Did ACOG Ban Elective C-sections? I Got Punked!

Lissa Rankin's picture

ban elective c-section

This morning, a very reputable women’s website called me and asked me to write an article about a press release they sent me, which read:

(April 1, 2011) For Immediate Release—ACOG ANNOUNCES PLANS TO STOP ELECTIVE C-SECTIONS

The American Congress of Obstetricians and Gynecologists (ACOG) announced today it is devising a comprehensive plan to lower C-section rates in the United States. C-sections in the U.S. have gone up 700% since they were first measured in 1965, when the C-section rate was only 4.5 percent.

“The nation’s C-section rate has been rising steadily for the last eleven years. It’s now over 31 percent,” said an ACOG spokesperson. “This is a deplorable situation that harms women and their newborns.”

An organization that advocates for quality healthcare for women, ACOG is asking obstetricians to halt elective C-sections.

“C-sections should only be a last resort. They should never be performed for the convenience of the doctor,” the spokesperson said, “or for financial or liability reasons.”

Since the use of electronic fetal monitoring has been shown to increase unnecessary C-section rate without any proven benefit to the mother or infant, ACOG is also calling on American hospitals to stop the routine use of electronic monitoring during labor. ACOG’s new guidelines encourage women to have freedom of movement during labor, labor standing up or squatting, and to eat and drink at will.

“Cesarean can save lives. But doctors and consumers have to remember that this is major surgery that carries major risk,” the spokesperson said, pointing to the example of 29-year-old Abbie Dorn, who suffered severe hemorrhaging and brain damage after her uterus was nicked during a Cesarean section at Cedars-Sinai Medical Center (2006), 32-year-old Diane Rizk McCabe, who died following complications from a Caesarean section at Albany Medical Center Hospital (2007), and Karen Vasques, 27, who died during a C-section at Beth Israel Deaconess Medical Center (2008).

Maternal mortality has risen every year in the United States for the past 25 years, while over the same period the rate of C-sections has gone up 33 percent.

“The skyrocketing rate of C-section in America has had devastating consequences,” the spokesperson said. “ACOG, the most highly respected organization of obstetricians and gynecologists in the United States, is leading the fight to stop it.”

Wow, Really?

As an OB/GYN promoting self-healing, reclaiming the heart of medicine, and ditching the over-medicalization of health care, they got my attention. Like, seriously.

Certainly, some advances in modern medicine have been good for us. We can cure some cancers, eliminate or control most infections, and safely repair diseased organs. But C-sections have not served us well. As C-section rates have risen, so have death rates for Moms. And the truth is that while C-section rates have gone through the roof, we haven’t done much to help protect babies. In fact, the trend of rising elective C-section rates may actually harm babies, since data demonstrates that labor helps prepare a baby’s lungs for birth. Those born by C-section are more likely to have respiratory distress at birth.

So when I read this press release, my first thought was, “Wow, seriously? How awesome! With fewer C-sections and no required monitoring, women might actually get to feel like they’re in the midst of something natural, rather than relinquishing all rights to feeling human as they’re poked, prodded, strapped in, and bedridden.”

As an OB/GYN, I watched things change over the years. When I first started my training in 1991, C-section rates were about 20%, and we thought that was exorbitantly high. I had never heard of elective C-section. C-sections were a last resort to save mother or baby, not some drive-thru convenience stop for busy mothers.

Back then, we thought monitoring babies would help save lives. That’s why you would want to labor in a hospital, rather than at home, right?

But science has proven us wrong, and I was delighted to hear that ACOG was motivated to make some changes.

WE’VE BEEN PUNKED!

So what did I think of ACOG’s announcement? Well, first I was PSYCHED -- and then I was bummed, because I was like, “Wait, who are they to dictate what a woman can or can’t do with her birth?” And then I started researching it further and started to get suspicious.

Why did the ACOG logo on the press release have a smiley face winking in it? Why did I see it reported on CNN and then it disappeared? Why couldn’t I find a single reputable news source reporting this GIGANTIC news?

So I checked ACOG’s press releases online, and I couldn’t find a thing.

