The Latest Thoughtful “Work” from the AMA . . . .

AMA Resolution Would Seek to Label “Ungrateful” Patients

Redondo Beach, CA, June 11, 2009 – At the American Medical Association’s (AMA) Annual Meeting next week, delegates will vote on a resolution which proposes to develop CPT (billing) codes to identify and label “non-compliant” patients (1)

The resolution complains:

“The stress of dealing with ungrateful patients is adding to the stress of physicians leading to decreased physician satisfaction.”

“This resolution is alarming in its arrogance and its failure to recognize, or even pay lip service to, patient autonomy,” said Desirre Andrews, the newly elected president of the International Cesarean Awareness Network (ICAN).

If approved, the resolution could hold implications for women receiving maternity care. For pregnant women seeking quality care and good outcomes, “non-compliance” is often their only alternative to accepting sub-standard care. Physicians routinely order interventions like induction, episiotomy, or cesarean section unnecessarily.

Liz Dutzy, a mother from Olathe, Kansas, delivered her first two babies by cesarean and was told by her obstetrician that she needed another surgical delivery. “My doctor told me that I needed to have a cesarean delivery at 39 weeks, or my uterus would rupture and my baby would die.” She sought out another care provider and had a healthy and safe intervention-free {home} birth at 41 weeks and 3 days gestation.

A recent report by Childbirth Connection and The Milbank Memorial Fund, called “Evidence-Based Maternity Care: What It Is and What It Can Achieve ,” (2) shows that the state of maternity care in the U.S. is worrisome, driven largely by a failure of care providers to heed evidence-based care practices. For most women in the U.S., care practices that have been proven to make childbirth easier and safer are underused, and interventions that may increase risks to mothers and babies are routinely overused. The authors of the report point to the “perinatal paradox” of doing more, but accomplishing less.


The resolution proposed by the Michigan delegation of the AMA could threaten patient care and patient autonomy for several reasons:

• Billing codes that would categorize any disagreement and exercise of autonomy on the part of the patient as “non-compliance” “abuse” or “hostility” could create a pathway for insurance companies to deny coverage to patients
• Use of these labels fails to recognize patients as competent partners with physicians in their own care
• Tagging patients as “non-compliant” fails to recognize that there is not a “one size fits all” approach to care, that different opinions among physicians abound, and that patients are entitled to these very same differences of opinion
• Labeling patients as “non-compliant” may, in fact, be punitive, jeopardizing a patient’s ability to seek out other care providers

The resolution also fails to address how it would implicate patients navigating controversial issues in medical care, like vaginal birth after cesarean (VBAC). While a substantive body of medical research demonstrates that VBAC is reasonably safe, if not safer, than repeat cesareans, most physicians and hospitals refuse to support VBAC. (3) The language in the resolution suggests that patients who assert their right to opt for VBAC could be tagged as non-compliant, even though their choice would be consistent with the medical research.

“The reality is that the balance of power in the physician-patient relationship is decidedly tipped towards physicians. The least patients should have is the right to disagree with their doctors and not be labeled a ‘naughty’ patient,” said Andrews.

About Cesareans: When a cesarean is medically necessary, it can be a lifesaving technique for both mother and baby, and worth the risks involved. Potential risks to babies from cesareans include: low birth weight, prematurity, respiratory problems, and lacerations. Potential risks to women include: hemorrhage, infection, hysterectomy, surgical mistakes, re-hospitalization, dangerous placental abnormalities in future pregnancies, unexplained stillbirth in future pregnancies and increased percentage of maternal death.

Mission statement: ICAN is a nonprofit organization whose mission is to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery and promoting vaginal birth after cesarean. ICAN has 110 chapters in North America and Europe, which hold educational and support meetings for people interested in cesarean prevention and recovery.

(1) Resolution 710 “Identifying Abusive, Hostile or Non-Compliant Patients”

(2) Evidence-Based Maternity Care: What It Is and What It Can Achieve



Welcome to ICAN Seattle!

