For a slight diversion from my usual froth and blather, I am going to take up a bit of blog-space to respond to ACOG's February 8, 2008, Statement on Home Birth. (If you click on the title above, you can read the full statement in all of its inflammatory glory.)
Let's do the worst, first: "The main goal should be a healthy and safe outcome for both mother and baby. Choosing to deliver a baby at home, however, is to place the process of giving birth over the goal of having a health baby." Shame on ACOG for playing the bad mommy card. I cannot think of any woman, regardless of where she chooses to deliver, whose primary concern is not the health of her child. Further, the process of giving birth and the goal of having a healthy baby are not mutually exclusive; in fact, they are inextricably linked. Many families who choose home birth do so specifically because they are concerned with their child's welfare, and want their entry into the world to be as peaceful as possible. The excessive intervention that seems to come with hospital births often results in unnecessary interventions for babies, too, and much of this is avoided at home.
Indirectly, what ACOG is asserting is that, in an emergency situation, the midwife in attendance would not call on paramedics or transfer the woman to a hospital. It paints the picture that midwives irresponsibly avoid interventions even when they are called for, which is such a low blow. This (in combination with the statement that women who choose to birth at home don't care about the health of their babies) really accuses us all of a complete lack of thoughtfulness, when in fact, I have found home birth parents to be so well-informed about birth and parenting.
Further, midwives have the same goals of healthy mom and baby, and I can't imagine a scenario in which a midwife, under emergent circumstances, wouldn't transfer to the hospital. And even though, tragically, mothers and babies die at home, they die in hospitals, too. The notion that being in the hospital means everything will be A-OK is chock full of professional hubris on the part of doctors.
I know a lot of people have done some eye-rolling about Ricki Lake's film, The Business of Being Born, and that is reflected in this statement: "Childbirth decisions should not be dictated or influenced by what's fashionable, trendy or the latest cause celebre." The idea that folks would choose to birth at home simply because its trendy overlooks the real reason home birth has seen a resurgence: women are finding the strength to trust their bodies to do the work they were designed to do. And for many of us who have healthy pregnancies, there is no need to be hooked up to fetal monitors, have IVs or hourly vaginal exams to give birth. Most of the women I know who have given birth at home spend a great deal of time considering their decision (which you have to do, because lord knows everyone you tell that you're having a baby at home is going to grill you about your choice) and becoming informed about birth and parenting.
I think ACOG's statement really is born out of fear that midwives are encroaching upon the medical community's turf. And being that they are a trade organization, I suppose this is to be expected. But wouldn't it be better, for the health of women and babies, to acknowledge the work that midwives and laboring women do, and open the door for partnership in emergency cases? I'm sure that because the only home births doctors ever see are transfer cases, their perception is deeply skewed. But ignoring the reality that healthy births can happen at home is naive. The cornerstone of a good birth, I believe, is being in a space you feel comfortable - and if that's in a hospital with an OB, I think that's wonderful. Because wherever, and with whomever, you feel most comfortable, this is the space in which your birth is likely to go the way you want it to. It's really a shame that ACOG isn't interested in seeing this perspective.
