Evidence used, evidence ignored: The case of home birth policy

“Outcomes of planned home births with certified professional midwives: large prospective study in North America,“ published June 18, 2005 in the British Medical Journal (BMJ), concluded that Certified Professional Midwives attending home births had similar perinatal mortality outcomes to low risk hospital birth but with ½ to 1/10 the number of caesarean sections, forceps, vacuum, EFM, and other interventions associated with hospital birth in the United States. The take home messages: 1) home birth with certified professional midwives is a safe option for low-risk woman and 2) the amount of intervention presently being used in hospital does not appear to be warranted.

Subsequent to publication, several states, including Indiana, Missouri, California, and Wisconsin, contacted the study authors directly to have them present or provide evidence for state legislators. As several states began to use both the BMJ study and the APHA resolution on out-of-hospital birth to promote regulation, ACOG released two guidelines. The first ACOG statement on LAY MIDWIFERY did not directly mention the study but attempted to discredit Certified Professional Midwives, whose practices had just been evaluated through the study, by purposely excluding them from the list of credentials for midwives of which ACOG approved. The second statement, OUT-OF-HOSPITAL BIRTHS IN THE UNITED STATES, October 2006, directly announced ACOG restrictions on programs condoning any out-of-hospital births including birth centre births, by any practitioners. ACOG did not mention the BMJ study but blankets all research on out-of-hospital birth as not being scientifically rigorous.