ICAN’s Mission Statement

ICAN’s mission is to prevent unnecessary cesareans through education, to provide support for cesarean recovery, and to promote VBAC.

ICAN’s Vision Statement

A healthy reduction of the cesarean rate driven by women making evidence-based, risk appropriate childbirth decisions.

Please browse our website to find out information on local support.

Modern medicine increasingly intervenes in the birth process

Journalist Mary Beth Pfeiffer knocks another one out of the park with her second article in the Poughkeepsie Journal, Modern medicine increasingly intervenes in the birth process which examines the role modern medicine and interventions have placed in decreasing the gestational age at which babies are arriving!  pregnancy-calculator

“In the decade through 2002, something momentous happened to babies in the wombs of American women, especially white women. The average time fetuses spent there decreased from 40 weeks to 39.

The decline, reported in a 2006 study in the medical journal Seminars in Perinatology, appears to have little to do with nature.

Instead, earlier births may be the outcome of “increased use of induction (of labor) and other obstetric interventions such as cesarean delivery,” said a January report by the U.S. Centers for Disease Control. Prematurity rose 20 percent since 1990, the report said, and the rate of low birth-weight babies hit a 40-year high.

“We are shortening the gestational age,” said Dr. Carol Sakala, program director for the research and advocacy group Childbirth Connection. “That is a big interference with mammalian evolution, human evolution.”

Is it possible that modern medicine, in a few short years, has managed to override the powerful and significant forces of evolution!

Birth by surgery: The skyrocketing cesarean rate

The Poughkeepsie Journal ran a great article, Birth By Surgery: The skyrocketing Cesarean Rate, by journalist, Mary Beth Pfeiffer recently that lamented the increasing rate of cesarean births, and shared the story of a woman in NY who had an unnecessary surgery for a suspected large baby and went on to have a vaginal birth with her second child.  Pfeiffer hits on all the hot topics, including defensive medicine, lack of options for VBAC women, malpractice concerns and malpractice insurance costs, benefits and risks to women and babies and more!  a-guide-to-pregnancy-complications-ga-7

From the article….”Two weeks before Kristi Ashley gave birth to a son in 2007, an ultrasound exam estimated the baby at a hefty 12 pounds, 10 ounces — too big, her doctor believed, for a safe vaginal delivery. After the child weighed in at 9 pounds, 4 ounces in the delivery room, Ashley came to believe that the planned cesarean section she had, with its attendant pain, long recovery and what she called “emotional damage,” may have been a rush to judgment.”

This is a worthwhile read, and most interesting are the comments published by readers after the article’s publicication!  Check it out and let us know your thoughts!

April is Cesarean Awareness Month!

April is Cesarean Awareness Month!  This is an opportunity to share with friends, colleagues, relatives and birth professionals that you come in contact with the impact of unnecessary cesareans on mom, baby, family, society, etc!  Tell your stories, provide resources and evidence based information, (lots of info here on our site,  or steer people to the ICAN National Site) and a tell the world the impact your cesarean birth has had on you!  Consider writing your birth story (Cesarean or other…) for the next edition of ICAN Seattle’s birth story book.

As referenced on the ICAN website, the Cesarean Awareness Ribbon debuted in April of 2004 for Cesarean Awareness Month. The burgundy color of the ribbons represents birth and the wearing of the ribbon upside down symbolizes the state of distress many pregnant women find themselves in when their birthing choices are limited. The loop of the inverted ribbon represents a pregnant belly and the tails are the arms of a woman outstretched in a cry for help.  cam_small1

And finally, consider joining ICAN as a member!  During the month of April, there are special membership prices for anyone joining or renewing their ICAN membership.  Membership in ICAN is a tangible way of demonstrating your support for ICAN and Cesarean Awareness, allows ICAN to continue it’s outreach programs and advocacy and also supports our local Seattle Chapter!  Join directly through ICAN Seattle, and our chapter benefits with additional funds staying in our chapter treasury!  Becoming an ICAN supporting suscriber is only $25 for an entire year of membership, $5 off, in honor of Cesarean Awareness Month.  Contact the ICAN Seattle chapter leaders to subscribe through our local chapter!

