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Thursday
Feb142008

The Best Response to ACOG Statement Yet

I've kept away from ACOG's Statement Against Homebirth because so many other people have done just fine responding to it.

However, I just came across a piece that is, to me, by far, the best response I have read. On
The Education of Genevieve's blog, she re-posts A Parody of the Recent ACOG Statement by a writer named Tienchinho. I've tried to find the author, but haven't been able to.

Assuming the author would love others to read her work, I re-publish it in its entirety.

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A Parody of the Recent ACOG Statement

FRESNO, CALIF.

As a home birth after cesarean mom (HBACM), I reiterate my support of home births. While complications can arise with little or no warning even among women with low-risk pregnancies, childbirth is a normal physiologic process that most women experience without problems. Continuous monitoring of both the woman and the fetus during labor and delivery in a hospital or accredited birthing center has not improved maternal or fetal outcomes.

I acknowledge ACOG’s right not to support programs that advocate for, or individuals who provide, home births, but I do not support a system that denies families the essential information to make informed decisions regarding maternal care. Nor do I support a system that lacks the resources to make VBAC a viable option for all women and ensure the quality of the mother-child dyad immediately after birth.

Childbirth decisions should not be dictated or influenced by what’s fashionable, trendy, or the latest cause célèbre. Despite the rosy picture painted by hospital birth advocates, a highly medicalized labor and delivery can physically and emotionally scar both the mother and baby. Attempting a vaginal birth after cesarean (VBAC) at the hospital is especially dangerous because seemingly benign interventions such as epidural anesthesia or Pitocin augmentation can lead to complications with potentially catastrophic consequences for both the mother and baby, including death. Unless a woman is in a supportive birth environment that allows the birth process to unfold on its own schedule, she puts herself and her baby’s health and life at unnecessary risk.

Advocates cite the lack of rigorous scientific studies as one justification for promoting hospital births. Consistent dismissal of existing Level I evidence defining the risks of unnecessary interventions such as episiotomy, epidural anesthesia, and amniotomy has concerned proponents of natural childbirth for the past several decades and we remain committed to changing this. Birth advocates throughout the world use childbirth education, grassroots childbirth networks, and recently, the media to provide mothers and caregivers with the evidence.

Multiple factors are responsible for the persistent exceptions to evidence-based medicine in maternal care, but emerging contributors include a fear-based climate that skews mothers’ decision-making abilities and forces caregivers to follow “standards of care” that ignore the scientific evidence. The availability of a birth attendant to provide continuous labor support and of a midwife to provide expertise and intervention may be life-saving for the mother or newborn and lower the likelihood of a bad outcome.

I believe that the safest setting for labor, childbirth, and the immediate postpartum period is one that respects and trusts the birthing process, that meets the Baby-Friendly and Mother-Friendly standards jointly outlined by the United Nations Children’s Fund (UNICEF), the World Health Organization (WHO), and the Coalition for Improving Maternity Services(CIMS) and is supported by birth advocacy groups.

It should be emphasized that childbirth comes with inherent risks. Implying otherwise is misleading and unjust to a birthing mother and her family. Although able to perform live-saving emergency cesarean deliveries and other surgical and medical procedures, board-certified obstetricians have been cornered into practice styles that perpetuate the need for these same measures.

They have lost skills such as detecting and adjusting a baby in the occiput posterior position. Untreated, this condition can result in prolonged labors mislabeled as “dystocia” and in cesarean sections. They minimize the profound impact of a woman’s birth experience on her future relationship with her children as well as her own view of herself. Since suicide and substance abuse are leading causes of maternal mortality, disregard for a mother’s emotional health can lead to tragic consequences for her and her baby.

I encourage all pregnant women to get prenatal care and to make a birth plan.
Safeguarding the process of giving birth promotes a healthy and safe outcome for
both mother and baby. Every woman should seek balanced information to guide her
decisions throughout pregnancy, childbirth and parenting. For women who despair in the lack of choices, they should look for hope in mothers who have navigated this climate of fear successfully. We are here.

(end post)

BRAVA!!!

Reader Comments (10)

I love it!!!!

I'm so glad I found your blog (even if it had to be through Dr. Amy's site).

Found a midwife, BTW. I am so happy!

February 14, 2008 | Unregistered CommenterMommy Dearest

It was originally written on MDC. Here is the link to the post:
http://www.mothering.com/discussions/showthread.php?t=843302&page=3

February 14, 2008 | Unregistered CommenterRixa

I love it. I'll be re-posting. It's originally posted on MDC.

February 14, 2008 | Unregistered CommenterJudit

Freeking Brilliant! Dang, it almost makes me want to have another baby!

February 14, 2008 | Unregistered CommenterOpening Pandora

Pandora/Jill... Where the HECK have you been? You have SO been on my mind lately - and I sure do miss your comments to my words. Thanks for commenting!

I MISS YOU! (and love you, too!)

Let's find time to get together, eh?

(Oh, how I wish *everyone* lived close enough to hang out with!)

February 15, 2008 | Unregistered CommenterNavelgazing Midwife

Thanks for sharing this! I posted some excerpts on my birth blog as well. I have appreciated reading your posts. I am a 2 x unmedicated hospital-birther. Trying to figure out where I'm going to have my next baby (though I'm not pregnant yet). I'd love to her your balanced and wise perspective over at my blog! http://birthfaith.blogspot.com Please feel free to comment and help me help women get the facts! Thanks!

February 15, 2008 | Unregistered CommenterLani

"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."

I couldn't agree with this statement more. As a result of my attempted home-birth my first baby died.

It is possible to have the birth you want in hospital. It is.

The most important piece of the whole thing is that your child is born alive, right?

YES.

February 15, 2008 | Unregistered CommenterBirdies Mama

Birdie's Mama... I am so sorry for your loss. I went to your website to see if you explained more how your precious baby died, but I didn't see anything.

What is challenging for homebirth midwives and the ACOG statement is that they now endorse out-of-hospital births (a birth center) for CNMs when I carry all of the same equipment and have all of the same emergency training as a CNM *in-an-out-of-hospital setting*. I don't carry the sedatives a birth center does, nor do I have an isolette, but in all the years of working in birth centers, I never saw the isolette even used once.

We also monitor the baby in the same way... intermittently and with a doppler, not continuous fetal monitoring.

The ACOG statement is simply confusing. If they'd have continued their stance on ALL out-of-hospital births, I would understand their thinking a lot more.

But, it is extremely apparent that they don't "get" TRAINED homebirth midwives and the role they/we play in a homebirth emergency.

(Although, I do admit not all homebirth midwives are as adept at ALL the emergency procedures or are able to administer all the appropriate medications or even start IVs if they have to. That aspect should be standardized, but is often impossible due to the laws that are in place.)

February 16, 2008 | Unregistered CommenterNavelgazing Midwife

I am so glad that you like my "statement." I am an HBAC mom in Fresno. I had my first in 2003 by cesarean for breech. I had my second in 2005 at home in water. I am a retired laparoscopic surgeon. Now I love caring for my girls and helping other women have the births they deserve to have.

Tienchin Ho

February 21, 2008 | Unregistered CommenterAnonymous

Beautiful!! Thank you so much for telling us who you are. :) I am delighted to have your words in my blog. Thank you for writing them down. Great, great job!

February 21, 2008 | Unregistered CommenterNavelgazing Midwife

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