8.26.2011

Failure to Progress... part two


Failure to Progress... Such an obtuse, erroneous, and deceptive term when used in conjunction with a woman's labor.

Let's take the term one word at a time.

Failure - omission of occurrence or performance; a failing to perform a duty or expected action; a state of inability to perform a normal function; a fracturing or giving way under stress; lack of success; a falling short : deficiency : deterioration, decay; one that has failed - Merriam-Webster Dictionary

to - used as a function word to indicate the result of an action or a process - Merriam-Webster Dictionary

Progress - to move forward : proceed; to develop to a higher, better, or more advanced stage; gradual betterment - Merriam-Webster Dictionary

So, failure to progress means 'an inability to, lacking of, falling short of, or otherwise deterioration of'... 'a forward movement, a higher better or more advanced stage; a gradual betterment'.

Hmmm....

With all due respect (and some amount of lack thereof), I would have to deem that the American Congress of Obstetrics and Gynecologists have failed to progress.


The ACOG's failure to progress has resulted in their recent very courageous admission that only 1/3 of their clinical guidelines are evidence-based practices. This means that the majority of obstetrical practices and recommendations for pregnant and birthing women is based on opinion and inconsistency.

I say courageous because it takes a lot of ovaries to admit:
Our findings highlight the difficulties in developing high-quality clinical guidelines. Although guidelines do not equate with standard of care and cannot replace clinical judgment, the College's recommendations clearly strongly influence the practice of obstetrics and gynecology ... clinicians must remain mindful of the limitations of guidelines. There is an urgent need to continue to conduct high-quality research in obstetrics and gynecology and to provide the funding to undertake such research.
Here is a short list of some of the practices that are based on limited or inconsistent evidence or are purely based on consensus and opinion (i.e. not evidence based practices):
  • Routine IVs/Heplocks
  • Continuous Fetal Monitoring
  • Erythromycin for all newborns
  • Routine cervical exams before labor
  • Routine cervical exams throughout labor
  • Routine administration of pitocin (augmentation or postpartum)
  • Coached pushing
  • Time constraints on labor
  • Time constraints on pushing
  • VBAC bans
  • Routine Induction after 42 weeks
  • Accepting 40 weeks as 'due' or 'term'
  • Late-term ultrasound for gestational accuracy and fetal weight
  • Elective cesarean
  • Elective induction
  • Non Per Oris
  • AROM
  • Calling homebirth risky
  • Newborn circumcision
  • Automatic Cesarean for breech presentation
  • Induction for (full term (37-42 weeks), big baby, low or high amniotic fluid, etc... etc...)
  • Lithotomy position for 2nd stage
  • Cervical ripening by Cytotec /Misoprostol
  • Restrictive or Required Weight Gain
  • Premature Clamping and Cutting of the Umbilical Cord
This is not to poo-poo on the ACOG; this is a reminder to women that, again, you are responsible for your healthcare.
"Many women... carry fear of being responsible for their own healthcare and the healths of their unborn children, so they relinquish that responsibility to doctors and hospitals, blindly trusting that those doctors have their best interests in mind. They fail to take into account, or choose to ignore, that the vast majority of obstetrical practices are not founded on infallibility, on evidence-based practices, or are without the personal ambitions, impatience, bias', and sometimes even greed of the individual hospital or care provider." - Fear
Be sure to hire a midwife or doctor who you trust to give you honest information regarding those options and recommendations which are rooted in evidence/science, those that have limited or inconsistent evidence, and those practices which are purely their opinion.

Further Reading:
Talk It Out
Tricky Research
If We Can't Make it Illegal
Profit of Pain Relief
Birth Partners
Quick History of Medication
GBS
US Childbearing Healthcare Crisis
The First Cut is The...
VBAmC
The length of uncomplicated human gestation
Perinatal Pitocin as an early ADHD biomarker

1 comment:

Mary said...

I read this article, and there is no list of recommendations that are not considered level A, just a list of the practice recommendation topics examined in the analysis. Can I ask where you obtained the list you posted?

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