebirth in 2000 to out of date papers about home and hospital birth extending back as far back as 1969.

"If that study isn't convincing enough, then one need only look to other developed countries like Denmark, Sweden and the Netherlands, where midwifery is the primary model of care"

Of course, Denmark, the UK and the Netherland, all countries that you praise for higher rates of homebirth, also have higher rates of perinatal mortality (the best statistical indicator of obstetric care). That's what the World Health Organization 2006 report on perinatal mortality shows.

"In summary, we have a large North American study citing midwife/home birth safety; Denmark, the Netherlands, Sweden, and the United Kingdom looking to midwifery as the primary model of care; Denmark with a home birth rate of 34% and a lower maternal mortality rate than the United States; as well as the World Health Organization supporting midwifery in many developing nations around the world. All of these things seem to indicate that midwives and home birth are a very safe choice."

Wrong, the BMJ study does NOT show homebirth to be as safe as hospital birth. Wrong, Denmark, the UK, and the Netherlands have higher rates of perinatal mortality that the US. Wrong, the World Health Organization supports midwifery in developing nations as opposed to untrained traditional birth attendants; there are no obstetricians available.

amygeekgrl, you've been scammed. Homebirth advocacy is based on mistruths, half truths and outright deceptions, and you've simply repeated many of them. Please consider doing some independent research on the subject, rather than accepting the word of professional midwifery advocacy groups.

Amy TuteurMD

It is terrifying what is going on in the birthing world. I gave birth with my midwife, in a hospital. I liked the fact that I was in a hospital, because if something did go wrong, there was immediate intervention available... HOWEVER.. my first birth experience was so wonderful, so amazing, because I was in charge of my experience, that I'm terrified for the second. I don't want a doctor to mandate what is going on with my body and my baby, when there is nothing *wrong* with me. I want my midwives back. The ones who didn't push epidurals and bag IVs, needles and C-Sections (yet didn't judge me when I needed something to help for the pain)... The ones that let me run the show. I think if more women had birth experiences through midwives, there would be far fewer C-Sections, far more breastfeeders, and far fewer complications.

Thank you especially for the links to the WHO annual report and the BabyWorld celeb news. I hadn't seen those before. Childbirth Connection is one of my favorite resources for evidence-based birth information. And I'm quite proud that ICAN responded to these press releases in a timely manner though I take issue with the word "condemn".

You are right, birth activists are really speaking out about ACOG's and the AABC's resistance to choices in childbirth. If I were to "plug" any one of my recent posts, it would be http://labortrials.wordpress.com/2008/02/12/thought-provoking/ because of a comment I excerpted from another site.

Best wishes,
Kimberly
http://labortrials.wordpress.com

Thanks for writing this. It's great. Here's my attempt to blog about it.

http://intedomine.blogspot.com/2008/02/earthy-birthy-mama-says-mouthful....

I think everyone should check out ICAN's reponse. I think it was thoughtful.http://www.ican-online.org/advocacy/ican-responds

Also, real quick about dr. Amy's comment. I don't think anyone is trying to claim that home birth is safer for high risk women then hospital birth. I think most of the studies explicitly state that we are talking about home birth for low risk women. Homebirth midwives are not going to work with high risk women.

So, just as you can not say home birth is ALWAYS the safest option you also can not simply state that home birth is NEVER a safe option.

Home birth has been shown to be safe for low risk women.

aedyrn:

"Home birth has been shown to be safe for low risk women"

No, homebirth has NOT been shows to be safe for low risk women. That's my point. The scientific evidence shows that homebirth has an increased risk of neonatal death ABOVE the neonatal death rate for LOW risk women in the hospital.

Women cannot make an informed decision about homebirth if homebirth advocates withhold the safety information or are dishonest about it. I know that homebirth publications assert that the scientific evidence shows homebirth to be as safe as hospital birth. That claim is false.

