Ending the our Mayday series with an aggressive Action Plan
This Acton Plan was developed to melt away the gorilla glue (c-EFM) that hold the “Made in American” hospital-based, high-tech, highly interventive obstetrical system in place!
So far political activism, irrespective of how sincere and dedicated, has been unable to correct the inappropriate obstetrical standard of care used in the US for healthy low-risk women, but I believe there is a successful strategy that will actually work.
It is simple and straightforward, will not increase the cost of maternity care but will dramatically reduce the C-section rate and its associated complications. This will, in turn, reduce the costs for health insurance companies and the federal Medicaid program.
Auscultation ~ The Evidenced-based Standard for Healthy Women w’ low-risk pregnancies
Auscultation, coupled with one-on-one care during active labor, is evidence-based and is the only logical Standard of Care for healthy women with normal pregnancies, regardless of setting (home or hospital) of type of birth attendant (midwives, L&D nurses or physicians).
The goal is to rehabilitate the provision of maternity care in America so that c-EFM is no longer the universal standard of care and healthy women with normal low-risk pregnancies are not treated as if they were high-risk.
This will require a public information campaign (like this Mayday series) that will lead to both legal and legislative action.
I believe these 3 proposals would end the inappropriate use of EFM and would restore the ethical foundation of American obstetrics and return obstetrical medicine to its noble place in the pantheon of modern medical science.
Action Plan 101 ~ How to replace the routine use of EFM with a highly effective protocol for auscultation and integrate physiologically-based maternity care into our mainstream healthcare system
1. Fully-informed Consent
1. The legal requirement of patient consent so configured that healthy low-risk women with healthy pregnancies can make fact-based choices about the kind of maternity care that best suits them.
This naturally would include specific information about auscultation of fetal wellbeing and c-EFM and other obstetrical policies, protocols, and procedures that might be recommended to them during their pregnancy or labor.
Information for childbearing families must acknowledge the inability of c-EFM to improved perinatal outcomes in low-risk pregnancies, as well as identifying the increased risk to the childbearing women directly associated with the statistically-significant increase in Cesareans (and their inevitable complications) relative to the routine use of c-EFM on healthy low-risk women.
It also must acknowledge additional increased risk when hospitals use central monitoring systems.
2. Embarking on public information campaign that includes investigative journalism from an organization such as ProPublica, PBS, and NRP
3. Requiring manufacturers and distributors of continuous EFM devices to acknowledge their legal “Duty to Warn“. This must include a product disclaimer printed in the technical manual shipped with each electronic fetal monitor machine that reports the published findings of scientific studies over the last 49 years.
The consensus of the scientific literature has unambiguously established c-EFM as ineffective at reducing the incidence of cerebral palsy and similar neonatal encephalopathies (i.e. neurological problems).
In addition, the routine use of c-EFM is medical inappropriate during the labors of healthy low-risk laboring women, as it increases the cost of care, the rate of Cesarean surgeries (with its associated increase in risks and complications) without any correlating benefit to the mother or baby.
Last but not least, is an additional “Duty to Warn” by the manufacturers of central EFM systems (CMS). Developers and manufacturers of the CMS must also acknowledge the scientifically-established fact that central EFM systems currently being used in hospital L&D units have an even higher C-section rate than the hospital’s standard use of c-EFM in which an L&D nurse is personally responsible for ‘monitoring’ the fetal monitor strip in real time.
Duty to Warn to provide explicit information covering the entire spectrum of Cesarean-related complications
The EFM manufactures’ Duty to Warn must especially address and include all the intra-operative, post-operative, delayed and downstream complications — both morbidly and mortality — associated with Cesarean surgery which includes but are not limited to:
Caution: Use of continuous EFM is associated with a statistically-significant increase in unplanned Cesarean deliveries.
These are the known complications — intra-operative, postoperative, delayed and downstream — of Cesarean surgery
♦ Intra-operative and immediate complications: drug or anesthesia reactions, hemorrhage, shock, peripartum emergency hysterectomy (13 Xs higher rate following CS than vaginal birth) that requires days or weeks in the ICU
♦ Post-op complication requiring a post-Cesarean mother to be treated for an infection following her surgery
♦ Inability to establish or maintain breastfeeding when new mothers have to be re-admitted to the hospital with a drug-resistant infection the requires a week or more of IV antibiotics
♦ Delayed complications in previous-Cesarean mothers who develop a placenta accreta or increta in a subsequent pregnancy that is so extensive a Cesarean-hysterectomy is required
♦ Downstream complications in which previous-Cesarean mothers find themselves to be one of the unlucky 7 to 10% of placenta percreta patients that, in spite of being care for in one of the best hospitals with the best doctors, blood banking and best of modern medical and technological equipment, dies from a massive and uncontrollable hemorrhage
♦ Rare long-term complication a post-Cesarean mother dies months later from post-op complications such as a necrotic bowel caused by adhesions that develop due to her Cesarean surgery
♦ Secondary infertility when post-Cesarean women find they are no longer able to get pregnant due to a post-Cesarean surgery infection that scared their fallopian tubes
♦ Maternal death due to an intra-operative, post-operative, delayed or downstream complication of an often medically-unnecessary C-section
♦ Impact on Spouse and other family members — maternal death makes her husband or partner into a widower and leaves their children without a mother.
An Aside:
The official definition of the terms Efficacious vs. Effective as used in publications of scientific research
“… the clinical and translational science literature selectively uses the words efficacious/efficacy and effective/effectiveness consistent with their medical definitions to differentiate between an intervention (such as a drug) that can work in a controlled patient population during a randomized controlled trial and one that works in the real world in day-to-day practice, respectively.6“
Studies on the ability of c-EFM to reduce the incidence of cerebral palsy and other neurological problems affecting newborns usually employ the term “efficacious”, which describes ideal conditions of the study.
Even with this narrow definition, c-EFM is NOT any more effective than auscultation and continues to be associated with an increased rate of operative vaginal deliveries and C-sections.
