Saturday, March 23, 2013

ACOG Smartens Up While DONA Throws Baby Boys To The Wolves...

I know. Has the world gone mad?! You read the post title right. I woke up this morning to find a published position from ACOG that discourages elective inductions and cesareans overall, and especially discourages either for macrosomia (big baby). Whaa??

Here are a few highlighted quotes from ACOG's statement:

“Let nature take its course.” Over the years, I’ve found this saying particularly applies to the process of giving birth. My personal experience as an ob-gyn and reams of scientific research demonstrate that Mother Nature knows best when a child is ready to be born."  - James Breeden, President of ACOG

Wait. Did you read that too? He said to let nature take its course. Sadly, I fear that these words are going to fall on the deaf ears of women who will still believe, due to long-time conditioning by Obstetricians themselves, that as long as baby is "term" then baby is ready. The funny thing is, state medical boards are ALL OVER regulating Midwives, citing the safety of women and babies as the reason. Where has the regulation been with Obstetricians who are happy to perform elective inductions and cesareans, which put baby's life at higher risk than home birth does? Where is the outcry for public safety?

Okay, okay...I give ACOG serious credit for taking a stance on this again. Yep, ACOG has long since discouraged elective anything, in favor of labor starting naturally. But, it seems that Obstetricians have not been held responsible when they do otherwise. Here's another quote from an article on Improving Birth:

"For one, induction or surgery for “suspected big baby” (macrosomia) is not medically indicated. This is one myth we hear about all the time, even though ACOG has been talking about the “imprecise” nature of diagnosing macrosomia for at least ten years. Bottom line: induction for big babies is NOT medically indicated.

Elective inductions prior to 39 weeks gestation is, again, not recommended. Studies have shown that babies do better when they are able to remain in utero until 39 weeks. In the article above, ACOG sais, “Early-term infants have higher rates of respiratory distress, respiratory failure, pneumonia, and admission to neonatal intensive care units compared with infants born at 39 to 40 weeks gestation. Infants born at 37 to 38 weeks also have a higher mortality rate than those born later." - Dr. Capetenakis, OBGYN in Encinitas, CA

So again, I have to ask where the accountability is? I am very excited that ACOG has published this. However, I am skeptical that all of a sudden Obstetricians will start practicing evidence-based medicine when it is more profitable for them and the hospital in which they have privileges to keep doing what they've been doing. And going back to the factor of women in all of this - it's going to take a LOT of effort if there is ever going to be a hope of women waking up and realizing that being uncomfortable is better than putting their baby at risk.

I was recently told a story. A friend of a friend is a L&D nurse. She kept saying that she was not going to term. She got a stomach bug at 36 weeks, contracted from the vomiting, and went in to L&D. Even though it was not causing any cervical change, she decided it was just time to get baby out. Because she was 36.6 though, they waited until just before midnight to induce, because otherwise it was against hospital policy. But she went ahead with it, with an epidural in place before the induction was started. Kept saying that she KNEW she wasn't going to term. After the delivery, she told everyone about what a blessing it was that she was in the hospital (and not at home, like my crazy friend) because baby ended up having complications.

I will keep my comments to myself here, because they aren't nice. They even include much foul language. But THIS - THIS is the type of system that women are in. The one where it's perfectly acceptable to choose to rip your baby out of the womb, just because you don't feel like being pregnant anymore. The one where it's perfectly acceptable for Obstetricians to manipulate, coerce, and even FORCE women into intervention, procedures, and consent when they had previously denied consent. My heart is heavy in knowing that we have a loooong way to go.

I also woke up this morning to a find that DONA (Doula certification organization) has published an article in their magazine that is in favor of routine infant circumcision.

"A family's decision about circumcision should come from personal values. Religious and cultural reasons usually win out over all other arguments. Otherwise, you can make the case that circumcision is mainly a cosmetic procedure, with some potential medical benefits. It typically takes less than five minutes, and complications are very rare."

