ACOG has sunk to a new low

As if scare-mongering and fact-twisting weren't enough, they have now sunk to exploiting a heart-broken couple's pain.  This Today Show segment is rapidly making the rounds on the internet (I've had about four or five friends post it to their Facebook pages so far, and it's popped up in at least four blog feeds, as well) and for good reason.  The segment is so obviously intended to further the position of the ACOG, so obviously meant to attack the midwifery and homebirth movements, and so obviously lacking in any effort to provide unbiased or well-balanced journalism that it is almost laughable.  Almost.

Exploiting a family tragedy in a veiled effort to shore up their own image by undercutting the alternative is utterly ludicrous.  Sadly, though, it's extremely common in this sensationalist-style "journalism" (though to call it that insults all of my journalist friends who do actual, you know, research before airing their stories).  No, what I find even worse is the blatant and slanderous insult.  Andrew Goldman of New York Magazine, and author of the article "Extreme Birth" is briefly on screen and delivers this soundbite:

 One of the doctors I spoke to said that he thought that homebirth had become almost the equivalent of a spa treatment, that it was this sort of hedonistic concept of birthing.

 As if insulting every woman who has ever considered or had a homebirth wasn't bad enough: they felt the need to slander, shame and blame the woman whose story they were exploiting for the very basis of the segment!  Obviously, if only she hadn't been so selfish, so self-involved and self-important, if only she had really considered her baby, she would have happily bought into the load of lies and half-truths and evidence-less practices so often sold by members of the ACOG.  If only...  

What's even more spurious about this segment is the date of its airing.  The very day the ACOG released the results of their 2009 Survey on Professional Liability, in which the ACOG admits that current practices are known to harm women and babies.

"This latest survey shows that the medical liability situation for ob-gyns remains a chronic crisis and continues to deprive women of all ages—especially pregnant women—of experienced ob-gyns," said Albert L. Strunk, JD, MD, ACOG deputy executive vice president. "Women's health care suffers as ob-gyns further decrease obstetric services, reduce gynecologic procedures, and are forced to practice defensive medicine."

 Forced to practice defensive medicine.   Let's all just ruminate on that phrase and consider it's meaning.  Continuous Electronic Fetal Monitoring.  Mandatory IV's.  Mandatory antibiotics for GBS mothers.  Mandatory induction after rupture of waters.  A national caesarean rate of 31.8% in the USA.

It has been stated to me recently that ob-gyns do not begin their practices in an effort to victimize women.  I would tend to agree with this statement.  I would like to think that, at their core, or at least in their genesis, doctors have a desire to help or to heal.  But that does not excuse engaging in practices and procedures which hurt women and children!  It does not excuse ignoring study after study after study which shows that common procedures routinely harm the very women and babies they are supposedly to help!  And it certainly does not excuse denying women bodily autonomy or informed consent.  For this there is simply. no. excuse.

It has been suggested that the current expectations for birth are unrealistic, that parents expect "perfection" from their doctor and that when their experience falls short they choose to litigate to make up for it.  Perhaps that is so.  Perhaps a 91% claim rate against respondents to the 2009 liability survey is indicative of parents having ludicrous expectations.  But should the doctors not shoulder some of that blame as well?  Should we, instead, address and acknowledge the fact that if the doctors are the "experts" they should be imparting a little of that wisdom to their "patients" (I'm utilizing sarcastic quotation marks again: a pregnant woman isn't sick) and having frank and earnest conversations about the realities and limitations of practitioners and birthing environments?  Perhaps if doctors were honest with women, were honest with parents, and actually divulged some of the information they so often try to keep hidden, there would be a greater understanding on the part of those parents after the birth for any perceived shortcomings.  Marsden Wagner writes in his recent paper "Fish Can't See Water":

One reason for the epidemic of epidural in many countries is that women are not told the scientific facts about all of the risks to them and their babies when epidural block is used for normal labour pain. Indeed, at one meeting of obstetric anesthesiologists in the US, discussions were held on how to prevent any information on risks of epidural from reaching the public. The excuse used was the typical patronizing approach of some doctors: "We don't want to scare the ladies." It is absolutely essential that any women offered epidural must be told all the scientific facts about the risks before she gives informed consent to the procedure. 

 Instead of respecting women - and also men; we must not exclude male partners from the equation - and dealing with them honestly, there is an overwhelming air of paternalism which often just smacks of chauvenism and downright misogyny.  And what's so totally ridiculous about it is that it only serves to shoot these same, paternalist, controlling doctors in the foot when claims are launched against them by dissatisfied and even injured women and parents (I say parents because if it is the child who is injured, the infant will obviously not be launching the claim).  Holly Barhamand, a doula and childbirth educator, contributed a comment to a recent post on Reality Rounds about whether patients can ever have any say in their own healthcare.  Her comment sums up my point better than I ever could.  With her permission:

I’m sure it’s a prevalent attitude, but I think it’s dangerous. When a patient has the decision making taken away from them, they are no longer responsible for the outcome. So when the outcome is adverse (and it will be sometimes, inevitably), then the doctor is at fault. Even if it was always out of the doctor’s hands. And this is a setup for distrust and fear for both sides and probably litigation. If a patient has a true voice in his healthcare, the responsibility for the outcome falls on his shoulders as well. I think this would solve a lot of problems, even if it means more time and investment for both sides.

How does this all come back to the Today Show segment?  The ACOG - through the guise of Peter Alexander - is trying to tell us that self-determination and personal responsibility are bad things.  They are trying to convince us that we want no part of the decision making process.  And they are, unequivocably and entirely, WRONG.