I THINK I’VE BEEN PUNKED! It’s April Fools Day, after all. I forgot. Huffington Post is playing tricks on their readers. Google is too with "Gmail Motion" and "Comic sans". I should have been more suspicious before I spent three hours on this!

So I put out a call out to my friend Elizabeth Cohen, the Senior Medical Correspondent at CNN, and after a few hours her team confirmed that it is a big, stinky hoax. From Elizabeth's team: "The information did not come from ACOG, and the CNN posting has since been removed. This was an April Fools joke ACOG has been dealing with all day long. Bottom line, ACOG has not and does not plan to issue guidelines to stop elective C-Sections or electronic routine fetal monitoring."

Yeesh.

So What Was I Going To Write?

Because it's such an interesting topic, I wanted to share what I drafted up this morning:

I applaud ACOG’s efforts to reduce C-section rates. I wholly support natural childbirth. I think elective C-section has gotten out of control. And I agree that electronic fetal monitoring causes more harm than good.

I’m all about de-medicalizing childbirth. I think we’ve lost the heart of medicine in many ways. We’ve forgotten that childbirth can be a deeply spiritual experience, and we’ve replaced it with monitors, drugs, and surgeries. So I’m all for trying to reduce the C-section rate.

But I don’t think this will be easy. After all, patients have come to expect that they have the right to ask for a C-section if they want one. They also expect perfect babies, and if some freak accident happens to their baby while they’re wandering around Labor & Delivery unmonitored, and if that baby winds up disabled or dead -- I guarantee you there will be a lawsuit. Someone will argue that, if she was being monitored, that accident of nature -- a prolapsed cord, a placental abruption, whatever -- could have been prevented. And some jury will feel pity for the broken-hearted mother who lost her child, and they’ll likely award a 10 million dollar payout, because in our society, when something goes wrong, we feel someone’s gotta pay.

Plus, I’m not sure I want some organization mostly run by men dictating whether or not we can choose how we deliver our babies. After all, we don't ban plastic surgery even though it's risky and unnecessary. Shouldn't a woman ultimately be involved in what happens to her body, even if it means incurring extra cost and risk? Again, I'm not a fan of elective C-sections, but I'm a HUGE fan of women.

What’s The Solution?
  • Most importantly, we need to reset our expectations so we understand that childbirth is risky, bad things might happen, and high C-section rates and electronic fetal monitoring just won’t prevent that. Until people understand that we can’t control much of what happens in Labor & Delivery, C-section rates will be high because doctors and hospitals are afraid.
  • We need tort reform to protect doctors and hospitals from runaway lawsuits that lead doctors to make soft calls on C-sections for fear of getting sued.
  • We need to educate people about the benefits of natural childbirth, the safety of vaginal birth, the risks of C-section, and the fact that childbirth is full of mystery.
  • Patients should be included in the decision of whether or not electronic fetal monitoring should be employed. The risks and benefits should be discussed, and patient autonomy should be respected.
  • While I fully support ACOG’s desire to eliminate elective C-section, I think it’s gonna be hard to turn the tide. You can’t just change the rules mid-stream. I think we need to respect patient autonomy, but be very clear about risks. If a patient wants an elective C-section, let her attend a class and pay cash for it, rather than expecting her insurance to pick up the tab. That will stop 99% of elective C-sections.

So anyway, take my words with a grain of salt. Given that the whole thing is a prank. CNN is writing a blog post on the whole hoax and asked for a quote from yours truly. Here's what I provided: "What sick person would do this? You're talking about pregnancy, childbirth, and babies here. I wish people respected women's issues enough not to joke about them. This is serious stuff. After reading this press release, some women got their hopes up that things might be changing. Learning that it wasn't true was heartbreaking for some people. Making fun of something that touches a nerve only hurts people. It feels mean-spirited, rather than clever."

Let's talk about it! What if this had been true? What would you think about this? Do women have the right to choose whether their baby is monitored or whether they get an elective C-section? What do you think will help reduce C-section rates? How can we turn the tides without a bazillion lawsuits?  

And what do you think about April Fool’s Jokes (personally, I’m feeling a bit foolish right now, so don’t ask me…)??

