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Abstract: In 2009, while 99.3% of US women delivered in hospital, 0.7% delivered at home. In response to this slight rise in homebirths, The American Journal of Obstetricians and Gynecologists (AJOG) issued a warning to all doctors and midwives to refuse to attend homebirth under all circumstances. In the absence of respected medical research showing planned homebirth to be unsafe, their recommendation is based on a single maternal death reported in the Daily Mail. American obstetrics is so profit orientated that it is willing to use misquoted newspaper articles as ammunition and pretend that 277 women don't die in the US annually from cesarean surgery at planned hospital births. AJOG articles are nothing more than publicity stunts created in an effort to maintain a monopoly on birth and not to forfeit even a small amount of business to competitors.
The American Journal of Obstetricians and Gynecologists (AJOG) published an article by 4 medical doctors and one PhD, October 31, 2012 (available free https://www.ajog.org/article/S0002-9378(12)01074-5/fulltext recommending that "all obstetricians and other concerned physicians, midwives and other obstetric providers, and their professional associations not support planned home birth... refuse to participate in planned home birth.. and recommend strongly against planned home birth" to women who ask about it. This was in response to the report that while 99.3% of US women delivered in hospital in 2009, the other 0.7% of births were reported on birth certificates as homebirths.
AJOG is prescribing one birthing option for all women and all situations. Expecting 100% adherence to a medical protocol ignores the splendorous diversity of human conditions. Although ACOG has connived 99.3% of women to give them business, they want a 100% monopoly and they wont let go of the other 0.7% of the market. How about women with white coat syndrome who get high blood pressure when they enter a hospital?
How about immune deficient women who can easily catch nosocomial infections in hospital, women with homes built around their physical and/or mental disability, women who cant urinate, defecate, or sleep anywhere but their own bathrooms or beds, women who have never had a vaginal exam and don't want one, women who fear needles, hearing impaired, the blind, women with agoraphobia who never leave the house, women with speech impediments in public so bad that you cannot understand them, women who never get touched by a man other than their husbands for religious reasons, women who wear burkas or tattoos and don't want flack about it, women who don't speak English or Spanish, women who fear birth AND fear having a cesarean or an episiotomy or having a stranger in the room, women who are educated enough to know that maternity care in hospitals is not evidence-based, women who are aware of the risks to themselves or their newborn of catching a hospital infection that may not be susceptible to Penicillin, women who would rather die than set foot in a hospital, women who had partners that they have court orders to stay far away from them and are hiding from them in unknown locations, women who are hiding from abusive parents, celebrities who want privacy, and women who know birth is not a disease and want to maintain control over their bodies?
Unless the government makes homebirth punishable by death, 100% of people will never deliver in hospital. Since AJOG has not managed to lobby strong enough to manage to pass a law calling for the death penalty or at least jail time for homebirth, they must resort to quoting the Daily Mail.
One of AJOG's arguments for eliminating homebirth is a misquoted article from the photo journalistic paper The Daily Mail (1), in which one woman reportedly died after an unattended birth in Australia. AJOG writes, "In summary, planned home birth does not meet current standards for patient safety in obstetrics, as illustrated by the recent preventable death from hemorrhage of an Australian midwife home-birth advocate while attempting delivery of her own child at home."
AJOG says she bled to death whereas the article states clearly that the cause of death was unknown. If she died of an embolism, she might have also died if she had birthed in hospital. The maternal mortality rate due to Amniotic Fluid Embolism that happens in hospital is 27%. (2) AJOG hide the fact that the birth was unattended by wording it as a woman attempted to deliver her own child. She didn't attempt to deliver her child. She did deliver her own child successfully, even though she might have had a previous cesarean on her first birth.
AJOG neglects to point out that having only one maternal death at hospital birth would be a great blessing when in the US annually 277 young healthy women bleed to death among the 1,386,000 cesareans performed each year. AJOG neglected to point out that the 277 women who bled to death from cesareans would be alive today, if they had chosen attended homebirth.
The calculations are simple. Landon (3) found that 1 woman dies among every 3000 cesareans (0.3%), but estimating that only 1 in 5000 or (0.2%) of women die from cesareans, 0.2% of 1,386,000 = 277 women die per year in the US who would be alive had they chosen attended homebirth. Maternal mortality and postpartum hemorrhage due to the overuse of cesarean are increasing quite dramatically in the US with increasing cesarean and induction rates. (4)
AJOG knows they lack scientific evidence of homebirth being anything but safe or safer. They state they "support" the findings of the Wax study, knowing full well that the authors were unable to do simple arithmetic, let alone perform a systematic review of planned full term homebirth.
It is now official: Evidence based medicine has been abandoned by mainstream obstetrics. Misquoting the Daily Mail is the new accepted source for AJOG's Evidence Based Obstetrics.
AJOG is willing to ignore the increasing maternal death and severe hemorrhage rates in a desperate fight for a monopoly on the profit provided by hospital birth. AJOG articles are nothing more than publicity stunts created in an effort not to forfeit even a small amount of business to competitors.
- 1. Shears R . Woman, 36, who campaigned for home births dies having baby daughter at home. Daily Mail online. Jan. 31, 2012 . https://www.dailymail.co.uk/health/article-2094348/Caroline-Lovell-Home-birth-advocate-dies-delivering-baby-daughter-home.html
- 2. Kramer MS, Rouleau J, Liu S, Bartholomew S, Joseph KS; Maternal Health Study Group of the Canadian Perinatal Surveillance System. Amniotic fluid embolism: incidence, risk factors, and impact on perinatal outcome. BJOG. 2012;119(7):874-9.
- 3. Landon MB, Hauth JC, Leveno KJ, et al. Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. N Eng J Med 2004;351:2581-9.
- 4. Knight M, Callaghan WM, Berg C et al (2009). 'Trends in postpartum hemorrhage in high resource countries: a review and recommendations from the International Postpartum Hemorrhage Collaborative Group', BMC Pregnancy Childbirth, 9, 55. https://www.biomedcentral.com/1471-2393/9/55
- Note: The American Journal of Obstetrics & Gynecology is the official publication of the following societies and associations:
- American Gynecological and Obstetrical Society
- Association of Professors of Gynecology and Obstetrics
- Central Association of Obstetricians and Gynecologists
- Pacific Coast Obstetrical and Gynecological Society
- Society of Gynecologic Surgeons
- Society for Maternal-Fetal Medicine
- South Atlantic Association of Obstetricians and Gynecologists