OB’s That Support Homebirth – Yes, They Do Exist

The words OB and Homebirth….when put together, our cultural likes to paint a black and white picture – that OB's are always at odds with homebirthers and midwives.

While our current birth climate does reflect that most OB's do not embrace homebirth and tend to become insecure and bully-ish when asked about homebirth's validity, the majority of people don't even consider that there are, in fact, some OB's who do wholeheartedly embrace homebirths.

Take, for example, Dr. Stuart James Fischbein – a Fellow of the ACOG.  Recently, ACOG released yet another statement on homebirth, basically repeating their last one.  To everyone's shock and dismay, ACOG was none too supportive of the practice.  Dr. Fischbein responded with this:

I am an obstetrician who has collaborated with both certified nurse midwives (CNM) and licensed midwives (LM/CPM) in California for more than 25 years and I am a Fellow of the American College of Obstetrics & Gynecology. I, myself, also attend home deliveries. 

What?  He – an OB – attends homebirths?!  What ACOG doesn't want you to know if that there are a handful of OB's who do attend homebirths.  Keeping this information underground prevents the fissure in their position on homebirth from becoming a crack.  He goes on to say:

It seems the College relied heavily on a paper by Joseph R Wax, MD in formulating its opinions. I have written the college before regarding the use of level C evidence (consensus opinion) to dictate policy and recommendations. Those of us who truly support a woman’s right to choose her own path based on true, not skewed, informed consent know the damage that can be done by a legitimate organization like ours when it puts out an opinion. The paper by Wax and colleagues is an extremely flawed article. It has been reviewed extensively by many who express legitimate criticisms. None of which ACOG chooses to address. This study demands a critical reading.

The meta-analysis of Wax, et al is the weakest type of data and should never be used as an exclusive measure of a topic. The fact that the authors cherry picked this data, including the use of one tiny study with 11 women, to prove its point while ignoring the largest studies from North America and Europe on planned homebirth demonstrates the clear bias. His paper compares apples to oranges. He goes back 40 years, mixes matched cohorts with prospective cohorts and record reviews, mixes urban and rural statistics and admits to many difficulties in interpreting this information including whether an attendant was even present and excludes many legitimate studies that do not fit his theory.

This OB is in essence chastising his own organization for using skewed, flawed data to base its position on.  Sadly, professional medical organizations have a history of commissioning studies that have a predetermined outcome, or manioulating data to serve its own purposes.

It is not that ACOG puts out an opinion that matters to me. It is that this opinion lacks any foundation of solid evidenced based medicine. Truth is our most important value. ACOG should never lower its standards of excellence in research to accept evidence against home birth, HBAC and selected twin or breech vaginal delivery simply because they may disagree with these choices. 

Ouch. 

Yes, this doctor – along with *others – makes a good, and scathing point.

To learn more about different models of maternity care, please visit birthologie.com

* Christiane Northrup, Don Creed, Mayer Eisenstein – all OB's – have been very vocal supporters of homebirth

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