how common is it for the anesthesiologist to refuse to give an epidural?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:doing something that women have done for millennia, and continue to do, without intervention

To be blunt, what women have been doing for millennia= dying of complications of natural childbirth that are readily preventable with modern medical interventions. By itself, the Zavanelli followed by a splash and slash crash C-section probably saves thousands of lives a year.

And the Gaskin maneuver has probably saved just as many women from your charmingly named “splash and slash.”

Look, there are definitely mothers and babies who would not be here (or be doing as well as they are) without medical intervention. But there are also many who were subjected to excessive interventions, one-size-fits-all approaches, and other attitudes and habits that were not exactly evidence-based, and sometimes downright harmful.

Well, modern medical care has greatly reduced the infant and woman mortality rate, so I think I'll take our "medical interventions" overall as a great improvement to humanity. Of course there are issues with overtreatment and iatrogenic harm -- in all of medicine. But I seriously doubt anyone wants to give birth in a mud hut.

The hilarious part in your rant is that ANY intervention,including pain control for the mother, can result in iatrogenic harm. They can decrease respiratory rates, ability to move and push, and while host of effects.

So interventions may have decreased mortality rates, but we need to look at which ones, and why they are being administered.

No one wants to talk about the hazads to the mother, until the mother is truly in dire straights, it sounds easy (eg. “Epidural”, until something goes wrong end there are complications).

I don't know what your point is. The medical profession is constantly trying to improve obstetric care and outcomes. You act like it's something revolutionary to say that the risks and benefits should be weighted. I invite you to look at the proceedings of the ACOG annual meeting -- FULL of efforts to improve maternity care. http://annualmeeting.acog.org/wp-content/uploads/2018/04/ACOGAnnualMeeteing-Final-Program416-1.pdf

[Anonymous]

Who is the grossly misinformed CNM or CPM on here talking nonsense? News flash: Ina May was in a cult. Her husband thought he was a guru akin to Jesus or Buddha. They took tons of drugs. Her famed statistics, to my knowledge, have never been validated, they are all self reported. She holds no medical licenses and has no medical training. I wish I had known all that before reading her garbage birth book that said a contraction was a rush and birth could be orgasmic. Maybe if I was tripping on LSD. Not sure why we laud this woman as our nation's leading midwife and give her MacArthur Genuis grants but it's time to call bullshit.

And for all the comments about maternal mortality and C section rate, the reality is that we should not be practicing medicine to try and hit a target c section rate. There is no such thing. Do you really want your doctor not giving you a section because it is going to screw up the rates? Because that is what these stupid new ACOG Guidelines have done. Midwives have screwed up obstetrics so badly that now we are in a situation where the nationwide effort to prevent C sections by changing longstanding guidelines, taking a hands off approach to labor, and increasing pushing time is causing harm to women and babies in the form of increased maternal and infant morbidity.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:doing something that women have done for millennia, and continue to do, without intervention

To be blunt, what women have been doing for millennia= dying of complications of natural childbirth that are readily preventable with modern medical interventions. By itself, the Zavanelli followed by a splash and slash crash C-section probably saves thousands of lives a year.

And the Gaskin maneuver has probably saved just as many women from your charmingly named “splash and slash.”

Look, there are definitely mothers and babies who would not be here (or be doing as well as they are) without medical intervention. But there are also many who were subjected to excessive interventions, one-size-fits-all approaches, and other attitudes and habits that were not exactly evidence-based, and sometimes downright harmful.

Well, modern medical care has greatly reduced the infant and woman mortality rate, so I think I'll take our "medical interventions" overall as a great improvement to humanity. Of course there are issues with overtreatment and iatrogenic harm -- in all of medicine. But I seriously doubt anyone wants to give birth in a mud hut.

The hilarious part in your rant is that ANY intervention,including pain control for the mother, can result in iatrogenic harm. They can decrease respiratory rates, ability to move and push, and while host of effects.

So interventions may have decreased mortality rates, but we need to look at which ones, and why they are being administered.

No one wants to talk about the hazads to the mother, until the mother is truly in dire straights, it sounds easy (eg. “Epidural”, until something goes wrong end there are complications).

