Home Birth Consensus Summit: ‘Much Ado about Nothing’?

Although the American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice has stated that hospitals and birthing centers are the safest place for childbirth, some women choose to have their children in their homes. According to a study published in the National Vital Statistics Reports, approximately 1% of births in 2008 occurred outside of hospitals. Of these births, 66.3% occurred in homes/residences and 28.1% occurred in freestanding birthing centers. Furthermore, there is concern that childbirth at home might be a growing phenomenon.

To address this concern and open a dialogue amongst professionals treating pregnant women during childbirth, a Home Birth Consensus Summit was held. As part of the summit, invited delegates from a variety of disciplines and patient groups were invited to discuss issues, find common ground, and devise working “statements” addressing the phenomenon and appropriate actions. Members of ACOG, the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Nurse Midwives, and the Association of Women’s Health, Obstetric and Neonatal Nurses were among the groups that participated in the process and summit. The summit was held from October 20 to 22, 2011, in Virginia.

As a result of their discussions, the attendees devised nine consensus statements that could be used as recommendations for improving maternal and newborn care among those patients who opt for home birth. The consensus statements included:

• An acknowledgment of a patient’s autonomy;
•Support of collaboration and communication among all disciplines involved in caring for pregnant women;
•A commitment to an equitable maternity care system without disparities in access, delivery of care, or outcomes;
•Support for licensure and certification of all health care professionals involved in childbirth, regardless of setting;
•Improvement in the medical liability system;
•Recognition and affirmation that the “value of physiologic birth for women, babies, families and society and the value of appropriate interventions based on the best available evidence to achieve optimal outcomes for mothers and babies.”

While the intentions and words involved in the statements might be well-meaning, the merit of the summit and its consensus statements is questionable. For one thing, ACOG has come out against home births. Earlier this year, ACOG released a committee opinion noting that published medical evidence shows home birthing carries a two- to three-fold increase in the risk of newborn death as compared with planned hospital births, making the practice questionable at best. Dr Richard N. Waldman, president of ACOG, explained in a statement to the press, “As physicians, we have an obligation to provide families with information about the risks, benefits, limitations and advantages concerning the different maternity care providers and birth settings.” He added, “It’s important to remember that home births don’t always go well, and the risk is higher if they are attended by inadequately trained attendants or in poorly selected patients with serious high-risk medical conditions such as hypertension, breech presentation, or prior cesarean deliveries.”

An obstetrician-gynecologist blogger further commented on the proceedings, saying the summit and its proceedings were “much ado about nothing.”

On her “The Skeptical OB” blog, Dr Amy Tuteur wrote, “The [statements] are so banal as to be nearly meaningless, and everyone agreed with them prior to the Summit. It put me in mind of a summit between two bitterly warring countries that is declared a great success because everyone agrees that ... peace is good. There’s nothing substantive here and the most critical issues are not addressed.”

She added that the two most important, pressing principle issues were not even included in the summit’s dialogue. “The two critical issues, threshold issues on which everything else is based, are these: American homebirth increases the risk of perinatal death, and the CPM credential does not meet the standards of any other first world country. If homebirth advocates refuse to acknowledge or even discuss these issues, the results of any consensus summit are meaningless.”

What is your opinion on home births?  Are they safe or not?  Add your comment below.

References:

References:

1) Home birth consensus summit. Accessed Nov 19, 2011.
2) Martin JA, Hamilton BE, Sutton PD, et al. Births: Final data for 2008. National Vital Statistics Reports. 2010;59(1):1-72.
3) ACOG. The American College of Obstetricians and Gynecologists issues opinion on planned home births. Press release. January 20, 2011.
4) Tuteur A. Homebirth Summit consensus statements: much ado about nothing. Nov 4, 2011. Accessed Nov 19.