International Cesarean Awareness Network

Statement of the International Cesarean Awareness Network

Regarding the AMA/ACOG Homebirth Resolution

June 30, 2008

The International Cesarean Awareness Networks (ICAN) condemns the recent resolution passed by the American Medical Association and put forward by the American college of Obstetrics and Gynecology suggesting that homebirth is unsafe and that legislation stating such should be passed by states. 

The resolution is not evidence-based and, in its apparent suggestion that homebirth ought to be outlawed, threatens long-held standards of informed consent and patient autonomy.   ACOG itself maintains that maternal autonomy is almost absolute.  The resolution is also a clear conflict of interest, since AMA and ACOG have much to gain in driving women away from using home-based care providers. 

The resolution ignores a solid base of evidence that consistently shows homebirth is safe for low-risk women.[i]   It also ignores the fact that there is no evidence to support the notion that hospital-based deliveries are superior for low-risk mothers.  In fact, while the obstetric community often touts the significant drop on childbirth-related deaths in the last century, little of this improvement has any relation to obstetric care practices, but rather the advent of antibiotics, sterile practices, and safe transfusions.  Approximately 95 percent of women in the U.S. give birth under the care of an obstetrician in the hospital and with this care, the U.S. has the second worst newborn death rate in the world[ii], and ranks 41^st in maternal deaths among all nations [iii]

This resolution comes at a time when the physician community increasingly fails to deliver quality, evidence-based care to women and their babies.   The most basic needs of laboring women – continuous labor support, food and drink, freedom to move, freedom from routine interventions, being allowed to push in an upright position, and immediate and unbroken contact with the newborn – are  routinely ignored in U.S. hospitals.   Additionally, major medical interventions such as induction and cesarean section are frequently used without true medical need. 

For many mothers, the hospital environment fails to meet their needs, which is why some mothers choose to deliver at home under the care of a trained professional midwife.  In our volunteer-based community, ICAN regularly supports mothers who were frightened or bullied into unnecessary interventions by their care providers or were never informed of the risks of interventions.    Because of concerns over legal liability and convenience, physicians have prompted over 300 hospitals to ban vaginal birth after cesarean, forcing normal healthy women into cesareans they likely do not need.

Every woman has the right to evaluate the risks and benefits of various care providers and birth settings and choose what is right for her and her baby.  Whether through legislation or institutional pressures, it is unacceptable for any professional trade organization to infringe on women’s autonomous decision-making process.

Many Women
Many Visions
One Scar
One Purpose

The International Cesarean Awareness Network, Inc (ICAN) was formed over 25 years ago in order to support women in their journey towards understanding the risks of cesarean section and with the purpose of helping them have healthy births and healthy lives after undergoing the surgery that changed them.

Twenty-six years later, many women are still being told the same reasons why they must have a cesarean or why they cannot have a vaginal birth after cesarean (VBAC) despite more and more research that states that cesarean surgery should not be taken lightly and that vaginal birth after cesarean should be encouraged in order to reduce further risks to both mother and baby.

ICAN wants you to read the research for yourself. We encourage you to ask questions and explore your options and if it begins to look like you don’t have choices, help to make the changes necessary to bring about healthy births for yourself and other moms. Here are some simple steps to help you:

• Ask questions. If your care provider tells you a risk is "This" percent, ask them to show you the study and explain how it applies to your situation.
• Explore our website. There is a lot of good research on here to be able to share with your family or friends when they are concerned about your plans.
• Don’t try to convince others that what you are doing is right. Save your energy and your faith for your birth. When you are approached by those who care abut you, take the time to calmly explain your beliefs, then ask them to respect your decisions. Growing a baby takes energy and peace. Allow yourself the right to walk away!
• Interview your care providers like your life depended on it. In order to have a healthy birth, trust is essential in a relationship. If your care provider gives you outlandish risk assessments or impossible criteria like "You have to have the baby by 38 or 40 weeks if you want a VBAC…" then you know to go elsewhere because that physician isn’t giving you adequate information or choices that apply to healthy birthing women.
• Know your options. Explore midwives, homebirth, CNM’s, OB’s, family practitioners, birth centers. Birth is not only in hospitals and not only with obstetricians. Remember that starting with low risk care and being assessed properly often encourages moms to stay low risk.

We hope you enjoy exploring our website and sharing your stories with other women, Keep researching and reading and coming back often to help support the idea of healthy birth!