C-sections decreased mortality rates on a population level until they got to a rate of 15-20% of all births. That's when the neonatal mortality rate leveled off. When CS rates got into the mid-20%s is when maternal mortality rates started to slowly rise again.

Inductions have been shown to have no effect on the neonatal mortality rate, nor prevention of stillbirths, despite routinely being used for that purpose.

But we’re not talking c sections. We are taking anaesthesiolgists and pain control. Keep up with the topic at hand.

Pain control is a totally different type of intervention than a c section. Pain control is not saving a life, it’s helping quality of life. You don’t want to acknowledge it but there is a difference. And that’s why the hazards are different.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I used to listen to the Birth Hour and there would occasionally be someone on who would note they couldn't have an epidural, but they usually knew that in advance. Seems odd that this wasn't communicated to your friend until after the induction was started when they could have strategized to avoid her being in so much pain. That sounds like bad coordination/communication on the part of the medical team. Epidural analgesia can have serious side effects even among totally healthy people so I have to think it's not unheard of to risk someone out.

CRNA here from above. This is somewhat rare. Usually complications/conditions that take epidurals off the table are discussed during pregnancy. However it could be that the anesthesiologist on call that night was a little more conservative and didn't feel comfortable doing it despite her getting epidurals in the past. It could be be a condition that tends to worsen with each pregnancy so maybe its something that would get an OK the first time around but not for the 2nd or 3rd birth. Its really hard to say. I have made a few calls that are contested. I immediately call my boss who always backs us up. I had one woman call the head of the hospital (as in the CEO…not even a DR) who then called me and apologized but felt like he "had to try." I am a mom, I am a care provider, I want you to be comfortable but I mostly want you to be alive. As someone who has given birth with and without epidural I realize how much relief it can provide BUT that relief has to be compared to possible risks and I can't make you a good candidate because a.) you know "people" b.) you have had one before c.) Dr. ABC and Dr. XYZ said it would be fine.

Can you please share some conditions that would make you refuse an epidural? Who would be a candidate for a no-epidural decision if you were making it?

Also, what are the other options for pain relief? GA?

If I wanted medical pain relief and couldn't have an epidural, I would make sure I delivered at a hospital that provided nitrous and that it would be made available to me. I would also hire a doula to provide other pain relieve techniques such as positioning, massage, pressure, heat, ...

I've also had fentanyl during labor but wouldn't chose to do that again or really recommend it. It gave me a chance to rest but it also made my loopy right as the Pitocin was kicking in and labor became really painful (it's just been long before that).

I've had 2 with no medical pain management and had fentanyl and pit with my 3rd. I asked for an epidural but progressed too quickly after starting the Pitocin so never received more than a hole in my spine.

I’m a person who knew in advance that she couldn’t have an epidural during labor. In my case, it was due to low platelets caused by an autoimmune response and made much worse with pregnancy. It was too risky for the anesthesiologist to do an epidural due to the risk of bleeding in my spine. As I knew it was likely in advance, I did everything possible to prepare. I took Bradley classes, tons of prenatal yoga, signed up with midwives, and hired an amazing doula, and felt totally prepared. Let me tell you, it did nothing compared what labor was actually like. I ended up with an induction due to preeclampsia and was on full dose pitocin for literally days, including the last day with my water broken. I had a morphine (I think - I was so out of it at that point) shot at one point but it did nothing. The experience was like torture and I finally begged for the c section I was trying desperately to avoid. I was ultimately able to get a spinal because the anesthesiologist determined there was a lower risk and lower platelet threshold for doing so; otherwise I would have had to go under general anesthesia.

Even though I wouldn’t have wished that on my worst enemy, I completely understand and respect the anesthesiologists’ position and I’m glad they didn’t take any unnecessary risks.

Ugh that is awful! Apart from that being a torturous experience to put you through, I don't understand the logic of letting an induction go on for days when there is a serious health issue like that. If it's serious enough that you need to deliver sooner than later, then how can you also afford to wait 3 days to deliver, you know?

