Midwives, home birth proven safe - contrary to ACOG's false assertion

BlogHer Original Post

Last week I wrote about The Big Push for Midwives, a national grassroots campaign pushing for the regulation and licensure of Certified Professional Midwives (CPMs) in all 50 states, Puerto Rico and the District of Columbia. As it currently stands, there are 26 states that ban CPMs. If caught practicing there, midwives could be subjected to fines, jail time, even face the possibility of a felony conviction in Missouri.

Despite the fact that other developed countries in the world that have adopted midwives as the primary care providers for healthy pregnant women, the United States has yet to catch on. One percent of American women choose to give birth at home. Just last week the American College of Obstetricians and Gynecologists (ACOG), a trade union representing the financial and professional interests of obstetricians, released a statement reiterating their opposition to home births and CPMs, and suggesting that mothers who give birth at home with a midwife are choosing the birth experience over the health of their baby. Rather than advocating for "quality health care for women" as the group claims is part of their work on their about page, the entire statement perpetuates FUD; Fear, Uncertainty, and Doubt.

The Big Push for Midwives campaign countered with their own press release stating the ACOG is Out of Touch with Needs of Childbearing Families and said not only do they claim "out-of-hospital birth is 'trendy,'" but they also try to play the “bad mother” card. The International Cesarean Awareness Network also issued a statement "condemning" the ACOG for their statements, as did the Childbirth Connection who states ACOG Place of Birth Policies Limit Women's Choices Without Justification and Contrary to the Evidence.

In addition to these organizations, many other sites and blogs have done an outstanding job of weighing in on this topic and have covered it in much more detail than I can attempt in this single post. Therefore I'm going to stick primarily with addressing the safety "concern."

The ACOG says, "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." This, however, is a false assertion. 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. 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).

The study also states:

What is already known on this topic

  • Planned home births for low risk women in high resource countries where midwifery is well integrated into the healthcare system are associated with similar safety to low risk hospital births
  • Midwives involved with home births are not well integrated into the healthcare system in the United States
  • Evidence on safety of such home births is limited

What this study adds

  • Planned home births with certified professional midwives in the United States had similar rates of intrapartum and neonatal mortality to those of low risk hospital births
  • Medical intervention rates for planned home births were lower than for planned low risk hospital births

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.

The organization of maternity services in Denmark, Sweden, and the Netherlands was studied under the sponsorship of the World Health Organization European Headquarters Office of Maternal and Child Health. Midwifery care is highly respected and is a central feature of obstetric care in each of these countries. In Denmark and Sweden, almost all births are in the hospital, and autonomous midwives are employed by national health services. About three-quarters of Dutch midwives are in independent practice, and 34% of Dutch women give birth at home. In each country midwives provide "the first line" of care for normal pregnant women and are viewed as essential to the excellent perinatal outcomes these three countries enjoy."- Models of midwifery care. Denmark, Sweden, and The Netherlands.

Also worth noting is Denmark's maternal mortality rate was 5 deaths per 100,000 live births according to the World Health Organization's Maternal Mortality in 2000 report. Compare that to the United States where the maternal death rate was 17 deaths per 100,000 live births.

The United Kingdom, another developed country, also supports home birth for women in uncomplicated pregnancies. The Royal College of Obstetricians and Gynecologists and the Royal College of Midwives Joint Statement No.2. from April 2007 states:

"The Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynaecologists (RCOG) support home birth for women with uncomplicated pregnancies. There is no reason why home birth should not be offered to women at low risk of complications and it may confer considerable benefits for them and their families. There is ample evidence showing that labouring at home increases a woman’s likelihood of a birth that is both satisfying and safe, with implications for her health and that of her baby."

Thanks to Rixa at The True Face of Birth for looking up and sharing that information.

The World Health Organization (WHO) itself recognizes the important role that midwives play in prenatal and birthing care. In the WHO's Department for Making Pregnancy Safer 2006 Annual Report, it is noted that there is a great need for midwives in both the industrialized and developing nations. "Evidence for the decisive role of skilled birth attendants (SBA), and particularly midwives, in reducing maternal mortality is plentiful from both the industrialized and developing countries."

I found it particularly interesting that the WHO is working to reduce maternal mortality in these developing nations and is looking to the training of more midwives to achieve this task, citing an example of how midwives have already helped in Malaysia and Sri Lanka. "In a study of how Malaysia and Sri Lanka successfully reduced their maternal mortality rates since the 1960s, it was noted that the outstanding feature of maternity-related health services in the two countries has been 'the pivotal role of trained and government-employed midwives. They have been relatively inexpensive, yet they have been the cornerstones for the expansion of an extensive health system to rural communities. They have provided accessible maternity services in hospitals and communities, gained respect from the communities they serve, and are described with affection and admiration by the managers and policy makers in each country.'”

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. So why is the ACOG so against it in the United States? Are American pregnant women any different from pregnant women elsewhere in the world?

The truth is that safety is not the ACOG's biggest motivating factor. It's money. Money makes the world go around. As Belly Tales points out, "ACOG is a professional organization supporting and marketing the services of its members: obstetricians. In other words, a lobby. ...the bottom line is always the bottom line."

If the ACOG would acknowledge that these studies and practices in other countries are very relevant and support the legalization and regulation of midwives, as well as call on physicians to work with them and provide back-up support rather than against them, it is then that they would truly make birth safer for all women.

The positive thing here is that people are taking notice and questioning the status quo. Celebrities are talking openly about their home birth experiences and mainstream magazines are covering it. Women and their partners are seeing The Business of Being Born and learning that there IS another way. Women are talking. They are asking questions. And the ACOG is getting nervous. Let's keep the buzz going.

"In every country where I have seen real progress in maternity care, it was women's groups working together with midwives that made the difference." - Marsden Wagner, MD, MSPH

If you'd like to write a letter to the ACOG, please direct it to:
American College of Obstetricians and Gynecologists
409 12th St., S.W., PO Box 96920
Washington, D.C. 20090-6920
202-638-5577
Or email: communications@acog.org

Finally, if you've had a home birth and feel strongly about this, I encourage you to spread the word and write about it on your own blog, then leave a link to your post here in the comments. Also, if you've blogged about your home birth experience, please leave a link to that post in the comments as well. Thank you.

Additional resources:
The Big Push for Midwives
Citizens for Midwifery
International Cesarean Awareness Network - ICAN’s Response to ACOG AND AABC Statements on VBAC and Homebirth
The Compleat Mother - Homebirth: As Safe As Birth Gets
The Birth Book Blog - Latest ACOG statement against home birth
Belly Tales - ACOG's statement on home births
Pushed Birth - Parsing the ACOG Statement Against “Cause Célèbre,” Home Birth
Refuse to be a womb pod - What do I think about ACOG's homebirth statement?
The True Face of Birth - 10 responses to ACOG's statement on home birth

Contributing editor Amy Gates also blogs about attachment parenting, activism, green living and photography at Crunchy Domestic Goddess.

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