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ACOG Issues Statement On Home Birth Safety

The American College of Obstetricians and Gynecologists (ACOG) issued a committee opinion yesterday about home birth safety. Not many surprises here: It’s pretty much what you’d expect from a medical organization that has, heretofore, not been too hot on the idea of home birth.

In concordance with the highly criticized “Wax paper” (a big home birth study published last summer), the College states that while home birth for low risk mothers is associated with fewer medical interventions (and attendant risks) than hospital births, the risk for newborn death is higher.  While the “absolute risk of planned home births is low,” the statement reads, hospitals and birth centers are the safest locations for labor and delivery.

Still, ACOG is edging a tiny bit closer to what one might consider “support” for home birth; the paper encourages women to make their own decision about where to give birth, based on the best evidence.

The College offers some specific guidance, too: Women who give birth at home should have excellent prenatal care, they should work with certified nurse midwives or certified midwives or doctors participating in “integrated care.” Easy and fast access to hospital back-up care is essential. The College is adamantly against HBACs (home births after cesareans) and believe that home birth is not a safe option for high-risk pregnancies, postdate (42 weeks+) pregnancies, multiples or breech babies.

The risks of home birth go up, says Richard N. Waldman, MD, president of the College, with “inadequately trained attendants or in poorly selected patients with serious high-risk medical conditions such as hypertension, breech presentation, or prior cesarean deliveries.”

The Big Push For Midwives– an organization I support– posted a link to this report on Facebook last night with the optimistic update that the emphasis on a woman’s choice might be a step in the right direction. Most of the midwives and home birth advocates who commented, however, seemed to view the news as same old, same old. One woman wrote, “The usual BS, based on a misguided attempt to maintain dominion over their perceived turf, and based on flawed ‘evidence’ (Wax et al., 2010).”

It is my believe that home birth safety absolutely must be considered in light of each woman’s personal health, care and circumstances. Having looked extremely closely at the risks and benefits, and taking into account my own circumstances– low risk and across the street from a major city hospital– I decided to try for a home birth in 2008. All went well. What do you guys think of these recommendations? How do you make your decisions about where to give birth when the evidence about various risks and benefits is so often clouded by controversy?

photo: Chris and Jen/Flickr

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