Women also need to know that MANA (the Midwives Alliance of North America), the trade union for certified professional midwives (CPMs), has been collecting data on homebirth since 2000. The data from 2000 was used by Johnson and Daviss in the BMJ 2005 study; Johnson is the former Director of Research for MANA. MANA has assembled what may be the largest collection of data on homebirth, perhaps as many as 30,000 homebirths.

There's a big problem, though. MANA is withholding the data. MANA has publicly announced that the data is available, but ONLY to midwifery organizations that can prove they will use the data for the "advancement of midwifery". Even then, midwifery organizations are required to sign a legal non-disclosure agreement promising not to reveal any of the data to anyone else. It does not take a rocket scientist to suspect that MANA's database almost certainly shows definitively that homebirth with a CPM to have a higher neonatal death rate.

We can get some idea of what is the database by looking at state statistics from those states that have a category for planned homebirths with a direct entry midwife in the state's vital statistics. For example, Wisconsin state statistics show that in every year from 2000-2006, PLANNED homebirth with a direct entry midwife had a neonatal mortality rate 2-5 higher than planned hospital birth with a nurse midwife.

If homebirth advocates are concerned about the truth, they should take a close look at available statistics, and they should pressure MANA to release the national safety statistics.

Amy TuteurMD

Those of you who'd like to do your own research on the neonatal death rate might find this response interesting (from Henci Goer)

Amy
Crunchy Domestic Goddess
BlogHers Act contributing editor

Further reading: BMJ Home Birth Study Questions

Amy
Crunchy Domestic Goddess
BlogHers Act contributing editor

I know the argument here is about Home vs. Hospital Birth... But I think it is also about Dr. Vs. Midwife treatment. I believe the midwife treatment of pregnancy is an enormously different approach to birth than a traditional doctor. Why?

Midwives do more that 'treat' pregnancy. They educate their patients. Each appointment is a time to learn about what is going to happen for the next few weeks. No need to spend hours online, or reading about pregnancy, worrying about every little thing. Sure, some doctors may do this, and their nurses have a big part in it too, but face it. Doctors don't have (or often take) the time to do all of that. I didn't see a whole practice of doctors and nurses who never took the time to get to know me personally, I saw ONE midwife, and her partner when necessary. For the first half of my pregnancy I went to a traditional OB/GYN clinic, with a traditional Doctor.. or rather, doctors. I never saw the same nurse, OR the same doctor. I saw a different person every time. There was no consistency in care.

My midwife KNEW me.. knew my moods, the way I behaved, and when it came time to give birth, she knew what to do to help me. Midwives take care of everything... from the intial weigh-in to the actual birth process. They take their time to answer questions and make sure that the patient is informed about their options and choices regarding pain management. A midwife comes when you go INTO labor. They are there to help with paint management, and to help you through the LABOR and delivery. Often, Doctors show up when you are 10cm dilated, deliver the baby and leave.

I think this whole issue is being fought because DOCTORS are afraid they are going to lose their patients to MIDWIVES (and more importantly... lose money)... And, if more women were to give birth using them and then talk about their experiences, they would be right. They would be losing patients. Because, in my experience, midwives treat the whole person AS A PERSON going through a NATURAL FUNCTION of the human body, rather than a disease that needs to be treated. Midwives don't JUMP to 'fix' things that aren't broken (ie, give C-Sections) to avoid lawsuits, and they definitely don't 'demand' that their patients do anything that is not necessary.

Unecessary things Doctors do that midwives won't: (for a normal low risk pregnancy)

* Midwives will NOT require you to have an IV, just because you are pregnant.
* Midwives will NOT require the use of a Catheter.. You can pee on your own.
* Midwives do NOT perform uneccessary and sometimes dangerous cervix checks. Checking for dilation can introduce bacteria and cause false contractions, not to mention get a pregnant woman's hopes up, or down because of her progress or lack thereof. Not to mention, that having your progress checked when you're only 1CM dilated... It's not exactly the most comfortable thing in the world. That to me, was more traumatic than the ENTIRE birthing process.
* Midwives will allow you to labor at home until you are ready to go into the hospital (in areas where home birth is not available). I labored at home until I was nearly 7CM dilated. This allowed me to get through the majority of my labor in a place where I was comfortable, I could go into my shower and deal with my labor in my own way. (If you have a single stall shower, and are preggo.. contact me, I'll give you an AWESOME tip to help with Back Labor). Then, there wasn't the hours and hours and hours in the hospital, in an uncomfortable bed, being stared at, poked at, and prodded, waiting for baby to arrive. I showed up at 11PM, and Baby was born at 5:30AM.

