Ajog statement on planned homebirth

[duffers]

Hello everyone.
I desperately want to have a peaceful calm hypno home birth after the traumatic hospital birth of DD. However, much as I try to block them out, I can't help but be somewhat affected by the 'you're brave' and 'is it safe' comments.
The ajog statement was mentioned on a pro-home birth website I follow and I stupidly read it. Is the data they discuss about the dangers to be taken seriously or are they picking and choosing to suit their cause?

 

[gryphongrl]

Perhaps by Ajog (unfamiliar) you mean ACOG? They recently did put out an advisement and, yes they are probably picking and choosing to suit their case.

Unlike in the UK, most US women give birth in a hospital using an obstetrician (who is really more like a surgeon than anything else), not a midwife. Hence there is a financial incentive for ACOG to keep women in these hospitals. A normal vaginal non-medicated birth in a US hospital can easily run $10,000. A home midwife might charge $3000. I found out from my insurance that they would have covered that $10,000 in entirety had I chosen to go to a hospital, but they are only paying my midwife $2,200. ACOG needs to make homebirth look unacceptable not just to mothers, but to their husbands, their families and their insurance companies - and perhaps even to the lawmakers (as homebirth is still illegal in some states and I'm sure ACOG would love to see that list expand).

Anyway getting to the data, from what I've seen, when studies are done on "homebirth" they include all births NOT in a hospital which means the data lumps planned homebirths using competent midwives together with unplanned homebirths (accidents) and worse, women who completely ignored their pregnancy or were actively self-destructive throughout (drug addicts for example) and had zero prenatal care. The studies on actual planned homebirth are so small in the US (I saw one that had 29,000 women in it) compared to the number of hospital births they are compared against (more like 1,000,000) that any small statistical anomaly looks like a huge trend. There just aren't enough planned homebirths in the US to do any sort of reliable statistical study.

I can tell you that my midwife is approaching 900 births through her career, and has sadly lost one baby and no moms, and that is sad to think of but that number is many times better than my nearby hospital. She also has a c-section rate around 3%. Again, she could be a statistical anomaly, but if I chose to analyze the data the way AGOG has, I could say "homebirth is 30x safer than going to my local hospital!" or whatever.

Anyway I hope that all helps somewhat. When people tell me "you're brave!" I say, "you're brave for going to the hospital!".

 

[MindUtopia]

I haven't actually read their statement as I generally try to avoid anything ACOG publishes, but I've read some analysis of what they said. I'm going to put my health policy hat on now (I'm a medical researcher who does a lot of work in health policy and the organization of medical care, especially in the U.S.), and just say that ACOG is a lobbying organization for OBGYNs. While, yes, they do try to publish scientific and policy papers that are supposedly evidence-based and objective, they are doing it through a very specific lens with a certain goal in mind, that's lobbying for maximum rights and benefits for their constituency, which is OBGYNs. Even if the evidence showed to the contrary, they would never publish anything saying out of hospital births by midwives are beneficial for low risk women because that would be promoting the extension of non-physician caregivers into the professional terrain of the physicians who pay them to protect their claims to certain types of service provision.

I think the very fact that they say that 'home birth like' experiences can be had in hospitals means they very much acknowledge that they aren't getting it right a lot of the time and midwives in fact are. They're alluding to the fact that women are leaving hospitals because they are concerned about the quality of care there, and trying to flip that around for their own benefit. But they can't say home births are great because that would piss off all the OBGYNs who pay them not to say such things. So I'd say read it and digest what they have to say if you wish, but also read the studies on how safety out-of-hospital or midwife assisted birth is (there are lots of those as well). And take anything with a grain of salt that's coming from a professional lobbying organization. They aren't a neutral scientific body. They have a job to do and their first priority isn't the health of women and babies, it's protecting the professional and financial terrain of their membership base.

 

[fionar]

This whole thing makes me so mad because it's THESE studies that insurance companies point to when saying home birth isn't safe.

Interestingly (or infuriatingly - take your pick) enough, the RCOG (Royal College of Obstetricians and Gynecologists) has issued the opinion that home birth is optimal for some in some cases and that it should be supported and encouraged where appropriate.

GAH.

 

[gryphongrl]

Fionar, I've been reading about your insurance stonewalling you and it's so freaking ridiculous I can't believe it... They should not be able to pick and choose what kind of birth they'll pay for. Totally garbage.