Mamas on Bedrest: ACOG’s New Recommendations on Planned Home Births

February 4th, 2011

ACOG just released its new recommendations on planned home births.

As many of you may recall, last summer, ACOG “leaked” data from a study done by Dr. John Wax and colleagues at the Maine Medical Center stating that women who elected home births had a 2-3 fold increase in neonatal mortality. The study was published in the fall, but the data was publicized in July, Just as New York and Massachusetts were voting on whether or not to grant practice privileges to midwives. The study data was immediately criticized by the American College of Nurse Midwives, Childbirth Connection and a multitude of birth advocates. As the dust has settled, ACOG has reviewed its stance and published their latest recommendations in the most recent issue of Obstetrics and Gynecology. (Obstet Gynecol. 2011;117:425-428)

MedScape Summary of ACOG Home Birth Recommendations.

Each year some 25,000 women elect to give birth at home. A meta-analysis done of observational studies by Wax and colleagues concluded that there is a 2- to 3-fold increased risk for death for planned home births. Previous studies have also shown a decrease in neonatal mortality in regions with readily available transport to hospitals. In the United States, studies show that the lowest mortality rates in the presence of a highly trained midwife who is well-connected to the health care system. To reduce the risks, women who choose at-home birth should be informed about appropriate candidates for home birth. According to the committee, these include women:

  • With absence of maternal disease previous to or during the pregnancy
  • Singleton fetus
  • Head down presentation
  • Gestational age between 36 and 41 completed weeks of pregnancy
  • Spontaneous labor or labor induced as an outpatient,
  • Women who have not been transferred from a referring hospital.
  • Women who have had previous cesarean deliveries should absolutely not undergo planned home birth
  • Have at hand a certified midwife, certified nurse-midwife, or physician
  • Have consultation access
  • Have access to timely transport to a nearby hospital if needed.

The analysis also found that planned home births were associated with:

  • Fewer maternal interventions, such as epidural analgesia, electronic fetal heart rate monitoring, episiotomy, operative vaginal delivery, and cesarean delivery.
  • There were also fewer third- and fourth-degree lacerations and maternal infections and similar rates of postpartum hemorrhage, perineal laceration, vaginal laceration, and umbilical cord prolapse.

The percentage of planned home births will likely continue to grow, and according to this MedScape Editorial and many experts in obstetrics and gynecology and public health, it is incumbent on the medical profession to adapt and integrate the practice, though many physicians remain resistant to working with midwives.  Said Eugene Declercq, PhD, professor of maternal and child health at the Boston University School of Public Health in Massachusetts, who takes issue with the numerous “flaws” noted in the Wax Study,

“I’d prefer to have people finding ways to work together, rather than this ceaseless interprofessional battle. The reality is that there are more and more women seeking planned home birth, and we need to make it safer for everybody.”

The complete MedScape News Editorial is located on the Medscape Website.

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