CDC Data for 2007 Released – Cesarean Rates Continue to Rise

The CDC has just released preliminary birth statistics for 2007, and the cesarean rate in the US has gone up again, for the 11th consecutive year, and is now at 31.8% of all births. The rate in Washington State has risen about half a percentage point from the 2006 numbers to a current 29.0% of all births. New Jersey takes #1 with a 38.3% cesarean rate, up almost an entire percentage point over the previous year. None of this is surprising information, but it does give one pause to wonder just what is going to be an attention-grabbing ENOUGH statistic to effect change in maternity care?


ICAN has issued a press release about this new data as have several other organizations, including Lamaze International

The History of VBACs and Cesareans in the USA

Another fantastic post by The Well Rounded Mama! A History of VBACs and Cesareans in the USA

A must read for anyone trying to figure out how we ended up were we are today, in the land of the VBAC Ban.

I really love what this VBAC mama blogger has to say! And I love that she provides all the evidence to support it! Enjoy!

“The Problem Is Only Beginning To Mushroom”

“The problem is only beginning to mushroom,” stated Carolyn Zelop, ACOG member,in regards to the increasing risk of cesarean deliveries. She was interviewed for the recent Time article, “The Trouble with Repeat Cesareans.”

I have linked to the study Zelop was referring to on our Resource Index page, but am quoting from the abstract here:

RESULTS: The prevalence of delivery hospitalizations (per 1,000) complicated by at least one severe obstetric complication increased from 0.64% (n_48,645) in 1998-1999 to 0.81% (n_68,433) in 2004–2005. Rates of complications that increased significantly during the study period included renal failure by 21% (from 0.23 to 0.28), pulmonary embolism by 52% (0.12 to 0.18), adult respiratory distress syndrome by 26% (0.36 to 0.45), shock by 24% (0.15 to 0.19), blood transfusion by 92% (2.38 to 4.58), and ventilation by 21 % (0.47 to 0.57). In logistic regression models, adjustment for maternal age had no effect on the increased risk for these complications in 2004–2005 relative to 1998–1999. However, after adjustment for mode of delivery, the increased risks for these complications in 2004–2005 relative to 1998–1999 were no longer significant, with the exception of pulmonary embolism (odds ratio 1.30) and blood transfusion (odds ratio 1.72). Further adjustment for payer, multiple births, and select comorbidities had little effect.
CONCLUSION: Rates of severe obstetric complications increased from 1998–1999 to 2004–2005. For many of these complications, these increases were associated with the increasing rate of cesarean delivery.

As the cesarean rate in the USA races higher by the day, indeed we must be headed toward some sort of explosion! Implosion? I don’t know what to call it, but Zelog’s reference to a “mushroom” brings to mind the image of a nuclear explosion. And that scares me! A lot!

“Immediately Available”

Please check out this wonderful post by The Well-Rounded Mama, speaking to the VBAC ban by both hospitals and OB practices all around the country! I think she hit the nail right on the head! What do you think?

Check out the comments behind the VBAC Ban data

If you followed the link in a previous post, to the ICAN VBAC Ban database, you could see the VBAC status of all the hospitals in the US, listed by state. Most interesting, is the comments that you can read when you click on a particular hospital. WOW! When a hospital was listed as “allowing” VBACs, the next question was “Do you allow VBAMC?” The responses are listed there.

Another great thing about this database, is that readers can provide updated information and comments on each and every hospital. If you have something to add, please go do it! This will only make this database more accurate and powerful to all women in search of their next VBAC!