There are medical contexts in which this is appropriate or necessary. For example, if the baby is below a certain gestational age, giving the mother a steroid -- usually Betamethasone injections 24 hours apart -- can help mature the lungs of the baby and make it much less likely that the child develops bronchopulmonary dysplasia or other chronic lung problems. If you can give multiple doses, the protective effect increases, but you want to give at least 24-48 hours before delivery. The earlier the gestation, the more doses, if the benefits outweigh any risks of delaying delivery.

[Anonymous]

Anonymous wrote:Who is the grossly misinformed CNM or CPM on here talking nonsense? News flash: Ina May was in a cult. Her husband thought he was a guru akin to Jesus or Buddha. They took tons of drugs. Her famed statistics, to my knowledge, have never been validated, they are all self reported. She holds no medical licenses and has no medical training. I wish I had known all that before reading her garbage birth book that said a contraction was a rush and birth could be orgasmic. Maybe if I was tripping on LSD. Not sure why we laud this woman as our nation's leading midwife and give her MacArthur Genuis grants but it's time to call bullshit.

And for all the comments about maternal mortality and C section rate, the reality is that we should not be practicing medicine to try and hit a target c section rate. There is no such thing. Do you really want your doctor not giving you a section because it is going to screw up the rates? Because that is what these stupid new ACOG Guidelines have done. Midwives have screwed up obstetrics so badly that now we are in a situation where the nationwide effort to prevent C sections by changing longstanding guidelines, taking a hands off approach to labor, and increasing pushing time is causing harm to women and babies in the form of increased maternal and infant morbidity.

Citation? Just a reminder, correlation is not causation.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I used to listen to the Birth Hour and there would occasionally be someone on who would note they couldn't have an epidural, but they usually knew that in advance. Seems odd that this wasn't communicated to your friend until after the induction was started when they could have strategized to avoid her being in so much pain. That sounds like bad coordination/communication on the part of the medical team. Epidural analgesia can have serious side effects even among totally healthy people so I have to think it's not unheard of to risk someone out.

CRNA here from above. This is somewhat rare. Usually complications/conditions that take epidurals off the table are discussed during pregnancy. However it could be that the anesthesiologist on call that night was a little more conservative and didn't feel comfortable doing it despite her getting epidurals in the past. It could be be a condition that tends to worsen with each pregnancy so maybe its something that would get an OK the first time around but not for the 2nd or 3rd birth. Its really hard to say. I have made a few calls that are contested. I immediately call my boss who always backs us up. I had one woman call the head of the hospital (as in the CEO…not even a DR) who then called me and apologized but felt like he "had to try." I am a mom, I am a care provider, I want you to be comfortable but I mostly want you to be alive. As someone who has given birth with and without epidural I realize how much relief it can provide BUT that relief has to be compared to possible risks and I can't make you a good candidate because a.) you know "people" b.) you have had one before c.) Dr. ABC and Dr. XYZ said it would be fine.

Can you please share some conditions that would make you refuse an epidural? Who would be a candidate for a no-epidural decision if you were making it?

Also, what are the other options for pain relief? GA?

If I wanted medical pain relief and couldn't have an epidural, I would make sure I delivered at a hospital that provided nitrous and that it would be made available to me. I would also hire a doula to provide other pain relieve techniques such as positioning, massage, pressure, heat, ...

I've also had fentanyl during labor but wouldn't chose to do that again or really recommend it. It gave me a chance to rest but it also made my loopy right as the Pitocin was kicking in and labor became really painful (it's just been long before that).

I've had 2 with no medical pain management and had fentanyl and pit with my 3rd. I asked for an epidural but progressed too quickly after starting the Pitocin so never received more than a hole in my spine.