I think the issue so much isn't LOCATION of care, but QUALITY of CARE. Rather than being a number, or 'another pregnant whiner' (like I felt at the OBGYN's office) I was a person, who was about to give birth. I felt as though I knew what was going to happen and had some control in how I was going to deal with it. I wasn't told what was going to happen to me, I was allowed to dictate what was going to happen to MY body and MY baby (within reason). Period. Doctors don't let you do that. Because Homebirths are taken care of by Midwives and not doctors, more people are taking that route, because they LIKE THE TREATMENT better.

Why would someone choose to give birth at home vs. giving birth in a hospital? Because. It's nicer at home. Home is comfortable. The beds are comfortable. Your family is there to help. You can control your environment by dimming lights, playing music, doing whatever you need to do to help with pain managment.. That isn't always available in the sterile, cold environment that most hospitals provide... Oh yeah, and WOMEN HAVE BEEN GIVING BIRTH AT HOME FOR THOUSANDS OF YEARS, AND STILL DO IN MANY OTHER COUNTRIES..

Our country has an EXTREMELY high infant mortality rate.. I believe it is not because of where we give birth, but because of the way we as pregnant women are treated by our doctors... If doctors would start treating us as people going through a natural function, rather than a number with a 'condition' requiring 'treatment' then, women would be more comfortable with giving birth. Women would be less frightened about what is happening to them, and they would relax more, they wouldn't be stressed about the pain (that is totally managable by most people in most circumstances if they were educated about it). FEAR causes PAIN to be worse.. and I didn't have a doctor that has EVER eased my fears about anything. My midwife, on the other hand... She was there to hold my hand and help me through the pain and the fear.

To sum this up, I think that the MAJOR issue here is the way DOCTORS are treating their pregnant patients. I have seen it, heard it, and experienced BOTH ways first hand. I prefer the midwife approach whole-heartedly. I believe that if women would get over the belief that Midwives are all natural, no drugs only types of people, rather than someone who is there to give you the best and safest birth experience possible, they would choose a midwife over a doctor nearly every time.

As someone who has done the whole range of birthing experiences--c-section, VBAC hospital, and home birth, I can absolutely say that our home birth was the most comfortable, safest, natural, and best option for us. Period.

My first birth started with a midwife in a freestanding birthing center, but ended up with a cesarean section in the hospital. It was the right choice, our midwife was with us, and we felt great about.

The second birth was a VBAC with a midwife. Due to increasing restrictions on VBACs, we were not allowed to birth in the birthing center, we had to birth at the hospital. Still our midwife was there and we loved the experience. But, we checked out a few hours after the birth because we were tired of being poked and prodded by staff who interrupted natural mama-baby bonding time.

Third and final birth was a homebirth with a midwife. I was so relaxed and comfortable, it took me hours to realize I was in labor. People have asked us if we felt like we were risking the baby's life, or mine, by doing a homebirth. On the contrary--we felt like we got the BEST medical care because the midwives were focused solely on the baby and I. Midwives are highly trained professionals, they are prepared to deal with emergencies, and the ambulance was only a phone call away if we really needed it. But, we didn't.

A large part of homebirth is the preparation months ahead. We had to have all of the birthing supplies, a birth plan dealing with all contingencies (including emergencies) ready well ahead of our birthing time. We had routes planned out to the hospital of choice if we needed it, alerted our local ambulance service that we were doing a homebirth and that we just wanted them to be aware, and knew what to do and where to go in case we needed transport. All of that prep work ahead of time made it easier to forget about it when birthing time came. Everything was covered, we didn't have to worry or be taken by surprise. Instead, we had a nice relaxed birth, where our baby and I were well taken care of. Nature as it should be, imagine that? Homebirth, when properly practiced, with experienced midwives is safe and the best care around. Fear should not be part of making birthing choices.

