I haven’t posted on my blog about this topic (ACOG’s support of elective C-section, but opposition to home-birth), although I did post something to the Independent Childbirth Educators’ blog. But I came across this short article written by Amy Haas which expresses so well and succinctly the problem, that I asked her permission to post it on my blog. In addition to the well-written post, she provides a plethora of studies so that others can look up and verify what she says. I have noticed a trend among doctors (especially obstetricians) to have an attitude of “trust me, I know what’s best.” This is what I like about being a childbirth educator–finding out the facts for sure, and not just relying on anyone’s opinion. I’ve found that sometimes there is a great difference between what people say and what the research actually shows. Enjoy!
From Amy V. Haas, BCCE:
Trendy Birth: An Odd Dichotomy
Recently the American College of Obstetricians and Gynecologists (ACOG) released a statement against homebirth, calling it, among other things, a dangerous popular trend in modern times. Oddly enough the latest trend in birth truly isn’t homebirth (an occurrence that has existed since the beginning of time) but elective cesareans, or Too Posh to Push, as the media has dubbed it. A few years ago ACOG released a statement about elective cesareans, acknowledging the serious risks to choosing major abdominal surgery for birth, but stated that it was a choice that should be left up to the doctor and his patient.
When I started looking into existing research on both issues I was quite fascinated to note that, contrary to ACOG’s opinion, there was quite a bit of good research showing the safety of homebirth. In fact the one study used as the reason to restrict homebirth was actually flawed to the point of uselessness, due to, among other things, poor controls. Other than that one flawed study, used as the basis for ACOG’s opinion, I could find no other studies that showed homebirth to be riskier than hospital birth for low risk women. In addition to the latest large study on homebirth published in the British Medical Journal in 2005, I also found over ten years worth pervious studies that showed the safety of homebirth for low risk women attended by Midwives.
Conversely one of the sad benefits of the latest trend toward elective cesareans is that we now have enough of a population to determine the pros and cons of an extreme choice like elective cesarean. The results show some very extreme negative risks that are punctuated by increases in maternal and infant mortality.
So why, if there is this laundry list of serious risks to elective cesarean, but no real studies showing serious risks for low risk moms having homebirth, is ACOG coming out full force against homebirth, but not against elective cesarean? Very strange, and very scary.
(References available upon request)
American College of Obstetricians and Gynecologists, News Release, February 6, 2008, ACOG statement on homebirths; Office of communications, firstname.lastname@example.org 201-484-3321.
American College of Obstetricians and Gynecologists (ACOG). (2000). Planning your pregnancy and birth. Washington , DC : ACOG.
Bernstein, P. S.; “Elective Cesarean Section: An Acceptable Alternative to Vaginal Delivery?” Field Notes in Obstetrics and Maternal-Fetal Medicine
Medscape Ob/Gyn & Women’s Health 7(2), 2002
Citizens for Midwifery; “Out-Of- Hospital Midwifery care: Much Lower Rates of Cesarean sections for Low Risk Women”.; www.cfmidwifery.org/pdf/cesarean2.pdf
Johnson, KC; Daviss, BA; “Outcomes of planned homebirths with certified professional midwives: large prospective study in North America ”; British Medical Journal,; 330:1416; 2005.
Johanson R, et al; “Has the medicalization of childbirth gone too far?” British Medical Journal 324:892-895 (April 2002)
Kolas, T. , et. al, , “Neonatal Outcomes Worse With Planned Cesarean Than Planned Vaginal Deliveries” Innlandet Hospital Trust, Lillehammer , Norway, Am J Obstet Gynecol 2006;195:1538-1543
MacDorman MF, et al; “Infant and neonatal mortality for primary cesarean and vaginal births to women with “no indicated risk,” United States, 1998-2001 birth cohorts, Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland 20782, USA. PMID: 16948717
Martin J., et al ; , “Births: Final Data for 2004”; National Vital Statistics Report; Center for Disease Control Volume 55 # 1, September 29th, 2006, http://www.cdc.gov/nchs/data/nvs…5/ nvsr55_01.pdf
Pang, JWY, et al; “Outcomes of Planned Home Births in Washington State ” Obstetrics and Gynecology Volume100:#2;253-259 (August 2002)
Schlenska, P F; “Safety of Alternative Approaches To Childbirth” Doctoral Dissertation; Stanford University , California , www.vbfree.org/docs/meadsum.html.
Weaver, J. J., Statham, H., & Richards, M. (2007). ” Are there “unnecessary” cesarean sections? Perceptions of women and obstetricians about cesarean sections for nonclinical indications.” Birth, 34(1), 32-41.
Weigers, TA, et al; “Outcome of planned home and planned hospital births in low risk pregnancies: prospective study in midwifery practices in Netherlands ” British Medical Journal 313: 1309-1313 ( November 1996)
“For Low-Risk Women, Risk of Death May Be Higher for Babies Delivered by Cesarean”, Birth: Issues in Perinatal Care. Black Well Publishing, August 29, 2006; email@example.com.
Amy V. Haas©2008
“I agree completely with the excellent article by Amy Haas on the ACOG position on home birth and on elective C section. The simple explanation for both these ACOG positions is the same—MONEY. ACOG is against home birth because it takes clients away from them and they are in favor of elective C section because they get more money with C section than with a vaginal birth “ Marsden Wagner , MD (Former head of the committee on maternal child health for the World Health Organization) 2/14/08