American, British docs split on midwife debate

Last week I wrote my Unda’ the Rotunda column about a midwife licensing bill under consideration in the House. A committee vote on the bill is expected Wednesday.

The column is more about me than about midwives. I don’t usually get so personal when writing about politics.

But one of the more interesting things I came across in researching the column were the contrasting views of American and British gynos on midwives, and particularly, home births. The British Royal College of Obstetricians and Gynaecologists (they spell it the Greek way, I guess) got together with the Royal midwives and produced a fully footnoted report reccomending home birth for normal, healthy pregnancies.

A few things I take away from the document: It is a way to cut down on overcrowding at hospitals, a more affordable means to childbirth and will most definitely improve women’s experience having babies and thus the early life of the new child.

In my case, the second reason is particularly applicable: we buy our own insurance and it basically does not cover normal pregnancy and birth costs. Our agent told us there is no individual insurance plan that does.

The third reason is a bonus too.

But American Gynecologists (American for Gynaecologist) don’t see it that way. They recently issued a statement that recommends against home birth and insists that a physician be part of any midwife assisted birth. The statement cites no research and uses some fairly inflammatory language.

Americans have a hard time talking about birth. Part of the problem with the medicalization of birth is that is all happens behind closed hospital doors and we have lost our knowledge of the process. I didn’t even know how a belly button was formed until my baby was born (that is a really obscure demonstrative statement).

But read the two statements excerpted below or go to the links for more info:

RCOG and Royal College of Midwives Joint Statement No.2.
April 2007

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.1–3

1. Introduction
1.1 The rate of home births within the UK remains low at approximately 2%,4–6 but it is believed that if women had true choice the rate would be around 8–10%.7

1.2 The development of maternity polices over the last four decades, combined with frequent reorganisations of service structure, have impacted on the availability of home birth and have concentrated on births in hospitals.8–10 Reasons for this appear to include:

  • financial constraints
  • the values and beliefs of organisations about maternity care
  • lack of staff with the appropriate competencies.

1.3 Throughout this time, women and voluntary organisations have challenged the one dimensional approach to options for place of birth and have influenced the portfolio of evidence now available to support a return to a more diverse range of childbirth environments.

The Royals’ position paper continues with detailed research and analysis. You can read it here or via PDF.

Compare that with the American Gynos position on the same exact thing. The statement below is mostly opinion… which holds some weight when you are talking about a doctor’s opinion. But no research is cited, except to cast doubt on any research done:

The American College of Obstetricians and Gynecologists Statement on Home Births

Washington, DC — The American College of Obstetricians and Gynecologists (ACOG) reiterates its long-standing opposition to home births. While childbirth is a normal physiologic process that most women experience without problems, monitoring of both the woman and the fetus during labor and delivery in a hospital or accredited birthing center is essential because complications can arise with little or no warning even among women with low-risk pregnancies.

ACOG acknowledges a woman’s right to make informed decisions regarding her delivery and to have a choice in choosing her health care provider, but ACOG does not support programs that advocate for, or individuals who provide, home births. Nor does ACOG support the provision of care by midwives who are not certified by the American College of Nurse-Midwives (ACNM) or the American Midwifery Certification Board (AMCB).

Childbirth decisions should not be dictated or influenced by what’s fashionable, trendy, or the latest cause célèbre. Despite the rosy picture painted by home birth advocates, a seemingly normal labor and delivery can quickly become life-threatening for both the mother and baby…

…The availability of an obstetrician-gynecologist to provide expertise and intervention in an emergency during labor and/or delivery may be life-saving for the mother or newborn and lower the likelihood of a bad outcome. ACOG believes that the safest setting for labor, delivery, and the immediate postpartum period is in the hospital, or a birthing center within a hospital complex, that meets the standards jointly outlined by the American Academy of Pediatrics (AAP) and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers.

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. Moreover, lay or other midwives attending to home births are unable to perform live-saving emergency cesarean deliveries and other surgical and medical procedures that would best safeguard the mother and child.

ACOG encourages all pregnant women to get prenatal care and to make a birth plan. The main goal should be a healthy and safe outcome for both mother and baby. Choosing to deliver a baby at home, however, is to place the process of giving birth over the goal of having a healthy baby. For women who choose a midwife to help deliver their baby, it is critical that they choose only ACNM-certified or AMCB-certified midwives that collaborate with a physician to deliver their baby in a hospital, hospital-based birthing center, or properly accredited freestanding birth center.

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