"No, I'm not pregnant, but thanks for asking!"
www.theredheadwrites.com

I too am a lover of mother nature and feel that the most natural way to do things is by far the best in most situations. I read the statistics about higher risk of neonatal death in home deliveries, but have to ask where are the statistics about delivery and immediate peri-natal problems that go untreated and that result in long term disibilities not death? I worked in a children's hospital for over ten years as a speech therapist and I would guess at least half of the children we worked with were being seen due to birth trauma causing a lack of oxygen to the brain (cerebral palsy). I know that this can happen whether in a hospital or not, but I would like statistics showing that it is more or less likely to be a concern with home birth. Anyone have any ideas?
I also do not believe that the physicians are solely to blame for the desire for hospital births I think that many of them agree that less medical intervention is better. None of them WANT to risk a woman's life by performing an unnecessary c-section, just as none of them WANT to lose their license and career because they made the most informed decision they could at the time, it just happened to be wrong. If the ACOG endorses then it will ultimately be to blame also.
There has to be a middle ground and it seems that that must include CNM's CPM's, OB/GYN, Local Hospitals and Insurance companies all working together to support a pregnant woman.
As someone with 2 c-sections, one emergency and one by choice, all we all really want out of pregnancy is a healthy little one to hold so lets try to get some cooperation amongst the providers to get us there.

What ACOG, Amy Tuteur (MD - hah!) and her ilk all ignore in this endless debate and tossing around of statistics is the actual experience of woman who give birth in contemporary America. Here's mine: I wanted to give birth to my third child in a hospital based birth center with a midwife. (My first two were born in a free standing birth center that had closed because they could no longer afford their insurance coverage.) I was told that I would be "disqualified" if (a) my pregnancy went past 41 weeks, or (b) the midwife guestimated that the baby's weight was over 9.5 lbs. This was of concern to me because my first baby was born at 41 weeks, 2 days (weighing all of 6 lbs 2 oz and without any signs of postmaturity, but whatever.) In addition, I was told that I would have to submit to a test strip of fetal monitoring and if it was "of concern" I would be transferred to the hospital with or without my consent. My GST test came back at 131 (even ACOG allows practioners to set the threshold at 140) and I was told that I could not have my baby in the birth center unless I agree to have the three hour GTT. At that point, I'd had enough and switched to a free standing birth center. I didn't have the GTT and I had a healthy 8 lb baby at 40 weeks and 2 days but that is besides the point.

If doctors believe that all women need to have their babies in hospitals "just in case" then why can't a woman just show up at a hospital and be left alone with a midwife to deliver a baby in a room that looks like a bedroom? In hospitals in America today, unless you arrive with a baby crowning, you will be required, at a minimum, to be hooked up to a monitor (which can be excrutiating for a woman in back labor, just for one example) and you will be required to have an IV or a hep lock. That is at a minimum. We all know that most women have much more than that done to them in today's hospitals. It is utterly impossible to go to a hospital to have a baby and to be left alone to do it. Birth in hospitals today is more accurately descibed as a "fetal extraction from an adult female" than it is as an actual birth.

So what we have here is a dichotomy - have your baby in the hospital where you will be at the mercy of a profession that is practicing "CYA" medicine. (ACOG's suppossed concern about the well being of women and babies is so obviously disingenous in the face of the organization's tolerance of the American c-section rate and it's tolerance of elective c-sections. On the subject of c-sections there is no scientific ambiguity. C-secitons DO pose very well documented medical risks to both mother and baby.) Or have a baby at home, with no integration with the medical profession should the unlikely complication arise. In fact, should a complication arise, you might be dumped at the ER and treated like a freak.

Is this really all there is???? Don't women deserve better than being forced to choose between these two equally unappealing options???