(how many acronyms can we throw in there?)
Remember me ranting and raving about the AMA and the ACOG their resolutions against homebirth? I sat there wondering why our country's midwives (both CNM and CPM) hadn't responded. Week after week went by, and I wondered if there would be a response at all.
Finally they (well, the CNMs) responded, and I have to say, it was worth the wait!
Check out the response from the American College of Nurse Midwives here.A few excerpts I love:
"Clinical practice must be guided by research. The scientific evidence strongly supports that planned home
birth under established selection criteria is a safe alternative to hospital birth. In the attached addenda, we summarize this evidence, explore the drivers behind the home birth choice and recommend specific strategies to improve the continuity of care for the small proportion of women and families choosing home birth." (pg 2)
"It should be noted that Resolution 205 erroneously states that ACNM has defined
Certified Professional Midwives (CPMs) as “traditional, independent (of the health
care system), non-formally trained and community-based providers of care during
pregnancy, childbirth and the post-natal period.” ACNM does not define CPMs in
this or any other manner, and will not do so. CPMs have their own
professional organizations to represent them and standards which address
their education, certification and scope of practice." (Addendum, pg 5)
"Addendum III
Home Birth is a Rational, Personal Choice
The language of Resolution 204 and 205 suggests that women who choose home
birth are participating in a fad rather than making a rational choice. The implicit
underlying assumption is that state bans on home birth and restrictions on the
providers of home birth services will put an end to the practice. The Resolutions do
nothing to address the fundamental factors that influence the choice of home birth.
Reseachers have described the factors affecting women’s choice of planned home
birth, and satisfaction with home birth, as the perceived differences in their ability to
control the environment and process of care. Specifically, women note that planned
home births increase their privacy, comfort and convenience; decrease the rates of
medical interventions and exposure to infectious agents; provide greater cultural and
spiritual congruency; change the provider-patient power dynamics; and facilitate
family involvement and a relaxed peaceful atmosphere. Women consistently report
that these factors increase their sense of safety and allow them the self determination
and empowerment necessary to fully participate in decision-making
around aspects of their care.
Women want and have a right to expect unbiased information based on current
scientific evidence and to share in decisions regarding their childbirth. Global
communication has made international research and evidence-based maternity care
options increasingly available to the public. Women and their families are aware that
recent cohort studies in national and international settings indicate that planned
home births are associated with similar perinatal outcomes and fewer obstetric
interventions compared to hospital births.
Expert advisory panels in several nations, including the US, recommend that a
woman’s informed choice of place of birth be respected and that appropriate home
birth maternity services be made available.
In 2003, the Society of Obstetricians and Gynecologists of Canada issued a policy statement on midwifery
that advocates for the further integration of midwives into maternity services and
“recognizes and stresses the importance of choice for women and their families in
the birthing process.”
Another factor in the desire for home birth in the US is the plummeting availability of
vaginal birth after cesarean (VBAC) despite current research demonstrating that
successful VBAC results in significant benefits and fewer risks for women and infants
than repeat cesarean delivery. Key elements of a successful VBAC include unbiased
appropriate informed consent, heightened surveillance of fetal heart rate patterns,
and appropriate arrangements for medical consultation and emergency care. In
many hospitals, VBACs are simply unavailable, forcing women to make the often
difficult choice between a repeat cesarean and laboring at home—where appropriate
surveillance and medical consultation are less likely to be available.
With so many factors influencing the choice of birth site, it is unlikely that even this
small number of home births can be legislated away. If AMA is truly concerned with
the safety of the birthing mother and infant, greater attention should be paid to
ensuring continuity of care for women regardless of choice of birth site or birth
attendant. By improving the conditions and communication around transfer of care
from one birth setting to another, or one care provider to another, even the small
risks to mothers and infants of electing out-of-hospital birth could be greatly
reduced."
"In recent years, high-quality prospective controlled cohort studies and descriptive
studies have established that planned home births achieve excellent perinatal
outcomes. Home birth is also credited with the reduced use of medical
interventions that are associated with perinatal morbidity, including narcotic or
epidural analgesia, augmentation or induction of labor, and assisted vaginal births or
cesarean section.
While a large randomized controlled study (RCT) would
constitute the gold standard, to date sufficient number of women have not consented
to be randomized according to birth site. Fortunately, recent data from a large
North American prospective study compare outcomes of planned home births and
planned home births when attended by midwives who apply consistent selection
criteria, and function within an infrastructure that provides support and consultation
as requested.
If we are to insist upon RCTs to prove the safety of home birth,we should consistently apply that standard to all birth settings and all routineobstetrical interventions applied to healthy childbearing women in the acute caresetting—including elective cesarean section." (emphasis mine)
"In its policy statement on home birth, ACOG has stated that “The development
of well-designed research studies of sufficient size, prepared in consultation with
obstetrical departments and approved by institutional review boards, might clarify
the comparative safety of births in different settings.” It is difficult to imagine how
this goal could be realized if home births were legislatively prohibited. To date, most
US obstetric departments have not engaged in the evaluation of alternative settings
for maternity care; on the contrary, most have demurred from even entering into
collaborative agreements with home birth providers."
Ok, instead of quoting the rest,
go READ it! Really, start to finish, worth a read. Now if only it would get the press the AMA resolution did.
Comments (1)
hehe, i got a little carried away