Rancid wrote:At a university.
Really? So you recommend your patients to have out-of-hospital birth?
OBGyn is one of the specialties in this country with the most litigious targets and there is no way in hell that you would be making such a recommendation when the official ACOG recommendation is actually that hospitals/birthing places are the safest (whether or not the evidence suggest this is irrelevant at this point). You could (and possibly will be) a target of multiple lawsuits during your career if this is indeed an accurate representation of what it is happening.
https://www.acog.org/Clinical-Guidance- ... eSet=false
ABSTRACT: In the United States, approximately 35,000 births (0.9%) per year occur in the home. Approximately one fourth of these births are unplanned or unattended. Although the American College of Obstetricians and Gynecologists believes that hospitals and accredited birth centers are the safest settings for birth, each woman has the right to make a medically informed decision about delivery. Importantly, women should be informed that several factors are critical to reducing perinatal mortality rates and achieving favorable home birth outcomes. These factors include the appropriate selection of candidates for home birth; the availability of a certified nurse–midwife, certified midwife or midwife whose education and licensure meet International Confederation of Midwives’ Global Standards for Midwifery Education, or physician practicing obstetrics within an integrated and regulated health system; ready access to consultation; and access to safe and timely transport to nearby hospitals. The Committee on Obstetric Practice considers fetal malpresentation, multiple gestation, or prior cesarean delivery to be an absolute contraindication to planned home birth.
And if that is not enough:
Although still uncommon, the rate of home births has increased during the past several years in the U.S. In a new policy statement, “Planned Home Birth,” in the May 2013 Pediatrics (published online April 29), the American Academy of Pediatrics (AAP) makes recommendations for the care of infants born in a home setting. Regardless of the circumstances of the birth, including location, every newborn infant deserves health care that adheres to AAP standards. The AAP concurs with the recent statement from the American College of Obstetricians and Gynecologists (ACOG) that the safest setting for a child’s birth is a hospital or birthing center, but recognizes that women and their families may desire a home birth for a variety of reasons. Pediatricians should advise parents who are planning a home birth that AAP and ACOG recommend only midwives who are certified by the American Midwifery Certification Board. There should be at least one person present at the delivery whose primary responsibility is the care of the newborn infant and who has the appropriate training, skills and equipment to perform a full resuscitation of the infant. All medical equipment, and the telephone, should be tested before the delivery, and the weather should be monitored. A previous arrangement needs to be made with a medical facility to ensure a safe and timely transport in the event of an emergency. AAP guidelines include warming, a detailed physical exam, monitoring of temperature, heart and respiratory rates, eye prophylaxis, vitamin K administration, hepatitis B immunization, feeding assessment, hyperbilirubinemia screening and other newborn screening tests. If warranted, infants may also require monitoring for group B streptococcal disease and glucose screening. Comprehensive documentation and follow-up with the child’s primary health care provider is essential.
Yes, and before you point out "the sentence ends with "but recognizes that women and their families may desire a home birth..." that does not in any way mean anything. Their recommendation in both cases is that hospitalis/birthing centers are safer, yet, for a healthy person with low risk that knows the risks, the added risk is sufficiently small that they are willing to take the risk.