Feeling punked,

Lissa

Lissa Rankin, MD: Founder of OwningPink.com, Pink Medicine Woman coach, motivational speaker, and author of What’s Up Down There? Questions You’d Only Ask Your Gynecologist If She Was Your Best Friend and Encaustic Art: The Complete Guide To Creating Fine Art With Wax.

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Comments

Lissa Rankin's picture

It was YOU Jennifer!

OMG- you TOTALLY got me!

And I was admittedly all over the map emotionally that day. The press release was sent to me in an email from the editor of a very popular women's webiste, without the wink. She asked me to write about it, and I saw it on the CNN ireport, but I got suspicious when I didn't find it on ACOG's list of press releases. And then I asked on Twitter- and heard that it was a prank. But not until after I had written a 4 page response to it!

But I forgive you..

And yes, we SHOULD be talking about this! Thank you for starting a long-overdue dialogue...

Much love to you all
Lissa

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Lynne Hurd Bryant's picture

Respect

I really DO respect the wishes, desires and needs of others. You have to understand that I am anomaly! I am was an Amazon woman, Earth Mother type...probably still am. I have had 6 vaginal deliveries, 3 of them 9+ lbs and those 9 lb babies were born without medications, with only one pushing effort and I walked out of the delivery room on my own two feet, no stitches, no tears. I am advocate of breastfeeding, having 13 yrs of it under my belt, but it not for everyone. With my first daughter, she was born at 4:13 on 03/14 and my milk was in before noon that day. I cannot imagine the pain I would have had trying to dry that up had I made another choice.

Motherhood is now a choice. The remarkable thing about it is that you make a lot of mistakes, but not the ones you think you will make. Choosing not to breast feed is not a mistake, it is a choice. Your child will only have had that experience, and the same for you. If your child is healthy and happy, what is the difference? (There are some lifelong benefits of breast feeding, but that is another issue for another day.) I have a young friend who suffered a lot of grief about wanting to do her daughter's nursery in camouflage. I told her, as I am telling you, there is nothing wrong with that choice, and so many other choices you make for your child. A child's experience of his/her mom will be the only one he or she knows in life and they accept it as normal.

Loving your child as unconditionally as you can figure out how to do it, accepting them for who they are and not what you want them to be, listening to them, taking time for them, encouraging them, being present for them is so much more important than how they were born or how they were fed as infants. Birth choices are OURS. We make them for ourselves. In the end, these choices influence how we mother our children and how we feel about ourselves are parents. What is best for us will, in the end, be the best for our children. If mama ain't happy, ain't nobody happy!

Lissa Rankin's picture

Elective C-section

Michele,
Thank you for sharing! I was going to tell my story too but I've been offline for 3 days and am just now catching up.

If any of you have read my book, you know that I too had an elective C-section. It was a tumultuous time- in the midst of my Perfect Storm. Here's the excerpt from my book:

