Monday, September 29, 2014

Examining the Lack of Communication Regarding Evidence Based Information in Childbearing Women and their Care Providers.

A Facebook friend recently posted this question:

“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:

Emily said...

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.