individuals that advocate for or who provide home births.” The reasoning behind its positioning on home birth was the lack of available data to inform the issue, according to Barth. That policy statement fueled the 6th edition of the American Academy of Pediatrics (AAP) and ACOG Guidelines for Perinatal Care (AAP and ACOG, 2007), which stated, “The hospital, including a birthing center within a hospital complex, or freestanding birthing centers that meet the standards of the [AAAHC, JC, AABC]3 provide the safest setting for labor, delivery, and the postpartum period.” The 6th edition guidelines also stated, “Until such data are available, home births are not encouraged.”

Also setting the stage for the dance was a controversial study by Pang and colleagues (2002), a retrospective cohort study conducted in Washington State that relied on birth certificate data as its sole data source.

With respect to where births were being delivered when the ACOG dance began, Barth said 24,970 home births were reported in 2006. Assuming that about two-thirds of those home births were planned, about 1 of every 263 births delivered that year was a planned home birth.

As more data were collected, Barth said, “the tides began to change.” Several studies appeared showing that neonatal deaths and other newborn outcomes associated with planned home births are no different than those associated with hospital births. These include a retrospective cohort study conducted in Sweden and based on data collected from the Swedish medical birth register and from follow-up phone calls (Lindgren et al., 2008); a retrospective cohort study conducted in the Netherlands and based on three different linked national perinatal databases (de Jonge et al., 2009); a retrospective cohort study conducted in British Columbia and based on provincial perinatal database registry data (Janssen et al., 2009); and a retrospective cohort study conducted in Ontario, Canada, and based on the Ministry of Health midwifery care database (Hutton et al., 2009). In addition to the relatively similar newborn outcomes in planned home birth versus hospital settings, another common theme of these studies was a decreased rate of interventions among planned home births compared to hospital births.

Also contributing to the landscape of the ACOG dance were the different views on home births being advocated by different organizations. Some organizations, like the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists, supported home births, while others, like the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, did not endorse home births.

The process for formulating an ACOG committee opinion is long. It

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3AAAHC, Accreditation Association for Ambulatory Health Care; JC, Joint Commission; AABC, American Association of Birth Centers.



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