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In a January 20, 2011 press release, the American College of Obstetricians and Gynecologists (ACOG) announced that its Committee on Obstetric Practice has issued a new Committee Opinion on Planned Home Birth.1 This new statement replaces ACOG’s sharply worded 2007 policy which declared that “ACOG does not support programs or individuals that advocate for or who provide home births.”2
The 2011 Committee Opinion strikes a different tone. “Although ACOG’s Committee on Obstetric Practice believes that hospitals and birthing centers are the safest setting for birth it respects the right of women to make a medically informed decision.” ACOG also urges the development of integrated systems of care to achieve favorable home birth outcomes. Unfortunately, ACOG’s opinion relies heavily on a widely-criticized and very flawed 2010 meta-analysis to support their assertion that birth is less safe when it occurs at home.3-6 Despite this, the document adopts a more respectful tone about women’s choice of birth setting and for the first time ACOG has acknowledged that some women are appropriate candidates for home birth. It is a small step towards future civil discourse.
ACNM agrees that there is a critical need to develop integrated systems of care that promote the best health for women and their newborns regardless of birth setting. “The door is open to explore how collaborative relationships and integrated systems of care can be developed to support women in their childbirth choices,” states ACNM President Holly Powell Kennedy, CNM, PhD, FACNM, FAAN. “However, creating a new dialogue that reverses decades of past beliefs, attitudes, and thorny discourse does not happen overnight. We must start with the respectful belief that all maternity care providers truly want the best possible outcomes for women and their infants.”
Upcoming Summit Offers Unprecedented Opportunity for Dialogue
ACOG’s new Committee Opinion comes on the heels of ACNM’s announcement that the Transforming Birth Fund (TBF) has awarded funding to a consortium of maternity organizations to convene a multi-disciplinary Home Birth Consensus Summit in late 2011. This forum represents a real chance to inform and influence change in home birth policy and practice. ACOG participated in planning for the summit and has committed to funding ACOG representatives to attend the meeting. Participants will represent a variety of stakeholder sectors, including maternity care providers, consumers and consumer advocates, health plans and liability insurers, policymakers, and more. Although planning for the summit is well underway, additional funding is needed to cover the full cost. Those interested in supporting the summit may do so by contributing to the A.C.N.M. Foundation, Inc., or by visiting http://www.midwife.org/homebirth_summit.cfm for more information.
ACNM views the 2011 ACOG Committee Opinion as a crack in ACOG’s long-standing negative stance on home birth. “We can focus on the negative aspects of this committee opinion, or we can seize this opportunity to redefine the discussion,” said Kennedy. “Beliefs and values about how to accomplish those outcomes are culturally steeped, experientially-based, and stem partially from professional training and socialization. Moving to a place of mutual understanding and agreement will require that we all use midwifery skills: patience with process, respect, listening, knowledge, presence, and strong leadership. ACNM is committed to working collegially with all health professionals involved in maternity care to clarify, define, and advocate for the best care practices for women in all birth settings.”
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With roots dating to 1929, the American College of Nurse-Midwives (ACNM) is the oldest women's health care organization in the U.S. ACNM is the professional association that represents Certified Nurse-Midwives (CNMs) and Certified Midwives (CMs) in the United States. ACNM provides research, administers and promotes continuing education programs, establishes clinical practice standards, and liaisons with state and federal agencies and members of Congress. In 2008, the number of births attended by CNMs and CMs reached a record high of 317,626, representing 11.1% of all vaginal births, and 7.5% of all births. CNMs and CMs attend births in hospitals (96.1%) freestanding birth centers (2.1%) and at home (1.7%).
1. Planned Home Birth. Committee Opinion #476. American College of Obstetricians and Gynecologists. Obstet Gynecol 2011;117:425-8. Available at http://www.acog.org/from_home/publications/press_releases/nr01-20-11.cfm (accessed February 2, 2011).
2. American College of Obstetricians and Gynecologists. Home Births in the United States. Washington, DC: American College of Obstetricians and Gynecologists; 2007.
3. Wax JR, Lucas FL, Lamont M et al. Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis. Am J Obstet Gynecol 2010; 203
4. National Childbirth Trust. Critique of a meta-analysis by Wax and colleagues which has claimed that there is a three-times greater risk of neonatal death among babies without congenital anomalies planned to be born at home. London: National Childbirth Trust; July 7, 2010. Available at http://www.nct.org.uk/active/network/representation/news (accessed February 2, 2011).
5. Offline: urgency and concern about home births. Lancet [Comment]. 2010: 376: 1812.
6. American College of Nurse-Midwives. The American College of Nurse-Midwives (ACNM) expresses concerns with recent AJOG publication on home birth. Silver Spring, MD: American College of Nurse-Midwives; July 7, 2010. Available at http://www.midwife.org/documents/ACNMstatementonAJOGhomebirthstudy_071310_2__2_.pdf (accessed February 2, 2011).
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