Concern at actions of ACOG in America

Released on 20/06/2008

NCT and the Independent Midwives' Association (IMA) voice concern over actions of ACOG on home birth

NCT and the Independent Midwives' Association (IMA) today voiced concern at the recent actions of the American College of Obstetricians and Gynaecologists (ACOG), that seek to undermine and threaten American women's opportunities to give birth at home.

The NCT and IMA call on the ACOG to reconsider their position as a matter of urgency. Following the example of its international counterparts it should consider all available evidence on the benefits and risks of home birth. Women in America should have access to home birth rather than being limited simply to the medicalised model of birth available in US hospitals.

In February this year the ACOG reiterated its long-standing opposition to home births. More recently, the ACOG, introduced a resolution to the American Medical Association (AMA) at their annual meeting. The resolution commits the AMA to "develop model legislation in support of the concept that the safest setting for labor, delivery, and the immediate post-partum period is in the hospital...".

NCT and IMA are members of the Maternity Care Working Party (MCWP), which advises members of the United Kingdom Parliament on maternity care and services.

Counted among the membership of the MCWP, are the Royal College of Obstetricians and Gynaecologists (RCOG), the UK equivalent of the ACOG, as well as the Royal College of Midwives. These two organisations issued a joint statement in April 2007 on home births which states:

"There is no reason why home birth should not be offered to women at low risk of complications and it may confer considerable benefits for them and their families. There is ample evidence showing that labouring at home increases a woman's likelihood of a birth that is both satisfying and safe, with implications for her health and that of her baby." (Royal College of Obstetricians and Gynaecologists/Royal College of Midwives Joint statement No.2, April 2007)

NCT and IMA also believe that all women should have access to a home birth and up-to-date evidence-based information that addresses their questions, so they can make the right choice for them.

Home birth should be considered a mainstream option and offered as a regular choice for pregnant women using the health service, whichever country they reside in. For a healthy woman with a straightforward, low-risk pregnancy, home birth is a safe option. It is important that midwives provide care for women at home and that they have experience in home birth, receive active support and supervision, and that their training needs are met. Women's individual needs must be assessed and the back up of a modern hospital system, with good communication and transport links, are important, should transfer be needed.

The views of the NCT and IMA are supported by UK Government policy which seeks to reduce unnecessary interventions in childbirth and increase the numbers of women who experience a normal birth.

In England for example, the Government explicitly wants every woman to have opportunities to make well informed decisions about their care throughout pregnancy, birth and postnatally by the end of 2009. This includes a guaranteed choice of place of birth. Depending on circumstances three options will be available:

home birth

birth in a local midwife-led unit

birth in a hospital supported by midwives, anaesthetists and consultant obstetricians.

The opportunity for home births is increasing in the UK, albeit slowly. In 2006, 39% of women indicated that this had been discussed as an option at the start of their pregnancy, compared to 18% in 1995. The home birth rate for the UK as a whole currently stands at 2.6%, but in some areas this rate is higher than 10%. In Wales in particular, where the Government has set a target for home birth at 10%, the rate is higher than in other parts of the UK.

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Notes to Editors

• The NCT is the UK's leading charity on pregnancy, birth and early parenthood. Every year the charity supports thousands of parents through an incredible life-changing experience, offering relevant information and mutual support through our network of over 300 local branches, UK wide helplines, antenatal and early days courses, breastfeeding counselling and peer support schemes.
• Operating for over 50 years, the NCT is recognised as the voice of pregnant women and new parents throughout the UK. The charity works continuously for improvements to maternity care and better services and facilities for new parents. We are viewed by many as independent experts in matters relating to pregnancy, birth and early parenthood and are an influential and trusted advisor to UK governments, royal colleges, private sector bodies and other charities. www.nct.org.uk
• The Independent Midwives Association (IMA) was founded in 1985 to disseminate information about, and support for, independent midwives, and to lobby for the traditional role of the midwife. www.independentmidwives.org.uk
• Independent Midwives have been forced to practice without professional indemnity insurance (PII) since 2002 when the last commercial insurance product was withdrawn from the market. Insurance is unavailable due to the small number of Independent Midwives and the potential for very high claims, even though there have been no cases of significant awards against Independent Midwives in the UK since 1994. All Independent Midwives explain the situation clearly to clients to ensure they understand that they will not have significant recourse in the event of a negligence claim.
• The Maternity Care Working Party (MCWP) acts as an expert advisory body to the All-Party Parliamentary Group on Maternity.

MCWP is an independent, multi-disciplinary body that campaigns for improvements in maternity care. It was formed to raise awareness of the public health implications of the rising caesarean rate and highlights the health and social needs of women and their families and the contribution that woman-centred maternity services can make to the promotion of public health.

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