What is birth anyway? Is it a medical event, where mom and baby are both in danger until the event has ended safely? It is a psychosocial event, where a couple turns into parents and a new person joins a family? What matters, the end or the means?
If birth is a medical event, then it would make sense to give birth in a hospital, with doctors nurses, medicine and machines. Something could happen, you know, and thank goodness they'll be there to help you. Such is generally the attitude of medical-model caregivers and this line of thinking seems to be what informed the newly released paper from ACOG on homebirth.
ACOG wrote: "Although the Committee on Obstetric Practice believes that hospitals and birthing centers are the safest setting for birth, it respects the right of a woman to make a medically informed decision about delivery."
Now, my experience working with medical care providers at this point has been that their idea of women making informed decisions involved 1) women being scared or guilted into doing what the provider is telling them to do and 2) doctors having a general attitude that women aren't capable of birthing their babies without medical intervention. I would be curious to see what ACOG's idea of a medically informed decision is. Doubtless, the doctors would explain that women need them to be there in case something happens and wouldn't mention any of the risks involved in going to a hospital setting to give birth.
About midwives who attend homebirths, ACOG has this to say, "At this time, for quality and safety reasons, the American College of Obstetricians and Gynecologists does not support the provision of care by lay midwives or other midwives who are not certified by the American Midwifery Certification Board."
In other words, CPMs (certified professional midwife) who are certified by the North American Registry of Midwives, need not apply. ACOG's position appears to be that midwives who are not nurse-midwives ought to not be attending births.
Additionally, and perhaps the most interesting thing in their paper, is that ACOG wrote, "The relative risk versus benefit of a planned home birth, however, remains the subject of current debate. High-quality evidence to inform this debate is limited. To date there have been no adequate randomized clinical trials of planned home birth."
Essentially, what this means is that the entire opinion paper is ACOG's uninformed opinion about the safety of homebirth. When they say that there have been no adequate randomized trials of planned home birth, what they're saying is that they have not adequately studied home birth vs. birth in other settings, but they've decided to make decisions about it anyway.
I would have to argue that ACOG has no business making statements about the safety of something that hasn't been studied. And the fact that they're going around announcing that homebirth carries a risk of perinatal death in the same paper that states that they haven't done trials of planned home birth makes the whole paper seem just a little bit silly.
There is one section of their paper that perhaps, has something to offer, " It also is important for women thinking about a planned home birth to consider whether they are healthy and considered low-risk and to work with a Certified Nurse Midwife, Certified Midwife, or physician that practices in an integrated and regulated health system; have ready access to consultation; and have a plan for safe and quick transportation to a nearby hospital in the event of an emergency." While I disagree that a midwife needs to be a nurse and was perfectly happy with the CPM I used for my last birth, I agree that women deserve to have access to consultation with physicians (who don't judge them or lecture them about their choice to birth at home) and access to hospital transport in the event of an emergency. I also think that medical institutions would do well to implement policies and staff trainings that teach their staff to treat women transferring to a hospital with respect.
What I would like to see is an integrated system where every woman has access to midwives and are able to choose to birth with a midwife at home, in a freestanding birth center or in a hospital. If a situation arose where the midwife decided that a doctor needed to be called in, one would be available and would treat the women in consultation with the midwife. Every book and study that I've read about maternity care has shown that women receive better quality care when they are primarily cared for by midwives.
If ACOG wants to form an opinion about home births, they would do well to study it and get back to us.
Resources about risks of hospital birth: