Editor’s Note: ACOG’s legislative wish-list for 2013 devotes over 1500 words to its insider agenda without ever once addressing or even acknowledging the Cesarean section epidemic in the US.
Nada, zip, zelch — doesn’t even contain the word “Cesarean”, even though the surgical deliveries rose by 50% in just the last decade.
ACOG totally ignores our sky-rocketing C-section rate, which is 33% of over 4 million annual births, or approximately the same number as students who graduate from college every year. They do however have time to make negative mention of midwives and midwifery as an independent profession that provides physiologic care for normal childbirth.
For more that 3 decates, the obstetrical profession has insisted the liberal use of cesarean would make normal childbirth consistently safer for mothers and babies, this justifying its higher direct cost as a way to reduce expensive complications.
However a substantial list of experts and policy-making groups, including JACHO (the very well-respected organization that accredits all hospitals in the US), have determined that the current rate of Cesarean surgery is medically unjustified and constitutes a public health hazard. It does not improve neonatal outcomes and it is associated with a steady rise in the maternal mortality rate in the US since the late 1990s.
This major abdominal surgery more than doubles the cost of childbirth in a hospital setting and is directly associated with cascade of immediate, delayed and downstream complications. Compelling research identifies the liberal use of Cesarean delivery to be a failed policy. One highly respected source recently identified 33 route-of-delivery complications associated with C-section, compared to only 4 for spontaneous vaginal birth.
From the standpoint of scientific evidence, these authors and organizations recognize the crucial role that physiologically-based management of normal childbirth (in contrast to the current highly medicalized model) plays in preventing medically unnecessary C-sections. In the early 1900s, the obstetrical profession wrongly assumed that normal childbirth was a pathological process of biology.
As a result,. medical schools stopped teaching the principles and technical skills of physiological management and replaced it with the routine use of medical and surgical interventions. The ultimate childbirth intervention is of course eliminating childbirth as a biological act in which the mother gives birth under her own power and replacing it with the major abdominal surgery of Cesarean section.
After a hundred years of an increasingly medicalized model, there is an immediate and urgent need to once again include the principles of physiologic childbirth as a core part of standard medical education and for practicing physicians to learn and utilize these methods when providing care to healthy women with normal pregnancies.
There also was no mention of the VBAC crisis, in which 1/3 of all hospitals and 50% of all OB refuse to provide care for women who do not want a repeat C-section. Certainly this is an area with desperately needs a ‘legislative’ remedy — one that would require hospitals and med-mal carriers to include VBAC as an ordinary obligation of their right to do business in the US,
While the words “Cesarean”, “C-secion” and VBA are totally absent from this document, the word midwifery, midwives and out-of-hosptial birth made the legislative wish-list for what ACOG members want legislative control over, or want to eliminate (non-nurse midwifery and birth in OOH settings.
American College of Obstetricians and Gynecologists
Ensure that the educational and professional standards of the American Midwifery Certification Board (AMCB) are used to evaluate and certify all midwives
Protecting the Physician-Patient Relationship•
ACOG opposes efforts to inappropriately interfere with the patient-physician relationship.
Highlight Women’s Health
• Unveil Women’s Health Resolution at CLC
• Introduce House and Senate Resolutionssupporting Women’s Health
• Build support in Congress and the advocacy community for the Women’s Health
Resolution
Protect Public Health Safety Net for Women
• Oppose further cuts to discretionary programs
• Oppose cuts to Medicaid and proposals that shift costs to states, including:
- Block grants
- Per capita caps
- Provider tax cuts
- Global caps
Support Medicaid cost savings opportunities, including:
- Women’s medical home
- Other options proposed by the Partnership for Medicaid
Oppose cuts to Graduate Medical Education
Fix Medicare Physician Payment
- Support SGR repeal.
- Oppose IPAB.
- Protect ob-gyn ultrasound from any reimbursement or coverage cuts.
Prevent Unintended Pregnancies and Reduce the Need for Abortions
- Every woman should have access to all reproductive health services. ACOG will promote access to contraception, including emergency contraception, for females of reproductive age, and advocate the use of medically accurate information.Enact Meaningful Medical Liability Reform
ACOG supports caps on non-economic damages. While we work toward that goal, we
support meaningful alternative reforms.
Make Medical Student Loan Repayment More Affordable
- Change federal loan repayment requirements to ensure interest deferral periods are not shorter than residency program durations.
Ensure ACA Implementation Meets the Needs of Ob-Gyns and Our Patients
We support proper implementation of:
- Maternity coverage for all women in all plans.
- Coverage and cost-sharing protections for women’s preventive health services under all plans.
- Health insurance market reforms that:
- Prohibit use of pre-existing condition exclusions, gender rating, coverage rescissions, and annual or lifetime benefit caps;
- Guarantee renewability and availability of coverage; and
- Provide direct access to ob-gyn care
- Medicaid Expansion to Cover Individuals Up to 138% of the Federal Poverty Line.