I’ve heard that celebrities get C-sections just for convenience. What do you think about this?
Ooh. This would be a great instance of “Do as I say, not as I do.” I’d like to say that I don’t advocate elective C-section- because I don’t- but that would make me a total hypocrite. Let me explain.
When I was pregnant, I had a placenta previa, meaning that my placenta was attached over my cervix, a condition that requires a C-section delivery. While some women with placenta previa are bummed out that they won’t be able to deliver vaginally, I have to admit that I was relieved. Back in my twenties, I suffered from a painful type of sexual dysfunction that made intercourse feel like torture. Finally, in my thirties, this syndrome resolved, and sex was fun for the first time in my life. So my secret fear about childbirth was that I would tear from my vagina all the way through my butt (a fourth degree laceration) and sex would hurt for the rest of my life. So while I knew C-section carried other risks, my irrational fear of tearing lead me to consider elective C-section.
Ultimately, my placenta moved out of the way, paving the way for a potential vaginal delivery. But by that time, my Dad was dying of brain cancer and my life was on a downward spiral into total chaos. Frankly, I just couldn’t handle one more facet of my life being completely out of my control. Motivated largely by my desperate desire for Dad to meet Siena before he died, my husband and I opted to schedule a C-section to deliver Siena two weeks before my due date, after doing an amniocentesis to make sure her lungs were fully mature.
This is not a choice I’m proud of. In fact, I lied to everybody at the time. My patients, the doctors in my practice, my best friend, even my mother. Only my doctor and my husband knew the real reason for my C-section. I lied because I didn’t want anyone to mistake my choice as an endorsement of widespread elective C-section. As it turned out, Dad got to meet Siena and died two weeks later. Had I made it to my due date, he would never have met her. I have absolutely no regrets.
My exceedingly personal decision aside, how do I counsel my patients? I don’t even bring up elective C-section. But patients do ask from time to time. Why would someone want to electively undergo a painful surgery? Some reasons include:
1. Wishing to avoid a long, painful labor
2. Scheduling birth in your busy day planner
3. Being delivered by the doctor of your choice
4. Avoiding going too far past your due date, which can increase the risk of complications with the baby
5. Lowering the risk of postpartum hemorrhage when compared to either planned vaginal delivery or unplanned C-section
6. Fear of sexual dysfunction or urinary incontinence (although elective C-section has not actually been shown to reduce these risks)
If a patient asks, I tell her she must listen to my spiel and sign her life away in consent forms. After this, if she still wants an elective C-section, I will perform the surgery. My spiel goes something like this:
Please don’t ever choose C-section because you’re afraid of the pain of labor. If this is your motivation, we can put an epidural in at the first sign of pain. And don’t choose C-section because you want to schedule your birth. We can always induce labor.
If you have other reasons for requesting a C-section, it’s critical to understand the risks, which include:
1. Greater pain postpartum
2. Longer recovery
3. Higher risk of postpartum infection, surgical wound complications, hysterectomy, anesthetic complication, blood clots, and other postpartum complications
4. Greater risk that the baby will have respiratory problems at birth, especially if C-section is done before 39 weeks gestation without first doing an amniocentesis to make sure the baby’s lungs are mature
5. Increased neonatal death rate
6. More risk in future pregnancies, including the risk of placenta previa and accreta, uterine rupture which may result in death of the baby, and surgical complications such as bladder injury, bowel injury, and scar tissue.
As you can imagine, at this point, most women shake their heads adamantly and never bring it up again. So why would I choose to make such a risky choice? I guess you could say I’m an informed consumer. I knew exactly what I was signing up for, and my doctor respected my autonomy and allowed me to make my own decision, which is the same thing I do if a woman understands the risks and chooses to proceed anyway. It’s not my job to judge anyone’s choice. My job is to educate, present both sides objectively, answer questions, and respect a woman’s right to make choices about her own body.

So yes, Michele, I agree. It's a very personal decision and not for anyone to judge...
Much love
Lissa

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Jennifer Margulis 's picture

The winking eyeball was supposed to be a dead giveaway

I wrote that press release. I didn't expect anyone to take it for real. At the top (or bottom, depending on where you read it) was the ACOG logo with a winking eyeball in it. I am so grateful for the work you and others like you do, Lisa, and I think we are all being punked by ACOG, which advertises as an organization that advocates for women and children but instead opposed home birth and comes down, time after time, in favor of intervention.

Here's a long explanation of the prank:

http://mothering.com/jennifermargulis/child-birth/americas-c-section-rat...

michele Campbell's picture

A Different Perspective

That certainly was not a very nice joke, but this is a very interesting topic. I would like to share my experience with an elective C-section. It was wonderful!

I had no labor pain and very little post-op discomfort. My babies birth was such a beautiful experience. I was able to welcome her into this world without being in horrible pain. We bonded immediately! I got to hear her first cry and snuggle with her and kiss her right away. When we got back home a couple of days later, I had to remind myself to abide by the restrictions given by my doctor because I felt so great. It was one of the most wonderful times of my life!

I believe this is a very personal decision. I made an informed choice and it was definitely the best one for me! Oh, and I liked the benefit of the reduced risk of incontinence (for mom of course).

My baby girl is 10 years old now. She is happy, healthy, well adjusted, and very intelligent! By the way I didn't breast feed either.

