Walk Softly and Carry An Automatic Rifle

I was up to nearly midnight the other night putting in a proposal for a break-out session for this year's MANA (midwives of north america) conference. The session is titled: "A Response to ACOG: An L&D Nurs'es Choice for Homebirth" My session centers around the new position by ACOG (American College of Obstetrics and Gynocology) that out-of-hospital birth is unsafe. (see below). The fallout from this is that it is harder than ever for CNM's (certified nurse midwives)to find back-up physicians for their homebirth practices. Insurance companies follow suit and won't insure docs who do back-ups for homebirth. (If you recall, this happened to my midwife, her back-up doc would lose his insurance if he continued to back her up and without a collaborative agreement, she's out of practice) This can leave entire communities without a homebirth option if they don't have lay midwives in their areas. This makes me so mad. They do it under the guise of safety- they say the research is not sufficient. But neither is the research proving that hospital birth is safer (and as a former L&D nurse, I don't see hospital birth as safe AT ALL). This isn't about safety. It's about out- of-hospital options being a threat to the status quo of obstetricians. This will only drive CNMs out of homebirth practice and make the stakes higher for DEMs (direct entry midwives) and CPMs (certified professional midwives). This position paper makes homebirth look irresponsible, and could be a step toward making it illegal. I believe it is a real threat to women's choices in birth. My session will be about my option to choose a homebirth, my perspective as a former L&D nurse, and the battles I fought to get it. I'll include some of the footage from my birth and excerpts from my book. For now, I'll keep my fingers crossed that my proposal is accepted. The conference is in October in Florida.

American College of Obstetricians and Gynecologists (ACOG) Statement of Policy as issued by the ACOG Executive Board on Out-of-Hospital Births in the United States

Labor and delivery is a physiologic process that most women experience without complications. Ongoing surveillance of the mother and fetus is essential because serious intrapartum complications may arise with little or no warning, even in low risk pregnancies. In some of these instances, the availability of expertise and interventions on an urgent or emergent basis may be life-saving for the mother, the fetus or the newborn and may reduce the likelihood of an adverse outcome. For these reasons, the American College of Obstetricians and Gynecologists (ACOG) believes that the hospital, including a birthing center within a hospital complex, that conforms to the standards outlined by American Academy of Pediatrics and ACOG,(1) is the safest setting for labor, delivery, and the immediate postpartum period. ACOG also strongly supports providing conditions that will improve the birthing experience for women and their families without compromising safety.
Studies comparing the safety and outcome of U.S. births in the hospital with those occurring in other settings are limited and have not been scientifically rigorous. The development of well-designed research studies of sufficient size, prepared in consultation with obstetric departments and approved by institutional review boards, might clarify the comparative safety of births in different settings. Until the results of such studies are convincing, ACOG strongly opposes out-of-hospital births. Although ACOG acknowledges a woman’s right to make informed decisions regarding her delivery, ACOG does not support programs or individuals that advocate for or who provide out-of-hospital births.

(1) American Academy of Pediatrics and /American College of Obstetricians and Gynecologists. Guidelines for Perinatal Care, 5th Edition. Elk Grove Village, IL, AAP/ACOG, 2002.

Approved by the Executive Board October 2006

The American College of Obstetricians and Gynecologists409 12th Street, SW, PO Box 96920Washington, DC 20090-6920Telephone 202 6385577