Apalling - New ACOG Policy out on Out-of-Hospital Births

Apalling - New ACOG Policy on Out-of-Hospital Births

Dear Friends,

It has just come to my attention that the Executive Board of the American College of Obstetricians and Gynecologists (ACOG) in October issued a new “Statement of Policy” regarding out-of-hospital births in the US. The statement in its entirety is included below. You will note that there is no URL for this new policy statement. ACOG chose to make this policy statement available on-line only to their members, and did not provide any press release about it.

In the statement ACOG claims that studies (comparing hospital and out-of-hospital birth outcomes) are “limited” and “not scientifically rigorous”.

The following sentences summarizes their policy: “…ACOG strongly opposes out-of-hospital births. Although ACOG acknowledges a woman's right to make informed decisions regarding her delivery, ACOG does not support programs or individuals that advocate for or who provide out-of-hospital births.”

People I have spoken with have suggested several possible implications. One is that because ACOG essentially establishes the legal “standard of care,” this statement takes out-of-hospital birth AND free-standing birth centers out of the standard. This not only gives OBs a strong basis for refusing to even interact with midwives or others who even just advocate for OOH births, let alone provide that service, but makes those OBs who DO support birth centers or home births or work with home birth midwives at legal and professional risk. Furthermore, this supports the agenda of the American Medical Association’s recently formed Scope of Practice Partnership (SOPP), a coalition of state medical associations and national medical specialty societies (such as ACOG) whose purpose essentially is to oppose any attempt by health professionals to obtain legislation or rules that permit or extend practice without physician control. (Of course the latter includes all licensed midwives – CNMs, CPMs, etc.)

At this time, we do not have any suggestions for meaningful or effective consumer actions to take. However, if you know of an OB who is friendly to normal birth, out-of-hospital birth, the right of women to choose where they give birth, etc., especially if they are members of ACOG, it would not hurt to make sure they know about this new policy and might take whatever action they can take with ACOG.

Surely some other organizations will be producing statements; I will let you know about these as they come along.

Sincerely,
Susan Hodges, “gatekeeper”


Available only to ACOG members through their website. No press release on the website. As of 11/11/06

ACOG Statement of Policy
As issued by the ACOG Executive Board

OUT-OF-HOSPITAL BIRTHS IN THE UNITED STATES

Labor and delivery is a physiologic process that most women experience without complications. Ongoing surveillance of the mother and fetus is essential because serious intrapartum complications may arise with little or no warning, even in low risk pregnancies. In some of these instances, the availability of expertise and interventions on .an urgent or emergent basis may be life-saving for the mother, the fetus or the newborn and may reduce the likelihood of an adverse outcome. For these reasons, the American College of Obstetricians and Gynecologists (ACOG) believes that the hospital, including a birthing center within a hospital complex, that conforms to the standards outlined by American Academy of Pediatrics and ACOG,(1) is the safest setting for labor, delivery, and the immediate postpartum period. ACOG also strongly supports providing conditions that will improve the birthing experience for women and their families without compromising safety.

Studies comparing the safety and outcome of U.S. births in the hospital with those occurring in other settings are limited and have not been scientifically rigorous. The development of well-designed research studies of sufficient size, prepared in consultation with obstetric departments and approved by institutional review boards, might clarify the comparative safety of births in different settings. Until the results of such studies are convincing, ACOG strongly opposes out-of-hospital births. Although ACOG acknowledges a woman's right to make informed decisions regarding her delivery, ACOG does not support programs or individuals that advocate for or who provide out-of-hospital births.

(1) American Academy of Pediatrics and /American College of Obstetricians and Gynecologists. Guidelines for Perinatal Care, 5th Edition. Elk Grove Village, IL, AAP/ACOG, 2002.

Approved by the Executive Board October 2006

The American College of Obstetricians and Gynecologists 409 12th Street, SW, PO Box 96920. Washington, DC 20090-6920 Telephone 202 6385577

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