America’s C-Section Rates Out of Control, but ACOG Refuses to Take Action

I was asked to take down the April 1 press release with the winking ACOG eyeball from Mothering.com on Monday, which I did. Here’s the backstory. I’m posting it here in case it also gets pulled:

As reported by Babble.com, the press release first appeared on CNN.com’s iReport but was pulled after it was discovered to be a prank.

As this post from another Babble.com blogger indicates, the subject of the press release–America’s skyrocketing C-section rate which is in violation of women’s fundamental rights–is anything but funny.

As the press release circulated via email and Twitter, bloggers have been writing about it:

*the Deranged Housewife “It’s clear to me that when it comes to the birthing choices of women, ACOG doesn’t really give a crap.”
*C-section Recovery Kit blog, and
*Owning Pink.

Yes, the press release was a prank.

I know because I wrote it.

Is it really a surprise that ACOG didn’t suddenly decide to advocate that women have their babies in the safest way possible?

Here’s how the press release should have read:

For Immediate Release: ACOG HAS NO PLANS TO STOP ELECTIVE C-SECTIONS

Screen Shot 2014-01-07 at 3.31.06 PM

The American Congress of Obstetricians and Gynecologists (ACOG) has made no announcement that it is devising a comprehensive plan to lower C-section rates in the United States. Instead, Greg Phillips, Associate Director, Office of Communications, The American College of Obstetricians and Gynecologists, has said that the April 1 press release indicating the organization would be spearheading a campaign to end elective C-sections “did not come from us and is clearly an April Fool’s joke.”

C-sections in the U.S. have gone up 700% since they were first measured in 1965, when the C-section rate was only 4.5 percent.

The nation’s C-section rate has been rising steadily for the last eleven years. It’s now over 31 percent. This is a deplorable situation that harms women and their newborns, but one that ACOG has continually downplayed or ignored.

Advertising itself as an organization that advocates for quality healthcare for women, ACOG has no plans to ask obstetricians to halt elective C-sections.

Though many birth advocates, obstetricians, gynecologists, nurse practitioners, midwives, and women’s rights advocates believe that C-sections should only be a last resort and should never be performed for the convenience of the doctor or for financial or liability reasons, C-sections are routinely done in this country when there is no medical necessity for them, often for the convenience of doctors or for fear of lawsuits.

Though the use of electronic fetal monitoring has been shown to increase unnecessary C-section rate without any proven benefit to the mother or infant, ACOG also has no plans to call on American hospitals to stop the routine use of electronic monitoring during labor.

ACOG has no new guidelines to encourage women to have freedom of movement during labor, labor standing up or squatting, and to eat and drink at will. In fact, given the organization’s repeated negative stance on out-of-hospital births, it can be inferred that ACOG actively opposes freedom of movement during labor.

Cesarean can save lives. But doctors and consumers have to remember that this is major surgery that carries major risk. Some examples: 29-year-old Abbie Dorn, suffered severe hemorrhaging and brain damage after her uterus was nicked during a Cesarean section at Cedars-Sinai Medical Center (2006), 32-year-old Diane Rizk McCabe died following complications from a Caesarean section at Albany Medical Center Hospital (2007), and Karen Vasques, 27, died during a C-section at Beth Israel Deaconess Medical Center (2008).

Maternal mortality has risen every year in the United States for the past 25 years, while over the same period the rate of C-sections has gone up 33 percent.

The skyrocketing rate of C-section in America has had devastating consequences but ACOG, the most highly respected organization of obstetricians and gynecologists in the United States, refuses to lead the fight to stop it.

Many people took offense at the original satire that I wrote to highlight how serious the problem is.

I had no intention of duping or disappointing those who really are leading the fight to stop a systemic problem in our medical system that has spiraled out of control.

I know that OBs who do not rush to C-section breech births, twins, and women who have had prior cesareans are often under tremendous pressure from the hospitals where they work, and from their colleagues, to do more surgery. There are many wonderful OBs who do not overuse the C-section operation, and they, too, advocate returning to a healthier balance and letting a woman’s body do what it evolved to do.

My dear friend who is having a baby on Friday via C-section was told by her OB that he forbids trial of labor. She is young and healthy. She has big bones and wide hips. But since she had an unnecessary C-section in her twenties, her doctor will not allow her to go into labor naturally.

A new mom recently posted her birth experience on a baby message board. Unfortunately, the only atypical aspect of her experience is that the doctor pretended to allow her to try for a VBAC. Here’s part of her story:

“After switching doctors several times during the course of my pregnancy, at the time I delivered I was under the care of an OB & Midwives group. I was told that I was a good candidate for VBAC, was offered water birth if things went well, and believed that I was in the best possible circumstances to avoid surgery & any un-needed medical intervention.

I arrived at the hospital dialated to 4. An hour & a half later, my water had broken on its own and I was dialated to 6.

