Wednesday, February 06, 2008

The Latest from ACOG

The American College of Obstetricians and Gynecologists "reiterates its long-standing opposition to home births":
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.
Anyone besides me think that this statement is a response to The Business of Being Born?
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.
Oh, that's nice. More and more doctors and hospitals won't "do" VBACs, but they're telling you not to do them at home either. I think most HBAC-ing women would rather have been in the hospital, if they thought they would actually have been successful there.
ACOG encourages all pregnant women to get prenatal care and to make a birth plan.
Really??? Then don't ignore our birth plans when we make them. And put pressure on the hospital staff to respect them, as well. How come the L&D nurses think that birth plan = cesarean section? What's up with that?
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.
But the two aren't mutually exclusive, the "process" and the "goal"! Don't you get it? A healthy process creates a healthy mom and a healthy baby. Disturbing the process adversely affects the outcome.

And I'm sorry, women who are so traumatized by their birth "experiences" that they will not set foot in a hospital again unless they are dying, are not "healthy". Women whose bodies are cut and then stitched back together are not "healthy". Babies who leave the hospital formula-fed when their mother had planned to breastfeed them are not "healthy". Healthy is not the absence of disease or medical condition. Healthy is body, mind, and spirit.

So ACOG, if you don't like out-of-hospital birth, start practicing evidenced-based medicine. Start trusting women's bodies to birth. Stop pretending that you know everything (anything?) about natural (normal, physiological) childbirth. Stop lying to women. Try listening to them instead.


Leah said...

Amen sister!

Anonymous said...

I wouldn't feel safe VBACing in my hospital. They only had 16 VBACs there in 2006 - less than 1% of their live birth population. The cesarean rate is over 30%. And the way they handled my miscarriage sent me over the edge. They insisted on inserting a heplock even though I did not WANT it. Of course it wasn't necessary - I was having a miscarriage not dying. The horridly evil ER OB admonished me for getting pregnant too soon after my first miscarriage (I followed my care provider's advice). Oh, and their radiologist (and ultrasonographer) can't read ultrasounds. They misdiagnosed me with a blighted ovum. Lost the pregnancy anyway, but still the whole thing was mismanaged. And the CNM I had established with never followed up.

I'm "done" with traditional maternal care. DONE! Unless I become high risk, which of course is highly unlikely. Glad I was planning on homebirth anyway!!

Anonymous said...

I'm currently 23 weeks pregnant. At 17 weeks I discussed a VBAC with my OB, because of course I don't want to be cut again if it's not necessary. He went into this whole schpill about uterine rupture and that unless I'm dialate to 9 at 36 weeks and can push the baby out before he cuts me then I'm not going to have a vaginal birth. Well that decided it for me...I had to leave him. As I researched and asked around, I really began to get the feeling that if I choose a hospital birth, I will likely end up with another cesarean. So I'm going with a midwife and birth center. I got my records from my doctor's office and the next week I received 2 letters (duplicates) from him, stressing the risks of a VBAC (2% chance of uterine rupture) and how if an emergency arises during my labor he will not be able to help me. Good!! I don't want his help. He seems to be overlooking the 98% chance of non-uterine rupture!!!

Anonymous said...

I am an OB physician who A) had a VBAC - to the astonishment of my peers and B) would not allow peds to remove my child from my chest for 4 hours and never from the room. My sister is a midwife and we share a lot of the same philosophies. I spend a significant amount of time advocating for VBAC, leaving babies on mom's tummies, avoiding cesarean and episiotomy, and giving birth back to the family, however, meaningful change within hospitals is hard to do when a single bad outcome (whether they were at fault or not) can destroy your career leaving you with massive debt and no income. Most physicians are not willing to risk that to "do the right thing". Lobby Washington, not the doctors!