Thursday, March 17, 2011

GRN: ACOG Is Not Qualified to Evaluate the Practice of Midwives

Grassroots News Message 2011-03-16

"ACOG Is Not Qualified to Evaluate the Practice of Midwives"

March 11, 2011
Grassroots Network Message
ACOG Releases Opinion on Homebirth

Hello Friends,

After a January press release announcement, the American Congress of Obstetricians and Gynecologists (ACOG) officially issued its current statement on the safety of homebirth in February (ACOG, 2011.). The numerous challenges posed by a physician’s trade organization releasing an opinion about homebirths (which most obstetricians do not attend), based on unsound research, will be explored below.

In the statement, ACOG acknowledges that they “respect the rights of a woman to make a medically informed decision about delivery,” but again asserts its long-held belief that hospitals and birth centers are the safest settings for birth.

ACOG’s opinion on homebirth is based largely on results from a poorly conducted, scientifically weak meta-analytic review (Wax et al., 2010).

This paper has been roundly criticized for its methodological flaws and shortcomings, rendering its conclusions inaccurate at best. You can check out these links for critiques:

The Big Push
Science and Sensibility
Our Bodies Our Blog
Midwifery Today

That ACOG would use poor quality science is a testament to the fact that ACOG is a private trade organization, not a scientific organization, whose primary goal is to support the interests of its members (for more on this). Perhaps even more important, ACOG, as a group, lacks any comprehensive knowledge of or experience with midwifery practice. ACOG is not qualified to evaluate the practices of midwives given the vast differences between modern obstetric practice and midwifery practice. Most obstetricians have never observed a single woman labor and give birth without any medical intervention, let alone in her own home. It is essential to keep these considerations in mind when evaluating recommendations from a trade organization such as ACOG.

While ACOG’s opinion on homebirth is not surprising, it is important to consider the potential negative impact it could have on the future of women’s access to homebirth. Some may recall the 1999 ACOG practice bulletin recommending that VBACs (vaginal birth after cesarean) only be attempted in hospitals with immediately available emergency surgical teams. This recommendation had an immediate (and long lasting) chilling effect on the number of VBACs occurring in the United States (see the figure below, reprinted from Roberts et al., 2007.). If ACOG’s statement on homebirth is used to set policies in the same way that the VBAC opinion was, access to homebirth could be jeopardized for many women for a long time to come.

In the statement, ACOG asserts that several of the current, well-conducted empirical studies illustrating the safety of homebirth cannot be generalized to the United States, given that they were conducted in countries in which midwifery is well integrated into the health care system. In light of this assertion, we call on ACOG as well as national and state medical societies to understand that criticism and to begin to support (rather than obstruct) efforts to license and integrate well-trained professional midwives into main stream health care delivery in the United States.

Lauren Korfine, PhD
for CfM


American College of Obstetricians and Gynecologists, Committee on Obstetric Practice (2011). Committee Opinion: Planned Home Birth, Obstetrics and Gynecology, 117(2), 1-4

Roberts, R. G., Deutchman, M., King, V. J., Fryer, G. E., & Miyoshi, T. J. (2007). Changing policies on vaginal birth after cesarean: impact on access. Birth, 34, 316-322

Wax, J.R., Lucas, F.L., Lamont, M., Pinette, M.G., Cartin, A., Blackstone, J. (2010). Maternal and newborn outcomes in planned homebirth vs. planned hospital births: A metaanalysis. American Journal of Obstetrics and Gynecology, 243, e1-8.)

From Roberts et al., 2007. Number of births by cesarean section over time. Note the sharp decline in VBACs after 1999, the year ACOG issued its VBAC practice bulletin that lead to VBAC bans in many hospitals.



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