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Wednesday, November 17, 2010

The "C" in ACOG stands for "Castrated"

OK, call me bitter. But every time I read about a brand new and improved ACOG guideline, especially the latest ones about VBAC and VBA2C being safe, I think, "What's the point? Who is really listening?"

Ever since this summer, the news of the safety of VBAC was on the tip of everyone's tongue and ACOG was urging doctors and hospitals to relax their restrictions on doing them. Yet, thousands of women are still turned away, led to believe no doctor will support them and that they are actually illegal, according to state laws. Thousands more are still telling other women how dangerous they are, even though they know little about them. I'd love to see the figures on what this lack of support is doing to increase the alarmingly high rate of c-sections in the US.

What does ACOG really mean when they restructure guidelines like this, or create new ones? Who's listening? As I decide about having a fourth baby, after two cesareans, what does it mean for me as a patient? And is there any doctor in my county who will "allow" me to have a vaginal birth?

I'm beginning to think that ACOG is the new United Nations, an organization that probably means well but has little power when it comes right down to it. They can shake their fist, demand better, and set 'guidelines,' which is really saying, 'We'd like you to do this, but we are powerless to do anything should you decide to ignore us.' Is ACOG personally going to come after and investigate doctors who have astounding c-section rates? Those who don't do VBACs? Yeah, as if.

One of the biggest reasons for primary cesareans, and in my case as well, is if the baby is breech. I had a primary cesarean in 2003 for breech presentation, and another one last year for breech as well. ACOG's website doesn't necessarily say "we don't recommend a breech birth," but neither do they say "This should be recommended as a way of cutting down on the number of cesareans." Not too many doctors, I suppose, would be willing to admit that a sheer lack of training (among other things, as well) in this area is what leads to a surgical birth. I think that perhaps that would be a blow to your pride, to have to admit that you don't know what the hell to do if a mom comes in at 10 centimeters, waters broken, with a footling breech (been there, done that). So you just whisk them straightaway to the OR.

ACOG's website on this subject actually implies that there are "options" for a mom when she realizes that her baby is breech. Yeah, like "would you like to be sectioned on a Monday or a Tuesday?" While they acknowledge that there can be risks to a vaginal breech birth, they admit that "most breech babies are born healthy." (No where do they mention the skill of a caregiver being able to mitigate significantly risks to you and the baby when he actually knows what he's doing.) Without really coming out and saying it, it's like they're quietly whispering, "If you have your baby vaginally, it'll probably be alright." Not screaming, "YOUR BABY IS GOING TO DIE!" They go on to say that "it's not always possible to plan for cesarean birth," and as your due date approaches, if your baby is breech your doctor "will discuss the risks so that together you can plan the delivery that is best for you." Cue the happy music and the hugely pregnant mom wading through a field of daisies ... I think I am going to barf.

Right! If you read between the lines, ACOG says right there in plain text: "Your doctor will discuss the risks." Of a vaginal birth, you mean. Never a cesarean. This is also what happened to me on at least more than one doctor visit - he sure discussed the risks with me, all right. Let's not mention the benefits of a vaginal birth - like not having a scar on your uterus and all the complications that come with it, both potentially life-threatening and just plain annoying. No more is this underscored than in the death of a mom after her fourth cesarean , due to a combination of placenta problems and doctor error.

This death could have been avoided, some suggest, if more women were encouraged to have VBACs, or - dare we say it - not have a cesarean in the first place, even if the baby was breech.

In this area, I wish ACOG would look north to their Canadian cousins - The SOGC, or Society of Obstetricians and Gynecologists - to get the scoop on how to handle breech vaginal births. It seems, from what they're saying, is you don't have to 'handle' anything: just let it happen, and chances are, the mom and baby will do fine. But that's our biggest problem: they can't keep their hands out of the cookie jar, even when the jar is empty and there's nothing to grab - just leave it alone already and we'll let you know when you're needed.

I'm beginning to think that if ACOG were really serious about lowering the c-section rate and giving women "options," they'd be passing that information on to everyone and her sister and not just allowing it to rest in the often idle hands (and brains) of your well-meaning, but obstinate, physician. Still think your OB is only acting with your best interests at heart?


Anonymous said...

Spoken from my heart. Some OB's are probably forced into "low risk" procedures (speak C-secition) by insurance companies for breech, repeated C-sections etc., many are simply not educated enough to weigh benefits & risks or to actually know how to deliver a breech etc. due to lack of hands-on experience. And then there is the reason of comfort. C-sections are so much faster (thus time to be home for dinner or the football game) and generally generate more cash. And the women - hey it's not about them after all, it's about getting those babies out, the quicker the better. Efficiency is all that matters, quality comes second.

I was personally very lucky. Had an unintended home birth due to spontaneous, rapid labor and delivered a breech baby (was vertex at the last prenatal appointment at home before paramedics made it to our place. (BTW, the baby is alive and perfectly healthy fortunately). Have been told this would have been a C-section in the hospital, I would not have been given a choice but been rushed to the ER with or without consent... In that way (and knowing everything ended well) I am extremely lucky that things went as they went