I’m a person who knew in advance that she couldn’t have an epidural during labor. In my case, it was due to low platelets caused by an autoimmune response and made much worse with pregnancy. It was too risky for the anesthesiologist to do an epidural due to the risk of bleeding in my spine. As I knew it was likely in advance, I did everything possible to prepare. I took Bradley classes, tons of prenatal yoga, signed up with midwives, and hired an amazing doula, and felt totally prepared. Let me tell you, it did nothing compared what labor was actually like. I ended up with an induction due to preeclampsia and was on full dose pitocin for literally days, including the last day with my water broken. I had a morphine (I think - I was so out of it at that point) shot at one point but it did nothing. The experience was like torture and I finally begged for the c section I was trying desperately to avoid. I was ultimately able to get a spinal because the anesthesiologist determined there was a lower risk and lower platelet threshold for doing so; otherwise I would have had to go under general anesthesia.

Even though I wouldn’t have wished that on my worst enemy, I completely understand and respect the anesthesiologists’ position and I’m glad they didn’t take any unnecessary risks.

Ugh that is awful! Apart from that being a torturous experience to put you through, I don't understand the logic of letting an induction go on for days when there is a serious health issue like that. If it's serious enough that you need to deliver sooner than later, then how can you also afford to wait 3 days to deliver, you know?

There are medical contexts in which this is appropriate or necessary. For example, if the baby is below a certain gestational age, giving the mother a steroid -- usually Betamethasone injections 24 hours apart -- can help mature the lungs of the baby and make it much less likely that the child develops bronchopulmonary dysplasia or other chronic lung problems. If you can give multiple doses, the protective effect increases, but you want to give at least 24-48 hours before delivery. The earlier the gestation, the more doses, if the benefits outweigh any risks of delaying delivery.

PS: The protocol is changing based on the most recent evidence, which suggests 1 dose may be sufficient for even the earlier gestational ages. however, in that case you want to delay delivery for 48h if you can.

[Anonymous]

Anonymous wrote:Who is the grossly misinformed CNM or CPM on here talking nonsense? News flash: Ina May was in a cult. Her husband thought he was a guru akin to Jesus or Buddha. They took tons of drugs. Her famed statistics, to my knowledge, have never been validated, they are all self reported. She holds no medical licenses and has no medical training. I wish I had known all that before reading her garbage birth book that said a contraction was a rush and birth could be orgasmic. Maybe if I was tripping on LSD. Not sure why we laud this woman as our nation's leading midwife and give her MacArthur Genuis grants but it's time to call bullshit.

And for all the comments about maternal mortality and C section rate, the reality is that we should not be practicing medicine to try and hit a target c section rate. There is no such thing. Do you really want your doctor not giving you a section because it is going to screw up the rates? Because that is what these stupid new ACOG Guidelines have done. Midwives have screwed up obstetrics so badly that now we are in a situation where the nationwide effort to prevent C sections by changing longstanding guidelines, taking a hands off approach to labor, and increasing pushing time is causing harm to women and babies in the form of increased maternal and infant morbidity.

Please don’t equate a competent CNM, likely delivering at a hospital or birth center, with Ina May Gaskin. You can’t be serious.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:doing something that women have done for millennia, and continue to do, without intervention

To be blunt, what women have been doing for millennia= dying of complications of natural childbirth that are readily preventable with modern medical interventions. By itself, the Zavanelli followed by a splash and slash crash C-section probably saves thousands of lives a year.

And the Gaskin maneuver has probably saved just as many women from your charmingly named “splash and slash.”

Look, there are definitely mothers and babies who would not be here (or be doing as well as they are) without medical intervention. But there are also many who were subjected to excessive interventions, one-size-fits-all approaches, and other attitudes and habits that were not exactly evidence-based, and sometimes downright harmful.

Well, modern medical care has greatly reduced the infant and woman mortality rate, so I think I'll take our "medical interventions" overall as a great improvement to humanity. Of course there are issues with overtreatment and iatrogenic harm -- in all of medicine. But I seriously doubt anyone wants to give birth in a mud hut.

The hilarious part in your rant is that ANY intervention,including pain control for the mother, can result in iatrogenic harm. They can decrease respiratory rates, ability to move and push, and while host of effects.

So interventions may have decreased mortality rates, but we need to look at which ones, and why they are being administered.

No one wants to talk about the hazads to the mother, until the mother is truly in dire straights, it sounds easy (eg. “Epidural”, until something goes wrong end there are complications).