Since I was laboring on a birthing ball, the midwife wasn’t confident about the fetal heartrate monitor, it was showing decels, so I was asked to consent to an internal monitor (screws into the baby’s scalp during labor). I refused the first time I was asked, then consented the second time. I consented because I thought my husband was beginning to panic and hoped that it would ease his stress. When I consented to it, I looked at my husband & said “That is medical intervention #1.”

Before the monitor was even plugged in, we were told that we were going to be moved to the OR “just in case” while being monitored more closely. The midwife had called an OB to consult & we expected to meet him in the OR.

On the way to the OR, my husband was sent to a dressing area to change into scrubs & I was sent straight into the OR. My husband & I were separated.

As soon as I reached the OR, the staff began prepping me for surgery. I stated that I did NOT want a c-section. I demanded to see my husband and stated that IF I was to receive a c-section my DH & I would make that decision together. I was told that my husband was on his way. I was also told that my baby needed more oxygen & I was told to breathe deeply in a new mask because it had a better seal on my face (the oxygen I was breathing before was thru a smaller mask).

The new mask wasn’t oxygen, I was gassed against my will.

I am unaware of what was done to me from the time I was gassed up until I awoke in recovery. I am assuming that I only had a C-section. Any further details have not been shared with me.

When my husband exited the dressing area & went to go to the OR, he was told that he couldn’t go in because I was already being anesthetized for surgery. He was not asked to consent on my behalf. He was not told that I had refused consent. He was not told that I had requested his presence. He was not told WHY I was having surgery.

I found out that my son had been born, and that I had been operated on, when I woke up in recovery. No medical professional came to me and spoke to me about my surgery. I have never been told WHY I required a c-section. I only know the name of the delivering physician because it’s on my son’s birth certificate. I never met him. He never came to talk to me before or after surgery. I also never saw the midwife again after I was wheeled into the OR…

I’m having an extremely hard time coming to grips with having been lied to and operated on against my will. I love my son, but I did not give birth to him. I was not present at his birth. That moment in my life has been taken from me … I don’t know if I’ll ever again be capable of trusting a medical professional to respect me as a whole person, instead of just a slab of meat ready for their whim. I thought that it was required of medical professionals to obtain informed consent whenever possible prior to performing surgery.”

Can we agree that what’s really cruel are experiences like these, not my April Fools joke?

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Categories: pregnancy and childbirth.

Comments

  1. Natalie

    Can you tell us more about why the post was pulled? Why you’re no longer blogging with Mothering? Maybe you can’t. Maybe you don’t want to. I must admit, however, to being incredibly curious.

    Are you going to be blogging here regularly?

    I appreciated your satire, but I was fooled at first. Wishful thinking, I guess.

  2. Thanks for asking Natalie. Your comment got stuck in a spam filter, which is why I only just posted it now.

    Since this is my personal blog, I think I can tell you more about what happened!

    The communications director at ACOG, Greg Phillips, wrote to two of the editors at Mothering and asked that the prank post be taken down.

    In his email he wrote: “This did not come from us and is clearly an April Fool’s joke. How it got posted on your website without review is unclear, but certainly raises concerns about credibility.”

    Although no one elaborated, I suspect Mothering decided to comply with the request in order to avoid a possible law suit. One blogger who wrote about the post mentioned how she was confident a reputable company like Mothering would not agree to censor it even if asked directly from ACOG.

    It may be that times have changed.

    But it also may be that many people in the birthing community were furious for the prank post and Mothering wanted to be sensitive to their sense of outrage.

    Here’s one particularly angry response I got:

    “I have been a childbirth activist and midwife going on 30 years this spring and this is one of the meanest pranks I’ve ever seen. It has a lot of people really angry. That’s not a good way to get a trusting conversation going about such a delicate, emotional, and life-and-death topic, in my opinion. It was a highly unprofessional use of an email list. And it wasn’t funny. It was in poor taste and disrespectful to the women who have been victimized by the obstetrics system. If you wrote it I do hope you will send a note of apology to all those who received it—-many of whom felt “played” by it. The traditional way to celebrate April Fools is to say APRIL FOOLS with the prank. Having just spent Monday evening negotiating a natural vaginal delivery for a woman who lost her baby at 28 weeks in a hospital system that wanted her in the OR, asleep, with the baby out and gone before she could see it—-I did not find the humor in it at all. The issues go a lot deeper than profit and convenience. I don’t think making fun of the people that hold the purse strings or the legal things is going to get them to think the better of your standpoint, either. I work with them every day. It is going to take intelligent and respectful conversation to recognize the pressures that bear from hospital risk committees, lawyers, and insurance companies. It is a tangled and confusing enough web without confusing jokes that play on peoples’ emotions. And email is too delicate a medium to require people to have to sort through what is real and what is a joke. Just not fair. Please, restore us to the day when what a journalist says can be trusted.”

