ACOG & AAP jointly publish Guidelines for Perinatal Care. The first edition was published in 1983, and the 6th in 2007. I was unable to obtain hard copies of the oldest and most recent editions, but below are excerpts from editions 2, 3, 4, and 5 pertaining to place of birth.
The language doesn't change dramatically from one statement to another. Notice the gradual shifts in wording from the 2nd edition to the 5th. Emphasis mine.
2nd: "...the normal physiologic processes occurring within both mother and fetus….Because a significant proportion of patients ultimately attain high-risk status as a result of intrapartum complications, continuous surveillance of the mother and fetus is essential."
3rd: "in regard to the normal physiologic processes occurring within both mother and fetus….Because a significant proportion of patients may experience intrapartum complications, ongoing surveillance of the mother and fetus is essential."
4th and 5th: "Labor and delivery is a normal physiologic process that most women experience without complications….Because intrapartum complications can arise, sometimes quickly and without warning, ongoing risk assessment and surveillance of the mother and the fetus are essential."
Guidelines for Perinatal Care: 2nd ed., 1988, pp. 60-61
In large measure, the patient’s and the family’s perception of the intrapartum experience is determined by information provided during the antepartum period, particularly in regard to the normal physiologic processes occurring within both mother and fetus….
Intrapartum care should be both personalized and comprehensive. Because a significant proportion of patients ultimately attain high-risk status as a result of intrapartum complications, continuous surveillance of the mother and fetus is essential.
The hospital, including a birth center within the hospital complex, provides the safest setting for labor, delivery, and the postpartum period. The collection and analysis of data on the safety and outcome of deliveries in other settings, such as free-standing centers, have been problematic, as documented by a study conducted by the National Academy of Sciences. Until such data are available, the use of other settings is not encouraged. There may be exceptional geographically isolated situations, however, that require special programs.
Any facility providing obstetric care should have at least the following services available:
• Identification of high-risk mothers and fetuses
• Equipment for continuous fetal heart rate monitoring
• Capabilities to begin a cesarean delivery within 30 minutes of a decision to do so
• Blood and fresh-frozen plasma for transfusion
• Anesthesia on a 24-hour basis
• Radiology and ultrasound examination
• Neonatal resuscitation
• Laboratory testing on a 24-hour basis
• Consultation and transfer agreement
• Nursery
• Data collection and retrieval
Guidelines for Perinatal Care: 3rd ed., 1992, pp. 70-71
In large measure, the patient’s and the family’s perception of the intrapartum experience is determined by information provided during the antepartum period, particularly in regard to the normal physiologic processes occurring within both mother and fetus….
Because a significant proportion of patients may experience intrapartum complications, ongoing surveillance of the mother and fetus is essential. The hospital, including a birth center within the hospital complex, provides the safest setting for labor, delivery, and the postpartum period. The collection and analysis of data on the safety and outcome of deliveries in other settings, such as free-standing centers, have been problematic, as documented by a study conducted by the National Academy of Sciences. Until such data are available, the use of other settings is not encouraged. There may be exceptional geographically isolated situations, however, that require special programs. Any facility providing obstetric care should have the services listed as essential components for a level I hospital (Chapter 1).
Guidelines for Perinatal Care: 4th ed., 1997, pp. 93-94
The goal of all labor and delivery units is safe birth for mothers and their newborns. [The rest of the paragraph talks about how the patient should feel welcome, comfortable, and informed, and how family should participate in the birth experience].
Labor and delivery is a normal physiologic process that most women experience without complications….
Because intrapartum complications can arise, sometimes quickly and without warning, ongoing risk assessment and surveillance of the mother and the fetus are essential. The hospital, including a birth center within the hospital complex, provides the safest setting for labor, delivery, and the postpartum period. The collection and analysis of data on the safety and outcome of deliveries in other settings, such as freestanding centers, have been problematic. The development of approved, well-designed research protocols, prepared in consultation with obstetric departments and their related institutional review boards, is appropriate to assess safety, feasibility, and birth outcomes in such settings. Until such data are available, the use of other settings is not encouraged. There may be exceptional situations, however, such as geographically isolated areas in which special programs are required. [no mention of list of facility requirements in this section]
Guidelines for Perinatal Care: 5th ed., 2002, pp. 125-126
125: The goal of all labor and delivery units is a safe birth for mothers and their newborns. [patient should feel welcome, comfortable, and informed, family should participate]
Labor and delivery is a normal physiologic process that most women experience without complications….
Because intrapartum complications can arise, sometimes quickly and without warning, ongoing risk assessment and surveillance of the mother and the fetus are essential. The hospital, including a birthing center within a hospital complex, provides the safest setting for labor, delivery, and the postpartum period. This setting ensured accepted standards of safety that cannot be matched in a home birthing situation. The collection and analysis of data on the safety and outcome of deliveries in other settings, such as freestanding centers, have been problematic. The development of approved, well-designed research protocols, prepared in consultation with obstetric departments and their related institutional review boards, is appropriate to assess safety, feasibility, and birth outcomes in such settings. Until such data are available, the use of other settings is not encouraged. There may be exceptional situations, however, such as geographically isolated areas in which special programs are required.
So what they are saying is essentially, "We are going to completely ignore all the data collected over the last 20yrs that prove the safety of out of hospital birth because we didn't design the parameters and our approval wasn't sought. However, since those stuides DO exist, we'll change our wording slightly so we don't sound like all pregnancies will likely result in some serious DOOM if we weren't here."
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