C-sections decreased mortality rates on a population level until they got to a rate of 15-20% of all births. That's when the neonatal mortality rate leveled off. When CS rates got into the mid-20%s is when maternal mortality rates started to slowly rise again.

Inductions have been shown to have no effect on the neonatal mortality rate, nor prevention of stillbirths, despite routinely being used for that purpose.

But we’re not talking c sections. We are taking anaesthesiolgists and pain control. Keep up with the topic at hand.

Pain control is a totally different type of intervention than a c section. Pain control is not saving a life, it’s helping quality of life. You don’t want to acknowledge it but there is a difference. And that’s why the hazards are different.

what's your point? you can't do a c section without anesthesia...

[Anonymous]

Anonymous wrote:

Anonymous wrote:Who is the grossly misinformed CNM or CPM on here talking nonsense? News flash: Ina May was in a cult. Her husband thought he was a guru akin to Jesus or Buddha. They took tons of drugs. Her famed statistics, to my knowledge, have never been validated, they are all self reported. She holds no medical licenses and has no medical training. I wish I had known all that before reading her garbage birth book that said a contraction was a rush and birth could be orgasmic. Maybe if I was tripping on LSD. Not sure why we laud this woman as our nation's leading midwife and give her MacArthur Genuis grants but it's time to call bullshit.

And for all the comments about maternal mortality and C section rate, the reality is that we should not be practicing medicine to try and hit a target c section rate. There is no such thing. Do you really want your doctor not giving you a section because it is going to screw up the rates? Because that is what these stupid new ACOG Guidelines have done. Midwives have screwed up obstetrics so badly that now we are in a situation where the nationwide effort to prevent C sections by changing longstanding guidelines, taking a hands off approach to labor, and increasing pushing time is causing harm to women and babies in the form of increased maternal and infant morbidity.

Please don’t equate a competent CNM, likely delivering at a hospital or birth center, with Ina May Gaskin. You can’t be serious.

My hospital CNMs all recommended her book as the #1 source for birth prep. And they brought her to DC some years back. So pretty sure CNMs do like her.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:doing something that women have done for millennia, and continue to do, without intervention

To be blunt, what women have been doing for millennia= dying of complications of natural childbirth that are readily preventable with modern medical interventions. By itself, the Zavanelli followed by a splash and slash crash C-section probably saves thousands of lives a year.

And the Gaskin maneuver has probably saved just as many women from your charmingly named “splash and slash.”

Look, there are definitely mothers and babies who would not be here (or be doing as well as they are) without medical intervention. But there are also many who were subjected to excessive interventions, one-size-fits-all approaches, and other attitudes and habits that were not exactly evidence-based, and sometimes downright harmful.

Well, modern medical care has greatly reduced the infant and woman mortality rate, so I think I'll take our "medical interventions" overall as a great improvement to humanity. Of course there are issues with overtreatment and iatrogenic harm -- in all of medicine. But I seriously doubt anyone wants to give birth in a mud hut.

The hilarious part in your rant is that ANY intervention,including pain control for the mother, can result in iatrogenic harm. They can decrease respiratory rates, ability to move and push, and while host of effects.

So interventions may have decreased mortality rates, but we need to look at which ones, and why they are being administered.

No one wants to talk about the hazads to the mother, until the mother is truly in dire straights, it sounds easy (eg. “Epidural”, until something goes wrong end there are complications).

C-sections decreased mortality rates on a population level until they got to a rate of 15-20% of all births. That's when the neonatal mortality rate leveled off. When CS rates got into the mid-20%s is when maternal mortality rates started to slowly rise again.

Inductions have been shown to have no effect on the neonatal mortality rate, nor prevention of stillbirths, despite routinely being used for that purpose.

But we’re not talking c sections. We are taking anaesthesiolgists and pain control. Keep up with the topic at hand.

Pain control is a totally different type of intervention than a c section. Pain control is not saving a life, it’s helping quality of life. You don’t want to acknowledge it but there is a difference. And that’s why the hazards are different.

what's your point? you can't do a c section without anesthesia...