Protecting the Physician-Patient Relationship
- ACOG opposes efforts to inappropriately interfere with the patient-physician relationship.
Highlight Women’s Health
- Unveil Women’s Health Resolution at CLC
- Introduce House and Senate Resolutionssupporting Women’s Health
- Build support in Congress and the advocacy community for the Women’s Health Resolution
Protect Public Health Safety Net for Women
- Oppose further cuts to discretionary programs
- Oppose cuts to Medicaid and proposals that shift costs to states, including:
- o Block grants
- o Per capita caps
- o Provider tax cuts
- o Global caps
Support Medicaid cost savings opportunities, including:
- Women’s medical home
- Other options proposed by the Partnership for Medicaid
Oppose cuts to Graduate Medical Education
Fix Medicare Physician Payment
- Support SGR repeal.
- Oppose IPAB.
- Protect ob-gyn ultrasound from any reimbursement or coverage cuts.
Prevent Unintended Pregnancies and Reduce the Need for Abortions
- Every woman should have access to all reproductive health services. ACOG will promote access to contraception, including emergency contraception, for females of reproductive age, and advocate the use of medically accurate information.
Enact Meaningful Medical Liability Reform
- ACOG supports caps on non-economic damages. While we work toward that goal, we support meaningful alternative reforms.
Make Medical Student Loan Repayment More Affordable
- Change federal loan repayment requirements to ensure interest deferral periods are not shorter than residency program durations.
Ensure ACA Implementation Meets the Needs of Ob-Gyns and Our Patients
We support proper implementation of:
- Maternity coverage for all women in all plans.
- Coverage and cost-sharing protections for women’s preventive health services
- under all plans.
- Health insurance market reforms that:
- Prohibit use of pre-existing condition exclusions, gender rating, coverage rescissions and annual or lifetime benefit caps;
- Guarantee renewability and availability of coverage; and
- Provide direct access to ob-gyn care
Medicaid Expansion to Cover Individuals Up to 138% of the Federal Poverty Line.
- Testing a woman’s medical home, including care for pregnancy, recognizing that many women consider their ob-gyns their principle care physicians and rely on direct access to them.
- Research into the causes, diagnoses and treatments of postpartum depression and psychosis and programs to assist women suffering PPD.
- Medicaid coverage for tobacco cessation counseling and pharmacotherapy to pregnant women.
- The Medicaid state option to expand coverage of family planning services for lowincome women.
- Reauthorizing activities under the Indian Health Care Improvement Act.
We support repeal of:
- The Independent Payment Advisory Board (IPAB).
- The budget neutral value-based payment modifier which will reallocate Medicare
- payment among physicians.
- Federal recognition of and reimbursement to untrained midwives delivering babies in out-of-hospital settings.
We support modifications to:
- Extending the Medicaid and Medicare primary care payment increases to ob-gyns.
- Make the EHR Incentive Program easier for small group providers to participate.
- Reducing the reporting burden for physician practices to comply with e-prescribing, PQRS and EHR incentive programs.
Making Obstetrics and Maternity Safer (MOMS)
Support Modest Funding Increases for:
- Biomedical research at NIH to address prematurity, obesity, maternal morbidity, and health disparities
- Data collection and surveillance programs, including vital statistics systems, maternal mortality reviews, and the Pregnancy Risk Assessment Monitoring System (PRAMS)
- Maternal health programs, including the Title V Maternal/Child Health Block Grant, Fetal Infant Mortality Review, and Title X Family Planning
Reintroduce MOMS Legislation, including:
- Maternal Health Accountability Act
- Gestational Diabetes Act
- Birth Certificate Enhancement Act
- Quality Care for Moms and Babies Act
- Birth Defects Prevention, Risk Reduction, and Awareness Act
- Stillbirth and SUID Prevention, Education, and Awareness Act
- Health Equity and Accountability Act
Continue Quality Improvement and Patient Safety Initiatives, including:
- Developing a Maternity Consumer Assessment of Healthcare Providers and Systems
- (CAHPS)
- Ob-gyn performance measures developed by ACOG through the Physician Consortium for Performance Improvement (PCPI) and dissemination through Medicaid Adult Health Measures and CHIP Quality Measures programs.
- Support reauthorization of CHIP Quality Measures program
- Widespread use of integrated health information technologyo Comparative-effectiveness research
- Evidence-based guidelines and patient education material
- Participating in Strong Start and other HHS programs to reduce elective induction pre-39 weeks, promote the use of evidence-based practice guidelines, and identify innovative and best practices in care coordination.
Require Appropriate Training And Adequate Numbers Of All Maternity Care Providers
- Identify maternity care provider shortage areas and support loan repayment programs for ob-gyns, certified nurse midwives and certified midwives
- Seek designation of maternity care shortage areas through the National Health Service Corps
- Ensure that the educational and professional standards of the American Midwifery Certification Board (AMCB) are used to evaluate and certify all midwives
- Increase the medical student loan deferral period to match the length of residency.
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