ACOG requests unsourced anecdotal home birth "data"

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    [FONT=ArialNarrow,Bold]"Problem" of Increased Demand for Midwife Care
    [FONT=ArialNarrow][FONT=ArialNarrow]Thousands of Activists Nationwide Force Physician Group to Scrub Its Website


    The American College of Obstetricians and Gynecologists (ACOG) has launched an internal request for unsourced, anecdotal homebirth transfer stories. Stating that the organization is "concerned that recent increases in home delivery will result in an increased complication and morbidity rate," obstetricians have been asked to submit stories about homebirth-to-hospital transfers, with outcomes reported by the physician handling the transfer. Just hours after its launch, ACOG's site went "viral," with thousands of women entering the site to relay stories of their positive homebirth outcomes. ACOG has since moved its request to a firewall-protected, members-only section. (See http://www.thebigpushformidwives.org...s_Research.pdf)

    ACOG recently stated that legislative opposition to legalization of "lay" midwives and homebirths is one of its highest organizational priorities. In the August 2007 ACOG State Legislative Update Year in Review, ACOG disparaged certified nurse-midwives as "fickle" allies, stating that "Whereas nurse-midwives have been ACOG's front-line defense against these bills, that's no longer a sure thing." Referring to 2007 legislative activity in Missouri (that in 2008 finally granted CPMs, CNMs and CMs the legal authority to attend homebirths in that state), the 2007 ACOG report said, "For example, in Missouri, 'lay' midwife bills get introduced year after year. These bills have been stopped--up to now--mainly by deft political maneuvering and hardball tactics employed by the State Medical Society, not by any persuasive testimony about comparative safety or quality of care."

    ACOG's most recent attempt to mine for unsourced homebirth data suggests a concerning return to the days when obstetrics was saddled with Archie Cochrane's infanous Wooden Spoon Award as the least evidence-based specialty in medicine. In fact, there is a worldwide abundance of scientifically rigorous studies demonstrating the safety of homebirth, including another just published August 31, 2009 by the Canadian Medical Association Journal: http://www.cmaj.ca/cgi/rapidpdf/cmaj.081869v1.pdf.

    ACOG would do well to bring itself into alignment with the American Public Health Association, the World Health Organization, the Royal College of Obstetricians and Gynecologists and other organizations and experts that write policies based on evidence-based studies demonstrating that homebirth is a safe option and that care by licensed and certified professional midwives actually improves perinatal outcomes while decreasing health care costs. Real concern for maternal-newborn outcomes would suggest making greater access to the midwifery model of care a far higher priority than, say, legislative concerns over money and turf. And since the United States spends more money annually on obstetrical care than any other nation in the world and presently finds itself ranked below Cuba and just above Croatia in terms of Infant Mortality Rate, this would be especially true. As the saying goes, "There are reasons, and there are results."
    Last edit by NRSKarenRN on Sep 3, '09
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  2. 44 Comments

  3. by   Elvish
    I'm not thrilled with the ACOG on its persistent insistence that homebirth is somehow unsafe. What is unsafe is that CPMs are unregulated in some states, so they go underground.

    I'm with you that they would do well to recognize what every other major health organization in the world has already recognized - that homebirth in the hands of a skilled birth attendant is safe for low-risk women. And something I am planning on with baby #2.
    Last edit by Elvish on Sep 2, '09
  4. by   morte
    money
  5. by   lisamc1RN
    Ugh. ACOG has been taking homebirthers on for years and after all this time, this is what they come up with? Anecdotal evidence? The smell of desperation is in the air.
  6. by   anggelRN
    I guess there is a problem when women realize that in most cases a baby can be safely delivered without the help of a surgeon.
  7. by   dcav
    ACOG is a trade guild and, as such, they are merely trying to protect their financial interests. Talk about health care reform. THink of how much money we would save if midwife care was the paradigm of pregnancy. More than that, think of how our outcomes would improve if we would adapt a system like the one in Netherland, where about a third of the births take place at home. Shame on ACOG!
  8. by   joyouter
    As a British trained midwife and a BScN, I am continuously amazed by the "folklorish" media approach to home births. This approach is designed for profit at the risk of addressing the reality of obstetrician and trained midwifery practice Training as a midwife in Britain is a 18 month -2yr course which you appply for once you have completed RN training and hold RN status. The alternative is a 3 year diploma course. Both courses are difficult, stringent and demand extensive study for student midwives. The study addresses physiology, psychiatric, psychological and social issues, moral and ethical considerations, effects of drugs substance abuse, both for the expectant mother and the fetus, among many other topic of study.
    The rules which govern education and examinations as well as home delivery, govern the SCM (State Certified Midwife registration) are set down by the Royal College of Midwifery in keeping with University Medical and Nursing schools. The Uk, especially Edinburgh's Simpson Maternity Pavilion has a long and excellent history in midwifery training and research and midwives work in tandem with obstetricians.
    There are no folk tales and mothers desiring home delivery must meet strict criteria and be assessed not only by the MD and the midwife but also by community nurses. The delivery is also in connection with the obstetrical dept. of the nearest hospital in case of adverse change during birth. As is sometimes the case, yes, if home births have untowards events, there are tragic results hence the need for a thoroughly trained and educated and experienced midwife and team backup. The criteria set for home births are well researched, subjected to multi modal assessment and use both qualitative and quantitative analyses.
    The problem appears to be an ill defined conflict between midwives and Obstetriicans. Of crucial note, are the "Lay midwife" which may or may not attribute a less than positive impression although many of these women meet the obstetrician's experience and may surpass them. This and the real problem of increasing high risk births which demand hospital delivery affect public opinon. We have older mothers, fertility treatments which are out of control and multiple births which threaten both the lives of mothers and infants. The role of the midwife is being altered in this scenario and as such we need to revisit the profession and develop more proactive roles for women interacting with midwives and obstetricians today. It is not just above delivery but safe delivery without vanity or reason.
  9. by   JenniferSews
    I personally know people who's hospital births of perfectly healthy babies should have been born alive, but instead were born still and never took a breath due to OB mismanagement. Is anyone looking for those "anectdotal" stories? I thought not. Everyone knows someone with a story. Real studies don't include those stories because they are just that, stories. Asking for transfer stories automatically discounts the thousands of births that went just fine at home with minimal or no interventions. My daughter included.

