ACOG (American College of Obstetricians and Gynecologists) has recently updated their opinion on the issue of homebirth. The latest statement from the professional organization of obstetricians includes some positives, such as an emphasis on patient autonomy…
“Although the American College of Obstetricians and Gynecologists…believes that hospitals and accredited birth centers are the safest settings for birth, each woman has the right to make a medically informed decision about delivery.”
… an admonishment to keep a civil manner with patients in the event of a transfer…
“When antepartum, intrapartum, or postpartum transfer of a woman from home to hospital occurs, the receiving health care provider should maintain a nonjudgmental demeanor with regard to the woman and those individuals accompanying her to the hospital.”
… and an expanded assessment of qualified homebirth providers to embrace midwives “whose education and licensure meet International Confederation of Midwives’ Global Standards for Midwifery Education” which would include some CPMs (Certified Professional Midwives). The opinion also makes clear that ACOG understands the importance of integrating homebirth services with the larger maternity system to improve safety and outcomes, an issue that the U.S. desperately needs to address.
However, the statement also takes a hard line against VBACs, breeches, and multiples as candidates for homebirth. This stance is highly problematic. While suggesting that providers “do all they can to facilitate transfer of care or co-management in support of a desired [VBAC],” they stop short of encouraging their members to offer VBAC services themselves or to become skilled at breech or multiple births. Not addressing this vacuum in the profession disregards an important issue in the homebirth debate. Until the lack of availability of VBAC-, breech-, and multiple-friendly providers is remedied, ACOG’s official opinion limits the majority of these women to a surgical delivery. The onus is on ACOG to create for her a viable alternative.
In fact, if ACOG is serious about a woman’s right to choose the birth setting for her child, it cannot deny the mothers of VBAC, breech, and multiples the option of homebirth. These women are not second class citizens who can be afforded lesser rights. They have the same capacity for informed consent and refusal as other women. Especially in light of the lack of providers for their situation, the right to birth at home for women facing a VBAC, breech, or multiple birth is inviolable.
Further reading:
ACOG’s 2016 Committee Opinion on Planned Home Birth
Henci Goer Compares and Contrasts the 2016 and the 2011 Committee Opinion
The National Association of Certified Professional Midwives’ Response