    Here’s another:
    “I’m usually interested in your posts and I’m sorry to hear that Mothering is going out of business but I am really unhappy about your “prank” press release. My best friend is going in for a necessary c-section THIS FRIDAY MORNING. She has a doctor who is passionate about doing VBACs and my friend unfortunately is not able to try for a VBAC in her specific medical case. The fact that her dream of a vaginal birth will never come true is very painful for her to accept. Your e-mail terrified her to the point that even after the hoax was announced, she is still having nightmares and anxiety that have put her in a very uneasy state as she prepares to welcome her daughter into the world. Of course, just as in any major surgery, she is aware that there are dangers with c-sections but sometimes modern medicine can save lives like the life of her wonderful 5 year old son who was saved by a c-section when he was born with complications. I am so grateful for the babies and moms who might not be here today if it weren’t for medical intervention. I agree that we need to reduce the rate of unnecessary c-sections but when you talk about mothers who died from complications in c-sections, you fail to mention the little ones who didn’t survive the VBAC attempts who may be with us today if they had had medical attention earlier. It’s a complex issue. Although I had two totally natural water births in the hospital with no intervention whatsoever, I’m glad for monitoring and modern medicine that was available if I had needed it. Your “fake” press release would have been better with a disclaimer that it was indeed fake from the get-go. Your intention was a good one but the careless delivery, in my opinion, was in very poor taste.”

  3. Natalie, I wanted to reply to your other questions as well. I am no longer blogging at Mothering.com because they are no longer in a position to pay me.

    They’ve laid off the vast majority of their staff and the company is going through some massive changes and reorganization that I’m not at liberty to talk about (but I am hoping Peggy will make public sometime soon.)

    This is my writerly blog, which means I usually just post boring updates that no one really cares about about articles I’ve published and whatnot. I don’t see this as a place for writing about controversial topics related to parenting, women, and children, but maybe I should…

    In the meantime, I plan to look for another outlet. I have been thinking about starting a new blog, that I own (so none of the posts will be censored, for one), but I’m not sure I can take that on right now. The book I’m writing is very research intensive and includes a lot of investigating, and I had already been fretting that the blog–and my other paying work–was taking too much time away from that.

    So, the answer to your question is I don’t know! But I will try to figure it all out. And soon.

    Your advice/thoughts/ideas more than welcome!

  4. Natalie

    Thanks for answering. I wondered if I had asked questions that were too sensitive. I didn’t want to offend you. I loved your mothering blog, and would love to see you find another outlet. I always tell my husband that I think the internet is boring. Your blog was one of only three things that I find entertaining on the internet, and now it’s gone. I can’t wait for your book, and I’d love to read your other articles. It would be great if you kept a list here (I don’t usually pick up some of the magazines you mentioned in your good-bye post.)

    Best of luck!

  5. Thank you Natalie! I’m laughing that you would worry about offending me (considering I have inadvertently offended so many people lately. Sigh.) My mother always said an honest question deserves an honest answer, and I think she’s right. I really appreciate your support and kind words. I hope to find another place where I can get paid to do a parenting blog. I do promise to let you know! What are the other two things that you read on the Internet? (I find it hard to wade through all that’s out there)?

  6. Natalie

    I’ve been following Katie Allison Granju’s story about her son Henry. I believe that you posted something about that once. Because I read her work, I was funneled to Babble.com, but I’m trying to avoid that site now. As one of the few readers there who is a strong advocate of breast feeding, baby wearing, and as someone who’s opposed to sleep training (maybe I should just go ahead and call myself a co-sleeper, since my five-month old sleeps in our bed), I found that I was getting wrapped up in some toxic comments conversations. I used to be a fan of the Mothering site since I discovered it 3 years ago around the time that my older daughter was born, but I’m not a huge fan any more. They recycle so much content, that I’ve read a lot of the articles on the site already. I’m hoping that they deal with that as part of whatever kind of restructuring they’re doing. So right now, there’s not much for me to do online. This is probably a good thing, since I don’t have much time for internet anyway.

  7. JennyUK

    I read and replied to that same thread on that baby forum. The OP said she was given gas without her consent or knowledge. That is she was told it was oxygen but it was gas. Then when she woke up she found they had done a C Section on her WITHOUT her consent. She did not consent to the c Section and neither did her husband. Yet if you read all of that thread 21 pages of it she said that no lawyer will take her case. And that same hospital has since done the same thing to another woman. I find it unbelievable that a hospital can behave like that. What happened to that mum was illegal as she was given something to put her to sleep without being told what it was. And she was operated on without her consent and then they falsified her medical notes to say she had an episiotmy not a C Section. I think that hospital should be shut down and those doctors and nurses involved should be instantly dismissed and have their credentials taken away. I am hearing more shocking stories every day of women who have been abused by their care providers and hospital staff in American hospitals and none of the USA childbirth groups or the government are doing anything about this. Not only that but other barbaric practices such as forcibly strapping down women to operating tables that is women having C Sections in the USA are forcibly strapped down by their arms to OR tables without their consent. I am just grateful that I live in the UK where such things don’t happen here and would never be allowed. I don’t know what it is with the USA system in America they don’t seem to care very much about the patients well being.

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