A Facebook
friend recently posted this question:
“What questions would you have of ACOG?”
“What questions would you have of ACOG?”
It really
caused my brain to begin working – what would I want them to know? What would I ask them? Limit it to just a
few, hard-hitting questions. Don’t whine
or play the victim. Act like what I am,
their colleague. Sadly, the four
questions that came to mind were the same questions I’ve been asking on this
blog since its inception in 2007. The
first, however, was fueled by a situation experienced recently at a local
hospital.
Question one:
Do you really
believe that 40-70% of American women are unable to go into labor without
dangerous medications such as Cytotec?
According to birth researcher Henci
Goer, 40% (or more) American women are unable to go into labor without
induction. Or so the statistics would
have us believe. In many other
communities, the rate of induction is higher than 40% and in some cases, nurses
working labor/delivery have never cared for a mother who is having her baby
without induction or augmentation. All
too frequently, physicians also have never cared for a mother who is having her
baby without induction or augmentation.
Question two:
What is the cause of the rise in
induction and augmentation?
Childbirth Connection offers one explanation:
“A
surprising number of women don't have accurate information about when it is
safe for a baby to be born, if there is not a clear medical reason. When we
asked women who had recently given birth in our national Listening to Mothers III survey,
just 21% chose 39 weeks or beyond; 35% identified 37 or 38 weeks, considered an
early term birth with known risks to babies. And 44% chose earlier weeks,
considered to be preterm births.
Childbirth
education classes that teach specific information about the risks, benefits,
and appropriate uses of labor induction reduce the number of women having
induced labor. However, attendance at childbirth education classes appears to
be decreasing in the United States, and childbirth education classes are
getting shorter, leaving less time to address this important topic.”
Question three:
How do you explain the horrific
maternal/infant morbidity/mortality in the US?
American women of childbearing age
are stuck in a vicious cycle. With an
increase in the number of interventions for birth and the non-evidence based
statements and practices regarding aspects of normal physiologic birth, our
rates are deplorable and horrific. For a
country as intelligent as it is, we continue to put our heads in the sand when
it comes to the safety of our women and children. The statistics do not lie.
Question four:
If our outcomes are not improving,
why are interventions including cesareans escalating?
Simply, there is no Voice.
No national Voice for childbearing
women, and no national Voice for babies. At the risk of sounding like there is
a “we” and “them” situation, there is definitely a power paradigm and the power
needs to shift from convenience and finance to the health of mothers and
babies. Women do not have
their own voice because of lack of information, lack of education and lack of
evidence-based information. Best
practice in the U.S., as defined in the research, has not permeated the
hospital policies and procedures. Nor
has the best practice found its way into the curriculum of most nursing schools
or medical schools.
In summary,
we have a plethora of evidence-based information that would reduce NICU
admissions, and improve the maternal/infant
morbidity/mortality rate BUT no one is being informed of this information – not
the childbearing women, not the hospital staff and not the physicians.
We have a huge failure to
communicate.
1 comment:
I am able to talk to ACOG reps frequently in my professional role as a public health worker. What I hear often in response to your last 2 questions is that women are more high risk these days -- large numbers of obese women, necessitating cesarean delivery and/or driving morbidities up due to their poor health.
But in many cases, they do understand the issues as we do, and its just that ACOG cannot force OB's to do anything, only recommend. Culture change takes time.
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