Np but they aren't the same. You can do a csections under general anesthesia or a spinal. Different than a regular epidural.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Who is the grossly misinformed CNM or CPM on here talking nonsense? News flash: Ina May was in a cult. Her husband thought he was a guru akin to Jesus or Buddha. They took tons of drugs. Her famed statistics, to my knowledge, have never been validated, they are all self reported. She holds no medical licenses and has no medical training. I wish I had known all that before reading her garbage birth book that said a contraction was a rush and birth could be orgasmic. Maybe if I was tripping on LSD. Not sure why we laud this woman as our nation's leading midwife and give her MacArthur Genuis grants but it's time to call bullshit.

And for all the comments about maternal mortality and C section rate, the reality is that we should not be practicing medicine to try and hit a target c section rate. There is no such thing. Do you really want your doctor not giving you a section because it is going to screw up the rates? Because that is what these stupid new ACOG Guidelines have done. Midwives have screwed up obstetrics so badly that now we are in a situation where the nationwide effort to prevent C sections by changing longstanding guidelines, taking a hands off approach to labor, and increasing pushing time is causing harm to women and babies in the form of increased maternal and infant morbidity.

Citation? Just a reminder, correlation is not causation.

Midwives have been very successful at demonizing C sections and interventions as unnecessary. Their campaign for normal birth also got a ton of support from hospitals wanting to lower costs. And of course let’s not forget Marsden Wagner of the WHO, who oversaw the setting a target C section rate of 10-15 percent which was based on no evidence and was later quietly retracted. And let’s not forget his awesome comment in BOBB about babies not bonding to moms if they are separated at birth. Add in a ton of press, movies like the Business of Being Born, and East Coast elite women embracing a seemingly feminist idea of an unmedicated vaginal birth as their birthright and something their body was designed to do without intervention and you got a situation of growing pressure on the nation’s OBs to stop medicalizing birth. Never mind that first time moms are older and fatter than ever and older bodies are less good at giving birth. Never mind that we have more women with more health complications, more high risk pregnancies, etc. Never mind that we are well nourished in this century which means babies are bigger and healthier and have bigger heads which are harder to deliver. No, none of that matters at all - just getting the C section rate lowered.

So then ACOG decides to change guidelines of how labor should be managed in their Prevention of the Primary C-section paper, ignoring decades of evidence. They decide women can normally push for far longer and labor for far longer. They decide instrumental deliveries are better than emergency C sections. Thy decide Friedan’s curve doesn’t matter anymore. This prompts Friedan himself at nearly 90 to speak out against it, and other doctors too (search old ACOG green journals, the letters are there), but it doesn’t matter. The organization caved and decided to allow the C section delivery rate to be a key performance indicator—regardless of the costs. And they continue to debate it at their annual meeting and meanwhile the midwives have gotten docs like Neel Shah and Atul Gawande bough on and waxing on and on about how bad sections are in front of any outlet that will publish their stuff.

So now you have a situation where studies are coming out showing that these guidelines are causing harm. More pelvic floor injuries, more death, etc. How is that feminist? How is that pro-woman? I’m not saying unmedicated vaginal birth is wrong or C sections aren’t without major risks or that midwives or OBs are bad, but women DESERVE to know how the decisions made in their births are affected by the political landscape and that may be to their detriment. And they deserve knowing the actual risks and be able to weigh those for themselves.

https://www.ajog.org/article/S0002-9378(17)31190-0/pdf

https://www.ncbi.nlm.nih.gov/m/pubmed/25891996/

https://www.ncbi.nlm.nih.gov/m/pubmed/27131590/

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Who is the grossly misinformed CNM or CPM on here talking nonsense? News flash: Ina May was in a cult. Her husband thought he was a guru akin to Jesus or Buddha. They took tons of drugs. Her famed statistics, to my knowledge, have never been validated, they are all self reported. She holds no medical licenses and has no medical training. I wish I had known all that before reading her garbage birth book that said a contraction was a rush and birth could be orgasmic. Maybe if I was tripping on LSD. Not sure why we laud this woman as our nation's leading midwife and give her MacArthur Genuis grants but it's time to call bullshit.

