ACOG's Home Birth Survey

September 2, 2009

Earlier this week, the American College of Obstetricians and Gynecologists posted a survey, Complications Related to Home Delivery, at its website. The survey, designed for OB/GYNs, has raised the hackles of home birth and midwifery advocates, who question the intent of the survey and limitations inherent in the design.

In the introduction to the survey, ACOG explains:

The American College of Obstetricians and Gynecologists is concerned that recent increases in elective home delivery will result in an increased complication and morbidity rate. Recent reports to the office indicate our members are being called in to handle these emergencies and in some instances have been named in legal proceedings. To attempt to determine the extent of the problem, a registry of these cases will be maintained at ACOG on a year-by-year basis.

The intro language strongly suggests that the organization is looking for bad examples (an “increased complication and morbidity rate”) to use in defending its stance against home birth. While OB/GYNs were asked to complete the survey “even if there was no adverse outcome,”  I wonder how many would bother to fill out the form when the stated purpose is to “determine the extent of the problem.”

In addition, I have concerns about the type of information collected by the survey. The survey was initially viewable and completable by the public – a cached version is available, and makes apparent that it included no identifying data that could be used to follow-up with the person reporting the cases or to confirm that the person completing the survey is actually an OB/GYN. There was (and is) no way to confirm or examine the details of any case, unlike real registries of patient data and outcomes.

The survey is still available, but is now behind password protection to limit it to ACOG members. Of course, even behind password protection, this is not a random sample of OB/GYNs capable of determining how often these providers encounter home birth transfers – it now excludes OB/GYNs who are not members, and would include information only from those providers who were motivated enough to respond.

Such a survey can produce anecdotes about provider experiences, but is unlikely to add much to the knowledge base about home birth and transfers in the absence of more comprehensive data collection – it’s simply not a well-executed scientific survey. As a Big Push for Midwives press release [PDF] notes, some suspect that the submitted stories – likely to represent the worst outcomes of home birth – are intended to be used by ACOG “to support its ongoing state and federal lobbying campaigns aimed at denying women access to out-of-hospital maternity care and Certified Professional Midwives.”

In response, home birth advocates – acting via Facebook, blogs, Twitter, and the like – encouraged the submission of positive home birth stories to the site before it was password-protected. Jill at the Unnecesarean provides an example of one of the calls that was going around, which includes the express intent to force the survey into the members-only area of the site.

On a related note, am I the only one who thought of pizza given the repeated “home delivery” language ACOG used? Think that tells us anything about the organizational perspective on birth?

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