10/17/2009 05:12 am ET | Updated May 25, 2011

ACOG Up to Dirty Tricks

A recent press release details some of the lengths that the American College of Obstetricians and Gynecologists (ACOG) is willing to go to preserve its near-monopoly over maternity care in the United States. In an effort to deter growing numbers of women from seeking out-of-hospital maternity care, ACOG urged its members to submit anecdotal, anonymous "data" (i.e. horror stories) about women who planned out-of-hospital births. This represents an effort to develop an unscientific case against out-of-hospital birth.

ACOG is not a protector of maternal or fetal life -- it is primarily concerned with avoiding competition from midwives that could negatively affect the incomes of its members. A campaign to expose ACOG's efforts to collect unscientific evidence used social networking tools like Facebook, Twitter, and email to encourage thousands of women to submit their own stories about healthy births in private homes and freestanding birth centers on ACOG's website. How did ACOG respond? It "quickly moved to scrub its website and placed its request for unsourced data from members behind a password-protected firewall" ( The survey is still there, in the members-only section, where it is "protected" from the public. What is likely to happen is that ACOG will then use the unscientific anecdotal data that it can collect from members to support lobbying campaigns directed at denying access to out-of-hospital birth and the midwives who are trained to provide it.

Will this work? Unfortunately it might, because ACOG has professional legitimacy and receives a lot of respect from members of the media and the general public. That's why advocates of reproductive rights -- which includes the choice of where and with whom to give birth - must increase awareness of what ACOG is doing. Otherwise ACOG will bring out their "data" to support opposition to out-of-hospital birth whenever the press offers them some attention. More people need to recognize that ACOG is a trade association (i.e. a cartel) that tries to protect its members from competition. Its primary goals do not include promoting science or evidence-based maternity care -- obstetrics is one of the least evidence-based specialties in all of medicine. In fact, the cherry-picked horror stories are designed to discourage women from examining the evidence and making rational decisions about where, and with whom, to give birth. Meanwhile, two recent well-designed, scientific studies of homebirth in the Netherlands and Canada, both published this year, provide solid evidence that planned out-of-hospital births have comparable perinatal mortality rates, lower rates of serious maternal and neonatal morbidity, and fewer interventions than hospital births among women who meet eligibility requirements for homebirth. These studies were well-designed scientifically because they compared women with the same level of "risk." (See Amy Romano's excellent summary of the results here, or a press release on the Canadian results here.) Given an opportunity to examine real evidence, like that in these recent studies, many women may rationally choose to give birth outside a hospital setting, and that's exactly what ACOG is going to desperate measures to prevent.

Obviously birth activists who want pregnant women to have the option of midwifery are interested in this, but really everyone should care about ACOG's self-serving behavior, which violates principles of anti-trust and is also relevant for the health reform debate. Maternity care in the U.S. is much more expensive than any other developed nation and has far worse results -- higher infant and maternal mortality, more premature and low birth-weight babies, and more infants in the NICU. Having a baby is the most common cause of hospitalization, and cesarean sections are the most common surgery in the United States. Out-of-control cesarean rates (around 1 in 3 births) and high-intervention obstetric care for low-risk women represent huge cost burdens on the system as a whole. The health reform debate has said little about maternity care, and that is a major omission. One of the best ways to reduce health care costs while improving results is to better integrate midwifery care and out-of-hospital birth into the health care system. But ACOG clearly doesn't want that to happen, since it would reduce its members' bottom lines. It's time for this cartel to be broken up.