Thursday, February 07, 2008

The latest from ACOG & ICAN

For those who haven't seen it yet I must share ACOG's latest press release:

ACOG Statement on Home Births

Washington, DC -- The American College of Obstetricians and Gynecologists (ACOG) reiterates its long-standing opposition to home births. While childbirth is a normal physiologic process that most women experience without problems, 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.

ACOG acknowledges a woman's right to make informed decisions regarding her delivery and to have a choice in choosing her health care provider, but ACOG does not support programs that advocate for, or individuals who provide, home births. Nor does ACOG support the provision of care by midwives who are not certified by the American College of Nurse-Midwives (ACNM) or the American Midwifery Certification Board (AMCB).

Childbirth decisions should not be dictated or influenced by what's fashionable, trendy, or the latest cause célèbre. Despite the rosy picture painted by home birth advocates, a seemingly normal labor and delivery can quickly become life-threatening for both the mother and baby. Attempting a vaginal birth after cesarean (VBAC) at home is especially dangerous because if the uterus ruptures during labor, both the mother and baby face an emergency situation with potentially catastrophic consequences, including death. Unless a woman is in a hospital, an accredited freestanding birthing center, or a birthing center within a hospital complex, with physicians ready to intervene quickly if necessary, she puts herself and her baby's health and life at unnecessary risk.

Advocates cite the high US cesarean rate as one justification for promoting home births. The cesarean delivery rate has concerned ACOG for the past several decades and ACOG remains committed to reducing it, but there is no scientific way to recommend an 'ideal' national cesarean rate as a target goal. In 2000, ACOG issued its Task Force Report Evaluation of Cesarean Delivery to assist physicians and institutions in assessing and reducing, if necessary, their cesarean delivery rates. Multiple factors are responsible for the current cesarean rate, but emerging contributors include maternal choice and the rising tide of high-risk pregnancies due to maternal age, overweight, obesity and diabetes.

The availability of an obstetrician-gynecologist to provide expertise and intervention in an emergency during labor and/or delivery may be life-saving for the mother or newborn and lower the likelihood of a bad outcome. ACOG believes that the safest setting for labor, delivery, and the immediate postpartum period is in the hospital, or a birthing center within a hospital complex, that meets the standards jointly outlined by the American Academy of Pediatrics (AAP) and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers.

It should be emphasized that studies comparing the safety and outcome of births in hospitals with those occurring in other settings in the US are limited and have not been scientifically rigorous. Moreover, lay or other midwives attending to home births are unable to perform live-saving emergency cesarean deliveries and other surgical and medical procedures that would best safeguard the mother and child.

ACOG encourages all pregnant women to get prenatal care and to make a birth plan. 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 healthy baby. For women who choose a midwife to help deliver their baby, it is critical that they choose only ACNM-certified or AMCB-certified midwives that collaborate with a physician to deliver their baby in a hospital, hospital-based birthing center, or properly accredited freestanding birth center.

Check out that last paragraph. "Choosing to deliver a baby at home, however, is to place the process of giving birth over the goal of having a healthy baby." I beg to differ! How many of us have had hospital births that caused complications with our babies? Birthing in the hospital is NOT a guarantee that your baby will be healthy. In fact, for a low-risk woman it almost guarantees a greater chance of complications for mother and/or baby because of the standard hospital interventions.

I find it incredibly insulting that ACOG thinks that homebirthing moms (or those who choose freestanding birth centers) don't care about their children and are just about the experience of birth. Is a healthy mom and baby not EVERYONE'S first goal in birth? Is that not why so many women choose cesareans when their doctors tell them they "need" one? I know I would be cut open again in a heartbeat if I thought my baby's life was in danger. ACOG is just trying to make us all sound like a bunch of crazy hippies who give birth in the woods attended by fairies because we are all about the experience.

To me this is just another example of how ACOG is looking out for it's first priority-it's members. The doctors are #1 at ACOG and they'll do anything to protect their bottom line. I'm sure they feel pressured by all of the success surrounding "The Business of Being Born" but what's next? Getting rid of Family Practice docs too? Anyone who isn't an OB (or a CNM working with an OB) is not qualified?

