ACOG looking for home birth complications

Here’s the email I received:

Tell ACOG your birth story!

ACOG has a new database to collect anonymous data on “unsuccessful home births.” Let’s flood the database with entries on SUCCESSFUL home births!

It will take less than five minutes, but having even 25 people do it will send a loud and clear message and may force them to take it down due to bad data. At the very least we can force it into the members-only area, where far fewer OBs will bother to fill it out.

Go to http://www.acog. org/survey/ hdComplications. cfm

Below is information about the list of categories to fill out—you have to check each one except for the very last or the form won’t go through.

State

Select the month and year

Gravida (# of times you’ve been pregnant)

Para (# babies you’ve had who were born after 20 weeks)

Maternal Age

Gestational Age (number of weeks pregnant you were when your baby was born)

Problem – Please check OTHER and type in: Healthy baby born at HOME!

Fetal Outcome:  Please check: Successful delivery!

Pre-Arrival length of labor – give the overall length of your labor (you can’t leave it blank or it kicks you back)

Home Attendant – (CPMs are included as a choice!)

The final question to prevent accidental duplications is optional.

Thanks for taking a few moments to do this action.  It’s quick, easy and best of all – let’s ACOG know about all of the positive home births that happen every day!

And here’s the info from the ACOG website:

The American College of Obstetricians and Gynecologists is concerned that recent increases in elective home delivery will result in an increased complication and morbidity rate. Recent reports to the office indicate our members are being called in to handle these emergencies and in some instances have been named in legal proceedings. To attempt to determine the extent of the problem, a registry of these cases will be maintained at ACOG on a year-by-year basis.

If you have been called to attend, whether in the emergency room, operating room or labor and delivery suite, a patient who came to your hospital after an unsuccessful attempt at elective home delivery, please complete the following survey even if there was no adverse outcome. Include only current events after June 15, 2009.

So, it sounds like you’re supposed to be a doctor in order to fill this out. The problem I have with what ACOG is trying to do, is that it’s going to present an unbalanced picture. All the successful, non-complicated home births don’t even appear, which is one of the problems Melissa Cheyney discovered in her research:

Cheyney: One of the mechanisms for maintaining distrust between midwives and obstetricians is what my colleagues and I have termed “birth story telephone.” This is very similar to the childhood game of telephone where as the story spreads from one individual to another, it grows in nature and the details change substantially. As home and hospital birth stories are told and retold, and filtered through the lens of the teller, details shift to match the preconceived worldview of the teller. For example, a non-emergent transport for a slow, uncomplicated and non-progressive labor can turn into a mother laboring at home for days with poor heart tones and a uterine infection before the midwife reluctantly brings her in. By the time the story has been passed along, mother and baby who were actually never in danger were saved from a near death experience by the hospital staff.

So, if all you see as a doctor is when women come in with umbilical cord prolapse or something, then you’re going to think that every home birth has umbilical cord prolapse! That will be a false impression, but it will be true to you. So, even if this form were filled out only by doctors and only for planned home births and included no successful home births, it would still be an unbalanced picture. The only good thing about it, is that it would perhaps present a true (or true-ish) picture about what maternal and fetal/neonatal outcomes are — how many uncomplicated births there are, as opposed to complicated ones. Most studies into planned home births show that most transfers are for either pain relief or labor augmentation or some other non-emergent transfer, and would likely therefore end in an uncomplicated birth. At best, I’m hoping for these statistics to reflect that. Of course, there is built-in bias — some doctors may not realize that their patients have been having “shadow care” (planning a home birth with a midwife but also seeing an obstetrician; so their “doula” coming in with them may actually be the midwife) and may not realize that this patient that just came in was planning a home birth, not just “accidentally” came in at happening to be at 7 cm dilation without having realized she was really in labor, or whatever. Other doctors may not report the uncomplicated births but would be sure to report the complicated ones. [For instance, how many times do you tell your husband, “You know what? All the way to the store and back I didn’t see any car wrecks!” or that you saw a car broken down on the side of the road (it’s kind of a non-story, most of the times, right?) — as opposed to the one time out of thousands of trips when you did see a car wreck. And the more shocking the story, the more likely it will be told.]

[Update: apparently ACOG has changed it so now only members can post — it requires a login to even view the page. Not surprising. I don’t totally blame them, either — it was set up for obstetricians, not the general public. I almost didn’t want to blog about this as an encouragement for people to post their successful home birth stories, because, well, it did say that it was for doctors to fill out. ]

Updated again to include this link to a lawyer/doula’s tongue-in-cheek response to the ACOG website.

5 Responses

  1. I couldn’t get in it.

  2. #1. If this is anonymous, how can it possibly be verified? If it is not verifiable, then it’s possible that it’s complete BS put out by people who have a vested interest into making homebirths and midwives look as bad as possible.

    #2. If it can be verified, do these women know that they are taking place in “medical research” and have they given their consent?

  3. They wouldn’t have to collect data that way if MANA were not hiding its own statistics. MANA already knows that homebirth increases the risk of neonatal death. Don’t American women deserve to know, too?

    • Actually, if they wanted to collect data in a good and scientific way, they could fund a home-birth study for just that purpose. What are they afraid of finding, should they spend the money (like the BMJ CPM 2000 study did)? You’re so cock-sure that you’re right, it should be easy to get money together to fund a study that proves exactly what you want.

      From the MANA website:
      Who has access to this birth data?

      Outside access to data is restricted until the current dataset is complete. This will occur after a new dataform is ready to use, which we expect by the end of 2008. At that time, data collected to date (2004-2008) will be made available to researchers via standard data access procedures and after approval by an Institutional Review Board. Contributors and organizations of contributors (such as state professional midwifery associations) may access summary statistics on their own data at any time.

      The MANA Division of Research operates under the principles of Community-Based Participatory Research (CBPR). For further information on access to MANA data, please contact research@mana.org.

      Besides, if the data didn’t say what you wanted it to, you’d just claim that there was bias, or they scrubbed the “bad” statistics clean, or the midwife/wives conveniently dropped out of the study, or forgot, or some other excuse so that you’d still be “right.” And even then, you’d pick apart the data looking for loopholes, calling intrapartum deaths neonatal deaths (like you already do in the BMJ study), and stillbirths live births; or claim that the stillbirths they’ve recorded were intrapartum deaths not antepartum deaths, or even postpartum deaths, etc.

      But I bet that if and when this ACOG data is compiled and released, that you’ll be all over it like white on rice, claiming that no matter how fatally flawed the data collection process is, no matter how impossible it would be to trace much less verify the data, you’ll say that home-birth midwives have an excess of problems that they dump on the hospital. But what do you want? — You don’t want midwives to come into the hospital when there is a problem that actually needs obstetric support, but then when midwives don’t bring clients to the hospital who need obstetric support, then they’re castigated?

      And if this data is never released, will you be going everywhere whining about how they’re hiding their statistics? My guess is “not.”

  4. If they wanted to restrict the form to their own members, they could have made it password-protected to begin with. It’s just another example of ACOG’s general arrogance that they thought home birthers wouldn’t see it and call foul.

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