Wow — hard to believe it’s already here! At the risk of sounding terribly clichéd… where has the year gone?!?!?
There have been some big changes in obstetrics — that’s right — ACOG has changed its name from “American College of Obstetricians and Gynecologists” to “American Congress of Obstetricians and Gynecologists.” That is big news, because “college” refers to academics, or “A body of persons having a common purpose or shared duties”; whereas “congress,” of course, refers to sexual intercourse. No, seriously — that is one of the definitions of “congress”! — check the link. [Ok, I admit it -- I did read Dave Barry's "2009 in Review" column recently, and that sounds like something he would say. He must be rubbing off on me. ] But I suppose they mean one of the other more common definitions, such as “A formal assembly of representatives, as of various nations, to discuss problems,” or “A single meeting, as of a political party or other group.” I don’t like the political overtones of the name “Congress,” and don’t really know why they changed their name — it seems that academics is more of a high ground than politics, so why shift focus from that?
In other ACOG news, they finally realized that women in labor do not suddenly lose all their competence when it comes to eating, drinking, and being able to vomit without inhaling, so they are now magnanimously allowing women in labor to consume “modest amounts” of clear beverages. In a condescending quote, Dr. Barth upholds the restrictions on eating solid food in labor (which includes fruit juices with pulp and soup), by saying, “As for the continued restriction on food, the reality is that eating is the last thing most women are going to want to do since nausea and vomiting during labor is quite common.” This is logical?? — “We’re restricting food because most women don’t want to eat anyway.” No – it’s circular reasoning (and also quite false). If women don’t want to eat in labor, then why have a formal restriction? Just don’t force-feed ‘em! And if they do want to have something light, like soup, you ought to have a better reason than, “Trust me, dearie, you might end up throwing this up, so although you’re starving now, you’ll thank me later when you dry-heave bile and pure stomach acid instead of this yummy chicken soup!” Not all women want to eat during labor — I didn’t my first time, but did the second. I threw up the first time (and, gee, would you know it — I managed to keep from inhaling that vomit every single time, just like when I threw up with morning sickness, and just like I threw up as a child from a stomach bug — imagine that!) — threw up the entire large meal I had eaten just prior to labor starting, and then threw up the sips of apple juice the midwife urged me to take; but didn’t throw up the second labor nor have the slightest bit of nausea. Wow! Imagine that — maybe my body knew that it couldn’t handle labor and digesting Chinese food the first time; but likewise knew that I needed energy during my second (24-hour) labor, so I was hungry and thirsty like normal, ate whatever appealed to me, and didn’t throw up. Isn’t that just so weird?? [Not.]
In another statement on elective inductions, ACOG recommended that no elective inductions be done prior to 39 weeks, also saying, “A physician capable of performing a cesarean should be readily available any time induction is used…” Those of you who are around inductions (doulas, friends, L&D nurses)…
And once again, continuous electronic fetal monitoring for the low-risk mother/baby dyad is recommended against, since it doesn’t seem to help neonatal outcomes, nor lower the risk of stillbirth, nor lower the likelihood of cerebral palsy, but does raise the risk of C-sections. “The false-positive rate of EFM for predicting cerebral palsy is greater than 99%. This means that out of 1,000 fetuses with nonreassuring readings, only one or two will actually develop cerebral palsy. The guidelines state that women in labor who have high-risk conditions such as preeclampsia, type 1 diabetes, or suspected fetal growth restriction should be monitored continuously during labor.” However, women who are induced and/or given epidurals usually or always need continuous monitoring, in case their babies take a sudden turn for the worse, which is more common in drugged than natural births.
So much for ACOG changes — now for something that remained the same: demonizing CPMs and home births stayed at #2 on the ACOG Legislative Agenda. I guess a 99% share of the market isn’t good enough.