I find it equally amusing that ACOG does everything but call Ricki Lake out by name. They call homebirth "trendy" and a "cause célèbre." Funny when you consider that hospital births (and even elective cesareans) seem to be much more trendy these days. Homebirth is old. It's nothing new. It certainly didn't start with Ricki Lake's documentary. Ricki Lake just gets the credit for being willing to make a documentary that has caused many women to question their maternity care.

On a somewhat related note, today ICAN launched it's redesigned website. It's very exciting to see the changes that have been made. Hopefully this will help more women find the information they need and the support they desire.

Here's the full press release from ICAN:

Advocacy Group Unveils New Web site

Site features easy navigation, community resources

REDONDO BEACH, CA, February 7, 2008 – The International Cesarean
Awareness Network launches a new, user-friendly Web site today in an
effort to further the group's outreach efforts.

"The new Web site will make an impact in the battle against the
growing cesarean statistics by providing information to moms,
challenging them to take responsibility for their births and providing
a safe community for moms to heal" ICAN President Pam Udy said. "This
will give women the tools they need to make educated decisions about
their births – because this isn't about statistics. It's about every
mom and every baby getting the safest birth possible."

Easy navigation is a key feature of this Web site, which has been in
the works since July when ICAN Board Members recognized the need for a
more user-friendly Web site. (The Web site can be found at Site viewers will find information separated into
five categories: Pregnancy, Recovery, VBAC, Advocacy and Community.

"In our daily advocacy work, we saw a clear mandate for a site that
was simple to navigate, simple to understand and full of
easy-to-access information for the woman avoiding a cesarean,
recovering from a cesarean or on her journey to VBAC (vaginal birth
after cesarean)," Laureen Hudson, ICAN Publications Director said.
"ICAN interacts with women on very different journeys -- the messages
a pregnant woman needs to hear to avoid a cesarean are not the same
messages a woman on the journey to VBAC needs to hear. We like to
think that this site addresses those two complimentary, yet divergent,

The Web site lets women research the VBAC policies of hospitals near
them; learn how to correct problems (such as malposition or
pre-eclampsia) that commonly lead to cesareans; get quick physical
recovery tips to help after a cesarean; and stay up-to-date on medical
research on pregnancy and birth. New community features include user
birth blogs, videos and images; and the capability for users to create
their own homepage on the ICAN site to share with friends and family.
ICAN leadership also can connect more easily via the Web site with the
women ICAN serves. Further, the Web site features a new logo – the
logo, and all of the Web work, were completed entirely by volunteers.

"We wanted our site to be easy for the average woman recovering from
surgery and caring for a newborn to find the info they needed quickly
and easily," Webmaster Melissa Collins said. "One of my favorite
features is the online social community that is safe for moms planning
a VBAC or just wanting to avoid. I'm really excited to watch this new
community grow."

This new Web site comes after research in 2007 by the National Center
for Health Statistics showed the cesarean rate reaching a record high
of 31.1 percent. Further, a CDC report indicated the maternal death
rate rose for the first time in decades and Consumer Reports includes
a cesarean in its list of "10 overused tests and treatments." Other
research from 2007 cites a VBAC continues to be a reasonably safe
birthing choice for mothers. And while studies indicate a VBAC is a
viable option, women often have difficulty finding a health care
provider who encourages a VBAC – which is where one of the site's new
features comes into play.

"The most useful tool for women is probably the Hospital VBAC Ban
information," Collins said. "Women can look up the hospitals near them
and find out their VBAC policy and if any doctors are actually
available to attend them. It is getting difficult for so many women to
find a VBAC supportive provider and this is one way to make that a
little easier for them."

Mission statement: ICAN is a nonprofit organization whose mission is
to improve maternal-child health by preventing unnecessary cesareans
through education, providing support for cesarean recovery and
promoting vaginal birth after cesarean. There are more than 94 ICAN
Chapters across North America, which hold educational and support
meetings for people interested in cesarean prevention and recovery.
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