Michelle Medina's picture

I was born in 86, my mother

I was born in 86, my mother spent 2 days in hard labor and didn't use a c-section as an excuse so she could get back to her happy go lucky life. Of course, I still came out with my cleft. . . Anything like this, always has an affect on me/my thoughts and feelings around it because it is, and always will be one of my issues that I deal with daily. My parents didn't sue the doctors though, they went with life as it was and as it is now.
If I am ever fortunate enough to have a baby *I have a 1 in 4 chance of giving her my cleft plus deafness and mental challenges*, I plan on doing it as naturally as possible. No shots to numb me, no drugs, no nothing. I want my baby to be brought into this world as naturally as possible.
As for the prank, I'm not surprised, nothing is sacred these days, but like others have said, at least it's inspired conversation.

Lissa Rankin's picture

Wow- I am LOVING this conversation

As much as I was pissed off that this whole thing turned out to be an April Fool's joke, I'm uber grateful for this conversation. And Melissa, I love what you wrote about responsibility. It's not as easy topic!

But yes. No one can guarantee a perfect baby or a healthy mother. Childbirth is plain risky. I fear that many rights have been taken from women because docs and hospitals fear lawsuits- with good reason. There has to be a solution, but part of the solution comes from women and families recognizing that adverse outcomes are- in truth- unpredictable and often blameless.

If we want childbirth freedom, it means we have to accept that sometimes- no matter how much we do everything right- bad things happen. And it's no one's fault...

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Melissa @ Vegan CacaoBee's picture

Thoughts

I am saddened that maternal-child care was used as fodder for an April Fool's joke, but unfortunately I can't say I am surprised. Anymore, it doesn't really feel like anything is sacred. I definitely agree that educating patients + allowing them to have different options are key. Hopefully, empowering patients to play a more central role in their health care will decrease the need to find someone to blame in the case of an adverse event. However, I think this is an especially touchy situation in maternal-child health. When something bad happens, it seems like a knee-jerk reaction to look for someone or something to blame. With children, this response is magnified. If the weight of responsibility on health care providers has been lessened, are the mothers and other family members left to bear the burden of their decisions? Although there may be fewer lawsuits, the devastation for mothers and families would be staggering in this scenario too. I agree that it will take a different set of expectations with a greater respect for the risks associated with pregnancy and childbirth, along with a shift in how we view adverse events in health care and even just life in general (i.e. Despite all that can be accomplished medically, sometimes bad things just happen and no one is to blame. I know this is not an easy view to adopt!) I also think that viewing the doctor-patient relationship as a partnership rather than a hierarchy would help increase satisfaction with both the care and the outcome.

beebee's picture

Crash

I got SO excited that I posted a link to my Facebook page before I finished reading; and then was SO let down when I found out it was an April Fools "joke." How unusually cruel to those of us who have been working really hard to create a shift in the way women and childbirth are treated.

Tracy's picture

Yeesh!

This saddens me that someone would have such poor taste to pull such an April Fool's joke like this. On the other hand I'm happy to see it generated conversation around c-sections. I didn't realize how common it's become for women to schedule their babies' birth! I believe we should ultimately have the right to choose. I think it's up to the doctor to give us all the options with risks/benefits. Further more, it's up to us to do some research ourselves, go within to check with our guidance and then make a fully informed choice from there.

My first was born via c-section because he was trying to come out butt first. I didn't have a bad experience with the c-section. My son was brought to me as soon as possible and my husband was there for the whole thing. My daughter on the other hand was born VBAC. Comparing the two, I would do a vaginal delivery over C-section any day.

