Please, run, don’t walk, to the series called Lamenting the System at the Unnecesarean. It is a series of responses from practicing ob/gyns to an article called “An Obstetrician’s Lament” by Annette E. Fineberg, MD, which was published in the Green Journal (ACOG’s Obstetrics and Gynecology) this month. The Navelgazing Midwife reproduced the article in its entirety here.
Jill, blogmistress (I love that word!) at the Unnecesarean sent me a copy of the original article right before she started the series. It couldn’t have been better timing. My attending physician (in my pediatric ER rotation) was giving me a similar lecture to one I have gotten from almost every physician I have worked with – a lecture about what the “real world” was like, and how, in the “real world”, you couldn’t afford to offer VBACs. I argued about how VBACs were no riskier than primary vaginal deliveries, and how refusing to allow them flies in the face of expert consensus and ethical responsibility to the autonomy of the patient.
Then, I got the email from Jill. I eagerly read passages aloud to the intern sharing the service with me. She is a good friend and is leaving to start an ob/gyn residency in July. She is kind and open minded, but she did not have the benefit of training in a freestanding birth center with lots of spontaneous, natural births and plenty of successful VBACs, like I did. She has been subjected to as many if not more lectures on the “real world” as I have, and has probably only seen conventional hospital births with all of the constraints and interventions of modern obstetrics.
I read many passages, to her, including this one:
Each of these women deserves an honest discussion about the fetal and maternal risks of each birthing option. However, our lack of experience as obstetricians colored by our fear of liability is narrowing women’s choices, and sometimes motivating them to ignore fetal and maternal safety in an effort not to be coerced into unnecessary interventions. I sense a mounting tension, because many obstetricians do not have the willingness, time, or skills to provide maternal choices.
All of the articles in the series are good, but I especially love An Obstetrician’s Hope, the last one in the series, by David Hayes, MD. Every word in his piece spoke to me and to the type of practitioner I want to be. On the one hand, I am overjoyed to read of a physician supporting and attending homebirths, and even happy to see more obstetricians who support and attend homebirths in the comments. I am saddened, though, that he is leaving his practice here (although joining Doctors Without Borders is fantastic for him and the people he will help).
Here is an excerpt:
A woman choosing to have a home VBAC rather than be forced to have a repeat C/S in her local hospital is making a rational decision given the data we have available, a decision which we should be prepared to support if we cannot offer her a better alternative. I have delivered several hundred VBACs in the past several years without incident. In the same time frame, my local hospital has lost at least 3 mothers during or shortly following cesarean deliveries.
U.S. obstetricians have already come to the crossroads and have taken the wrong path. It can be fixed, but they need to start having honest and open discussions among themselves about the real maternal and fetal risks, about the rampant rate of unnecessary induction which leads to unneeded cesarean delivery, about the continued use of continuous fetal monitoring, restricted movement, withholding of nutrition, unneeded augmentation of labor, artificial rupture of membranes, epidural anesthesia and even multiple cervical exams, none of which have any proven benefit and all of which contribute to increased morbidity and even mortality.
Please go read the whole article, and the rest in the series.