Response to ACOG Statement

“The more the practice of midwifery grows and succeeds, the more threatening midwives are to the obstetric monopoly, so, predictably, there has been an obstetric backlash.” — Marsden Wagner, M.D., former Director of Women’s and Children’s Health at the World Health Organization.

And so it seems, as of February 6, 2008, that we are seeing this backlash from the American College of Obstetricians and Gynecologists (ACOG). Their latest statement against homebirth is a bullying move on the chess board of American maternity care, designed to intimidate, threaten and belittle an ever growing movement of “other than” birth in the United States. Is it no surprise that on the wake of a huge popular movement in many major cities across the country, inspired by a new movie, The Business of Being Born, which portrays midwifery and homebirth, ACOG felt compelled to puff out their chest and tell us once again there stance on homebirth? Really, it does seem somewhat disingenuous that they should reissue this statement at all, is it any different from their 2002 statement? But the midwifery movement is growing in both visibility and numbers. For once, natural childbirth activists feel hopeful that the pendulum may be swinging back to a more natural and simple way of birthing. So, of course, the bullies on the block have to step in to assert their own OPINION about the newest kid that’s treading on their turf.

“As midwifery becomes better established in the United States, it becomes more difficult for the obstetric establishment to perpetuate the myth that midwives are not as safe as doctors,” says Marsden Wagner in his book, Born in the USA. Posturing and an “our-way-is-the-only-way” attitude will be seen for the empty threats that they represent. American women are strong, capable and smart enough to figure out that what this really represents is a power struggle that really has no place in her own birth experience. Women are capable of doing the research (and 5,000 birthing women across North America does not represent a “limited” study, see BMJ article), and making their own informed decisions around where and with whom they would like to give birth. No birth is risk-free, no birth setting is risk-free; however, “a review of the research leaves no doubt that a planned home birth attended by a nurse-midwife or direct-entry midwife is a perfectly safe option for the 80 to 90 percent of women who have had normal pregnancies.”

So, instead of the backlash, instead of the resistance to change, substantiated by evidence-based research, instead of the defensive posturing, perhaps ACOG could use their dollars to support women’s choice, to honor women’s process and continue to improve upon collaborative efforts between doctors and out-of-hospital practitioners. Other countries already know that home birth is a cost-effective, safe and satisfying option for women. Will we always be last in regards to infant morbidity and mortality and will ACOG, who arguably directs maternity care in the US, continue to ignore the elephant in the living room? Midwifery is growing. Educational programs hail from even our most prestigious universities. Thousands of women every year have safe and soul-satisfying birth experiences without an increase in the infant mortality rate that is experienced in hospitals with the same low risk population.

Does anyone else feel the resonance with this and how global warming was treated at first. The truth is so threatening to the status quo. ACOG is defending their territory. But guess what? Birthing in America does not belong to ACOG. It does not belong to midwives. It belongs to women—healthy, smart, capable women who can make a choice.