Reading Born in the USA by Mardsen Wagner was very overwhelming and I was surprised by most of his points including the fact that the American Congress of Obstetricians and Gynecologists (ACOG) is not regulated or given responsibility to set the standards it does, the fact that off-label and against-label drug use by doctors is tolerated, why the US does not have regulations or required standards on recording and investigating maternal mortality, and the fact that doctors are surprised and complain about the “litigation crisis” while continuing to put into practice the things that result in litigation.
I have heard of ACOG several times before reading Born in the USA. It has been mentioned in other books and articles I have read as well as brought up in conversations when talking about home birth and specifically water birth. I was under the impression that ACOG was a very important organization that had the responsibility of setting standards for care providers. Much to my surprise, thanks to this book, I know the truth about ACOG. While they are a very important group (to doctors) no government agency has given them the responsibility and right to see such standards and have care providers be reprimanded if they practice against these standards and statements. How did they get so much power? I know there are several care providers out there that don’t agree with the way ACOG does things but they fear speaking out because they do have so much power and fear it would have negative effects on their careers. We need more people like Wagner to speak out with confidence against ACOG in order to overcome this organization that claims to care about the health of our country.
The tolerance of off-label and against-label drug use by doctors such as using Cytotec to induce labor, absolutely blows my mind! How is this even legal? Wagner mentions several studies that have been done that suggest Cytotec is not safe to use for labor induction and it says right on the bottle that this drug should NOT be used on pregnant women. Doctors have been using this drug for years against label and there have been so many cases with negative outcomes, and yet they continue with this practice. We need to make this illegal! I work in real estate doing appraisals for bank loans and for realtors when a house goes up for sale. I was discussing with my boyfriend the other day how ridiculously regulated the real estate market is compared to our health care system, specifically our maternal health care system. There are so many rules, standards, and regulations on how to put together an appraisal on a house and to make sure your appraisal is not misleading and contains 100% accurate information, but yet our doctors and nurses have a very relaxed system and very little accountability. It’s insane to me that more effort is put into making sure a house sale is legit and fair but yet obstetricians don’t have to or are not being reprimanded for not ensuring women are making informed choices about their health and are giving them drugs without their knowledge that are known to be dangerous and cause adverse effects.
The frustration about the use of Cytotec and the fact that doctors are giving women drugs without informed consent, including Pitocin among others, brings me to my awe that doctors are surprised with this “litigation crisis” and the raises in cost for malpractice insurance. Litigation isn’t just from the use of drugs but from all of the interventions that women feel they have no control over whether it be the doctors and nursing staff don’t tell the woman what they are doing or they impose an intervention on them against their will or without true informed consent. To this day, these care providers are still allowing and suing these practices. They blame their patients for having such high malpractice insurance and need to use some intervention to avoid litigation but it’s those very interventions that the care providers are getting sued for using. If care providers took the time to create a trusting relationship with their patients (clients) and truly gave them informed consent, their patients would not be taking them to court, or at least much less often. They need to allow for better communication and explain all of the benefits and risks of every option, and when there is a negative outcome, they need to be accountable to it and keep open communication with the families about what the possible cause was instead of making it so hard for them to figure out what happened.
When a poor outcome does arise and a mother dies, which sometimes you just can’t avoid, what are the chances that it would accurately reported or recorded at all? According to Ina May Gaskin, the CDC has admitted that maternal deaths are severely underreported. I do not understand why making sure maternal deaths are investigate and accurately reported is not a priority. We have one of the worst maternal mortality rates in the industrialized world and there seems to be no real effort in changing that, at least not from the medical model of care standpoint. They just keep focusing on how the latest technology should prevent negative outcomes but continue to be blind to the fact that using those technologies and continuing to intervene in one of the most natural processes of life, is actually what is causing those outcomes and insane mortality rates. We know that these rates can be much better by just looking at other countries and researching their systems. It makes me so sad that women and families are not respected enough to be worthy of investigation if they die during the childbearing cycle but yet the justice system can spend weeks, months, or even years on other death related events such as murders or even accidental deaths while on the job. Without these deserving investigations on maternal mortality, that should be a no brainer, the maternal health care system will be extremely difficult to improve because we won’t have the data to show where exactly needs improving and how we can make change. Putting in place regulations on reporting and investigation maternal death should be at the top of our health care system’s priority list.
It is ever so clear the need for change in our maternal health care system. Midwives are definitely a necessity in bring about the right change but without concern and dedication from other care providers such as OB/GYNs, the change will be very difficult. We won’t give up though. The need for midwives is growing and the number of midwives is growing. The health care system will be forced to work with us and they will eventually come to realize the need for change. Midwives can and do change the world!