An ACOG position statement claims home birth "triples the neonatal death rate" and accuses home birthing women of "plac[ing] the process of giving birth over the goal of having a healthy baby." This statement in and of itself is problematic, as surely you'd think a highly respected organization of doctors realize that processes usually dictate outcomes. A home birthing woman who is under the care of an experienced medical professional (a midwife) is likely to experience a low intervention birth in the comfort of her home. Because childbirth is a natural process as old as time itself, our bodies are fully capable of creating, growing, and delivering new live into the world. In most cases, this process is going to happen on its own, and the results are going to be healthy.
Which is not to say I don't see the place of medical science in prenatal and neonatal care. Complications arise, and it is important for home birthing women to be able to make informed decisions about when home birth is and is not a healthy option. Additionally, the midwife needs to be able to step in and suggest a transfer when she feels the situation has gone beyond her ability. When these complications arise, whether they're in the prenatal or neonatal period, we are fortunate enough to live in a society that can handle the problem and work diligently towards good outcomes for both mom and baby. (Though, our track record on this isn't as good as it should be, nor is it up to par with the rest of the developed world, but that's another post.)
However, a culture that assumes there will be problems and therefore micromanages the entire process from start to finish is outright harmful to women, their babies, and their birthing experiences. Additionally, many of these routine interventions cause more problems than they prevent, and if they weren't being carried out solely in a hospital environment, I guarantee we'd see higher neonatal mortality rates associated with them as well. I could go on and on, but I'll let The Business Of Being Born explain:
But getting back to the statement by ACOG. All of my work around debunking myths perpetuated by the anti-abortion camp (strangely enough with much information via ACOG) has taught me the difference between relative risk and actual risk. When the antis say abortion increases your odds of developing breast cancer by 50%, they're talking about relative risk. When they say the Pill increases your chances of experiencing heart attack or stroke by 50%, they're talking about relative risk. And all of their research is coming from meta-analysis, a method of data interpretation which is not appropriate for determining cause and effect.
ACOG knows this, but it doesn't stop them from utilizing the very same tactics as the antis, though ACOG's enemy is home birth. Their expert statements on the purported abortion-breast cancer link debunks the claims of anti-choice researchers by specifically stating that meta-analysis is not appropriate in determining cause and effect, and relative risk is not basis for overtly issuing scare-tactics disguised as medical research. And yet they turn right around and use research they know to be flawed in order to demonize home birth.
The American College of Nurse-Midwives issued this statement in response to ACOG's claims regarding home birth: "We are puzzled by the authors’ inclusion of older studies and studies that have been discredited because they did not sufficiently distinguish between planned and unplanned home births — a critical factor in predicting outcomes." ACOG's language in and of itself is meant to skew the reality of home birth risk. When they say the neonatal death rate is tripled, they are discussing a relative risk. From Medscape writer Andrew Vickers:
In place of a "tripling in death rate," the more informative statistic is the absolute increase in neonatal death associated with home birth. On the basis of the results tables, it is possible to calculate that this turns out to be 1 neonatal death per 1000 women who choose home birth. However, the results tables show that those women would also experience some benefits, including 40 fewer premature labors, 45 fewer cesarean sections, 140 fewer vaginal lacerations, and 140 fewer epidurals.Vickers goes on to say that, truly, weighing the cost-benefit ratio between infant mortality and maternal morbidity can seem, well, dark. But it's something each and every pregnant family does every day when choosing birthing options, deciding on a care provider, creating a birth plan, and making decisions about where and how they will bring their children into the world. Every obstetrician does this, too, when faced with a prenatal patient who is experiencing a complication. Maybe that's the issue ACOG is having with home birth, that it becomes far more the family and not the doctor who is in charge.
The reality is that birth is normal, and in the case of many women, home birth is an option that can be as healthy (if not moreso) than entering into a high-intervention hospital system where their bodies will be micromanaged. It is up to each woman and her family, not ACOG or the government, to make informed decisions about their birthing options, and they need to be able to readily find information that is evidence-based, unbiased, and accessible. Shock-doctrine headlines like "Home Birth Triples Neonatal Death Rate" is not any of the above.
P.S. How offensive is it for ACOG to charge that women only choose home birth because it's "trendy" and in-vogue??
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