And for all the comments about maternal mortality and C section rate, the reality is that we should not be practicing medicine to try and hit a target c section rate. There is no such thing. Do you really want your doctor not giving you a section because it is going to screw up the rates? Because that is what these stupid new ACOG Guidelines have done. Midwives have screwed up obstetrics so badly that now we are in a situation where the nationwide effort to prevent C sections by changing longstanding guidelines, taking a hands off approach to labor, and increasing pushing time is causing harm to women and babies in the form of increased maternal and infant morbidity.

Citation? Just a reminder, correlation is not causation.

Midwives have been very successful at demonizing C sections and interventions as unnecessary. Their campaign for normal birth also got a ton of support from hospitals wanting to lower costs. And of course let’s not forget Marsden Wagner of the WHO, who oversaw the setting a target C section rate of 10-15 percent which was based on no evidence and was later quietly retracted. And let’s not forget his awesome comment in BOBB about babies not bonding to moms if they are separated at birth. Add in a ton of press, movies like the Business of Being Born, and East Coast elite women embracing a seemingly feminist idea of an unmedicated vaginal birth as their birthright and something their body was designed to do without intervention and you got a situation of growing pressure on the nation’s OBs to stop medicalizing birth. Never mind that first time moms are older and fatter than ever and older bodies are less good at giving birth. Never mind that we have more women with more health complications, more high risk pregnancies, etc. Never mind that we are well nourished in this century which means babies are bigger and healthier and have bigger heads which are harder to deliver. No, none of that matters at all - just getting the C section rate lowered.

So then ACOG decides to change guidelines of how labor should be managed in their Prevention of the Primary C-section paper, ignoring decades of evidence. They decide women can normally push for far longer and labor for far longer. They decide instrumental deliveries are better than emergency C sections. Thy decide Friedan’s curve doesn’t matter anymore. This prompts Friedan himself at nearly 90 to speak out against it, and other doctors too (search old ACOG green journals, the letters are there), but it doesn’t matter. The organization caved and decided to allow the C section delivery rate to be a key performance indicator—regardless of the costs. And they continue to debate it at their annual meeting and meanwhile the midwives have gotten docs like Neel Shah and Atul Gawande bough on and waxing on and on about how bad sections are in front of any outlet that will publish their stuff.

So now you have a situation where studies are coming out showing that these guidelines are causing harm. More pelvic floor injuries, more death, etc. How is that feminist? How is that pro-woman? I’m not saying unmedicated vaginal birth is wrong or C sections aren’t without major risks or that midwives or OBs are bad, but women DESERVE to know how the decisions made in their births are affected by the political landscape and that may be to their detriment. And they deserve knowing the actual risks and be able to weigh those for themselves.

https://www.ajog.org/article/S0002-9378(17)31190-0/pdf

https://www.ncbi.nlm.nih.gov/m/pubmed/25891996/

https://www.ncbi.nlm.nih.gov/m/pubmed/27131590/

Wow. You are really invested in your conspiracies. “East coast elite women” lol.

[Anonymous]

DP. Doesn't look like conspiracies. Looks like analysis.

[Anonymous]

Anonymous wrote:DP. Doesn't look like conspiracies. Looks like analysis.

Analysis cites evidence. This is an op ed. All she has are ACOG decision papers. The guidelines changed because of scientific evidence that showed women’s labors have gotten longer since the 1950’s when Friedman’s curve came out and they need more time to push. But those insidious midwives, they want women to be botched and babies to die! Amazing how much sway they have when their profession is near extinction level. And how comforting the thought that OBs are just mindless robots following ACOG guidelines and denying women csections and causing all this death (except the cs rate has barely budged a fraction of a percentage in the US and yet maternal mortality has risen alarmingly).

[Anonymous]

Definition of analysis
plural analyses

1 a : a detailed examination of anything complex in order to understand its nature or to determine its essential features : a thorough study doing a careful analysis of the problem
b : a statement of such an examination

Are you familiar with references, PP? The journal articles cited have them. They're at the end.