    After doing my OB rotation I lost all interest in my dream of being an OB nurse. The Wooden Spoon award is still deserved in many hospitals and practices.
  10. by   RootedRedwood
    Quote from nizhoni
    ACOG's most recent attempt to mine for unsourced homebirth data suggests a concerning return to the days when obstetrics was saddled with Archie Cochrane's infanous Wooden Spoon Award as the least evidence-based specialty in medicine.
    Obstetrics is not really "returning to the days" of being saddled with the Wooden Spoon Award. They have been holding on to that spoon since it was first awarded.... and by the looks of all of this, it doesn't look like they are ready to give it up any time soon! A great read (although depressing) about lack of evidence-based care in obstetrics is a book by Marsden Wagner, MD called " Born in the USA"- check it out.
  11. by   cmonkey
    Maybe I should write them with my anecdotal evidence: two healthy children following planned midwife-attended homebirth. Hmmm... :chuckle
  12. by   CityKat
    This really bothers me. I'm about to give birth to my son in November with no to low intervention and the aid of fantastic midwives at my birthing center. I've often thought about a home birth b/c I want to birth in water. We'll see.

    I don't know much about the ACOG, but it definitely smells like money and power. Ugh..frustration, yet of course it isn't surprising
  13. by   mama-cruz
    All of my 3 children were born in the hospital, but 2 of them were actually delivered by OB nurses anyway, because the obstetricians weren't waiting IN THE DELIVERY ROOM when the babies were ready to come out. (My family has a history of VERY fast birth experiences.) I probably could have saved money, time, and trouble by having home births with nurse-midwives, but they were technically "high-risk" pregnancies so I suppose hospitals were a requirement.

    Ann
  14. by   Neveranurseagain
    Here is a copy of the request from ACOG with the address to report "adverse outcomes" --but where is the address to report favorable outcomes?


    [FONT=Arial,Helvetica]ADVERSE OUTCOMES MIDWIFE BIRTHS

    [FONT=Arial,Helvetica] p, li, div { margin:0in; margin-bottom:.0001pt;} As you all know, SB 477, a bill to license certified professional midwives to provide
    out-of-hospital maternity care services was signed by Gov. Jim Doyle as Act 292 this past year.
    Under previous law, only nurse midwives, who work primarily in hospital settings, were eligible for licensure.

    The Department of Regulation and Licensing has set up administrative rules to determine policies in granting of licensure, scope of practice and professional conduct.

    Generally, many insurers cover midwife care -- provided she is licensed according to state law and works in a hospital or approved birthing center. Not all midwives are certified nurses; those who aren't are sometimes referred to as lay midwives.

    Insurance coverage is spottier for those midwives who are not certified nurses, or who assist home birth or otherwise work outside the traditional hospital setting.

    The Wisconsin Section would like to document any adverse outcomes that physicians might encounter in their practice by patients who are assisted by professional midwives.

    Please send this information to the W/ACOG office to be kept on file for future discussion. Send to: W/ACOG, P.O. Box 636, Pewaukee, WI 53072.


    http://www.acog.org/acog_sections/di...&bulletin=1821


    Several years ago, a Licensed Midwife in Arizona delivered more babies than BOTH OB/GYNs in the same area did combined....they were furious at her! When she had a transfer, they wouldn't even let her off the elevator--even if the laboring mother requested the LM to stay with her!


    Last edit by Neveranurseagain on Sep 3, '09

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