:scream:  Actually, the medical need for a circumcision later in life is less than the risk of DEATH from routine circumcision. Complications are not, "very rare". From

Out of 100 Circumcised boys:

75 will not readily breastfeed post-op

55 will have adverse reactions from the surgery

35 will have post-op hemorrhaging to one degree or another

31 will develop meatal ulcers

10 will need to have the circumcision surgery repeated to fix prior surgical problems/error
8 will suffer infection at the surgical site

3 will develop post-operative phimosis

2 will have a more serious complication (seizure, heart attack, stroke, loss of penis, death)

1 will require additional immediate surgery and sutures to stop hemorrhage

1 will develop fibrosis

1 will develop phimosis

1 will be treated with antibiotics for a UTI (urinary tract infection)

1 will be treated with antibiotics for surgical site infection

Of those who do receive pain medication for the surgery (about 4% of those boys undergoing circumcision in the U.S.) some will have adverse reactions to the pain medication injected

Out of 100 Intact boys: 

2 will be treated with antibiotics for a UTI (fewer if the foreskin is never forcibly retracted)

1 will be told to get cut later in life for one reason or another (fewer if the foreskin is never forcibly retracted)

Note: One reader of these statistics (a man cut against his will at birth with 4 intact sons today) critiqued (quite accurately) that it is actually 100 of 100 circumcised boys who experience negative consequences as a result of circumcision. Each and every one has lost an organ responsible for a great deal of his life-long normal health and functioning.

DONA is taking a defensive stance, saying that the article does not reflect the organization's belief as a whole. If that's the case, I wonder if they would allow a guest post about elective inductions and cesareans being a perfectly acceptable choice? Or, as Gloria Lemay put it to them, what about an article endorsing the cutting of females? They have now pissed off a whole lot of people. Personally, I'm not a fan of DONA. Or of any organization, really, that capitalizes on making labor-support a certified position. I've always found that to be completely and utterly ridiculous, especially when said organizations are clear in restricting many Doulas from attending women who choose to birth unassisted, and who have made it a thing of status and income in disproportionate ways. And, as I have heard Nancy Wainer speak about the atrocities that occur in hospitals every day, and the doulas who stand by and are essentially part of the rape and injuries that happen, by holding the woman's hand and telling her that "it's okay".

But this is really a low point for DONA. Another quote from the doctor who wrote the article:

"Often dads have strong feelings about circumcision, so fathers should definitely be included in the decision-making. If the parents care about their son looking different from other boys in the neighborhood, they may research the rate of circumcision in the area." 

Right. Forgot about teaching our children that they need to look like everyone else. Except for the fact that intact is, right now, the majority. Does this apply to girls in the neighborhood who have smaller or larger breasts than average? Should we encourage breast enhancements or reductions in order for our daughters to not be made fun of? Should we start young children on contact lenses so that they will not be made fun of for wearing glasses? What about those who need to wear braces? What about children with Autism and Downs Syndrome? Should they be hidden from the general public so that they never face teasing?

This is a really shitty reason to permanently alter an infant's body without his consent. Period.

Another gem:

"But once they decide, they should be encouraged not to drive themselves crazy with second guesses - in the long run, it will probably be fine either way." - Marjorie Greenfield, MD. 

Yes. We wouldn't want parents to consider the gut feeling that they may be doing the wrong thing. After all, that's lost money! Err, I mean a child who might be ridiculed by his peers! I'm sorry, am I the only one seeing dollar signs here?!? Am I the only one seeing, "Doulas, keep your mouths shut. Do not encourage in-depth research into circumcision."?

Shame on you, DONA. Shame on you for allowing an article of this type in your print. Shame on you for essentially agreeing with the idea that Doulas should NOT be encouraging parents to keep their sons whole. I'm not sure it's possible, but I'm less of a supporter now, than I was before. You just made a joke of your entire organization.


Jer said...

THANK YOU!!! I was shocked at the ACOG revelations, but the DONA thing has me completely gobsmacked. Seriously, DONA??!?!

Katie P said...

I have to admit I am a DONA trained Doula, but I will not certify with them because of things like this. I just don't agree with them. It makes me wish I would have trained with a different organization.

Gena said...

Katie P you can certify through someone else, I will be this is pretty much the last straw for me. I am DONA trained not Certified...I am looking at DTI