Amanda's picture

April Fools Joke - Ban on elective C Sections

When i began reading this, I too was hopeful, then dissapointed and saddened to learn that, ofcourse it wasn't true. A strange and sort of cruel joke - however, at least it gets people talking about a very important topic. Having recently given birth to my first child via C Section (where i live, i had little choice, as it is standard procedure for breech births) this topic is very close to my heart. whilst not wanting to deny the rights of any woman to choose, i really beleive that C Section is an awful way to go unless you really need to. All i can comment on is my own experience however, and perhaps if i'd had a natural birth (as i desperately hoped for) i'd have found that difficult, painful, and frightening too) Following my surgery i was in so much pain, I felt as if i'd been hit by a bus. I was so shocked and traumatised that i felt i couldn't properly care for my baby, in fact, sadly, i even felt distant to him at first. I couldn't breastfeed, my baby was away from me and in the incubator for the entire first night, and two nights after that. My husband was not allowed to join me until the following day, and then after that, we couldn't afford the ridiculous cost for him to stay with me in the hospital, when i truly needed him most. I can honestly say, 4 months on, that what was supposed to be an amazing and beautiful challenge was instead a horrendous and frightening experience. After pumping my breasts to feed my son for the last 4 months, and after a very slow recovery, from the wound, and the huge allergic reaction i had to the surgical paste and bandage, i am completely exhausted, occasionally depressed, and often still very angry and upset at the hospital, the doctors, midwifes and the whole system. I really feel that this trend can be damaging to the bond between mother and child, and instead of empowering us it actually makes us victims, how can we care for our babies when we ourselves need such care, after surgery, drugs, and being bed-bound withs tubes attached to us?? Not to mention the guilt and stigma that can go along with having a C Section (i read a comment a few days ago on a parenting website that mothers who have had a c section have no right to say they have given birth :( ) Please, please, people, both mothers and fathers to be, research the effects and dangers of C Sections before you decide to choose this option. My poor husband ended up doing everything as well as looking after a shell shocked wife for a lot longer than the first few weeks. I really hope next time i can try a natural birth, and i wish everybody good luck, no matter what they choose.

Christina's picture

Hold On

I think this will only have been seen by a relatively small number of women with active daily interest in birthing issues, journalists, bloggers and the like. It's already disappeared from CNN.

That it is now generating discussion on a variety of websites seems like a good thing as the fake news release makes very valid points about cesarean delivery. It is major surgery, there are inherent health risks involved and rates are at an all time high.

These are all things that need highlighting and open discussion - especially during Cesarean Awareness month.

A 'ban' on elective cesareans is unrealistic and likely not legal, but the issues are real, the consequences of 32.9% cesarean rate on the health of both women and children is real - so let's focus on that.

Christina Hemming
www.csectionrecoverykit.com

Lynne Hurd Bryant's picture

I have watched these rates too

I am only a medical transcriptionist, but I have worked at teaching hospitals across this country, quite literally from New Jersey to San Diego. I have been in this for 15 years and I have had 4 vaginal deliveries with 4 healthy kids and did the last 3 unmedicated.

When I first started, I saw episiotomies done routinely. Repeat C-sections were common. I saw that most doctors favored breast feeding. Then VBAC (trial of labor, vaginal deliver after C-section) became what every doctor seemed to want.

Right now, and my experience is current, doctors do not encourage breast feeding, and while episiotomies are becoming rarer, the elective C-sections I see have become a daily occurrence. I rarely hear a doctor dictate that the patient was even offered a trial of labor, he/she just scheduled the surgery, no questions asked. There were plenty of times when a woman didn't want to go through labor, but wanted to schedule a C-section on her time frame...always she is accommodated! Again, no questions asked.

Women are partly to blame. When you labor for many long hours and your friend had a "simple" scheduled C-section, you'd think that was the way to go, even over and over having one because it is so easy. Well, news flash, the first C-section is generally not a problem, but the second one can be very messy, not to mentioned a third, a fourth or fifth. I have listened to a doctor dictate a sixth or seventh C-section and it is just awful, they can take hours, much blood loss and they are a mess.

We are back to where we were 30 years when my first child was born! Take control of your birth experience, we were told, embrace it, be prepared, C-sections are only for absolute emergencies, knowledge about birth is empowerment! We have not listened and Lissa, thanks for reiterating what some of us old timers have known for a very long time!

Colleen's picture

Awful.

Wow. When I read your article I went through hope and awe and then complete disappointment. The medical system is broken and an April Fools Joke like this is horrible and mean. There are people who wouldn't have spent the extra time to verify it, thinking it came from a reputable source, and made birthing plans based on that article. I agree that women's issues are not taken seriously enough. It is shown by this "Joke" and the actions within our government right now to prevent women the right to rule their own body and have access to affordable healthcare.

Saddened,

Colleen

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