Need for Transparency

The C-section rate is at an all-time high. We need to know why. Click here for a press release from CIMS (The Coalition to Improve Maternity Services) that discusses the need for transparency in maternity care. One midwife was quoted as saying, “In the United States, we are seeing increased public reporting of outcomes and procedure rates for facilities in surgical and cardiac care, but, access to maternity care data remains almost non-existent.” We need to change that.


5 Responses

  1. 110% agree that transparency is the key. However, I think we all know the reasons why the C/S rate is so high. Until the public demands transparency the status quo will rule. You’re post makes me curious however. Are American women incensed by the high C/S rate? Do they care? I will have to look for some studies on this. If I can’t find any, I may have to research it myself.
    Thanks for the brain stimulation Kathy.

    • Some American women are obviously incensed by the high C-section rate. What percentage are, I could not say. Obviously, I have surrounded myself with like-minded people, so pretty much everybody I talk to is fed up — not just with the high C/s rate, but also unnecessary inductions, augmentations, IVs, forced bed rest, NPO during labor, etc. So, I’m not a good judge of the “average” person. 🙂 Often, women do not educate themselves about interventions in birth including a C-section until after they’ve already been cut once. Then they join ICAN, or say, “It was [or must have been] necessary.” It is a curious fact to me that identical circumstances can yield opposite responses in two different women. Some women have a traumatic first birth, and then refuse to go to a hospital to give birth ever again; other women may instead choose a C-section so they can have no surprises; and others may choose a hospital VBAC — even forcing the issue if necessary.

      I think a small but vocal minority of American women are upset about the high C-section rate; and most women probably don’t care — women like my husband’s cousin who blindly listens to her doctor on everything, and doesn’t research any options. Women who expect that doctors will always tell the truth and will never do what is merely convenient for them, but always in the best interest of the moms & babies. Women who have been socialized to accept that hospitals are where you are supposed to give birth, and you don’t need to prepare at all, because the nurses will tell you exactly what to do, and your “birth plan” should just consist of “go to hospital; have baby.” Women who spend more time picking out their crib and layette than in choosing their obstetrician. Women who take longer researching the differences in diaper brands than in how to avoid a C-section.

      Ah, well, I can’t change the world, can I?

  2. No, you can’t change the world, but thanks for trying. I am in the process of writing my first birth experience to post. It is an example of what is wrong with the current system. Hopefully we will be able to make a change, even if it is a small one.

  3. Just an interesting aside on the transparency issue:

    Harvard Medical School in Ethics Quandary

    Published: March 2, 2009
    BOSTON — In a first-year pharmacology class at Harvard Medical School, Matt Zerden grew wary as the professor promoted the benefits of cholesterol drugs and seemed to belittle a student who asked about side effects.

    Mr. Zerden later discovered something by searching online that he began sharing with his classmates. The professor was not only a full-time member of the Harvard Medical faculty, but a paid consultant to 10 drug companies, including five makers of cholesterol treatments.

    “I felt really violated,” Mr. Zerden, now a fourth-year student, recently recalled. “Here we have 160 open minds trying to learn the basics in a protected space, and the information he was giving wasn’t as pure as I think it should be.”

    Mr. Zerden’s minor stir four years ago has lately grown into a full-blown movement by more than 200 Harvard Medical School students and sympathetic faculty, intent on exposing and curtailing the industry influence in their classrooms and laboratories, as well as in Harvard’s 17 affiliated teaching hospitals and institutes.

    The students argue, for example, that Harvard should be embarrassed by the F grade it recently received from the American Medical Student Association, a national group that rates how well medical schools monitor and control drug industry money.

    Harvard Medical School’s peers received much higher grades, ranging from the A for the University of Pennsylvania, to B’s received by Stanford, Columbia and New York University, to the C for Yale.

    Harvard has fallen behind, some faculty and administrators say, because its teaching hospitals are not owned by the university, complicating reform; because the dean is fairly new and his predecessor was such an industry booster that he served on a pharmaceutical company board; and because a crackdown, simply put, could cost it money or faculty.

    Further, the potential embarrassments — a Senate investigation of several medical professors, the F grade, a new state law effective July 1 requiring Massachusetts doctors to disclose corporate gifts over $50 — are only now adding to pressure for change.

    The dean, Dr. Jeffrey S. Flier, who says he wants Harvard to catch up with the best practices at other leading medical schools, recently announced a 19-member committee to re-examine his school’s conflict-of-interest policies. The group, which includes three students, is to meet in private on Thursday.

    Advising the group will be Dr. David Korn, a former dean of the Stanford Medical School who started work at Harvard about four months ago as vice provost for research. Last year he helped the Association of American Medical Colleges draft a model conflict-of-interest policy for medical schools.

    The Harvard students have already secured a requirement that all professors and lecturers disclose their industry ties in class — a blanket policy that has been adopted by no other leading medical school. (One Harvard professor’s disclosure in class listed 47 company affiliations.)

    “Harvard needs to live up to its name,” said Kirsten Austad, 24, a first-year Harvard Medical student who is one of the movement’s leaders. “We are really being indoctrinated into a field of medicine that is becoming more and more commercialized.”

    David Tian, 24, a first-year Harvard Medical student, said: “Before coming here, I had no idea how much influence companies had on medical education. And it’s something that’s purposely meant to be under the table, providing information under the guise of education when that information is also presented for marketing purposes.”

    The students say they worry that pharmaceutical industry scandals in recent years — including some criminal convictions, billions of dollars in fines, proof of bias in research and publishing and false marketing claims — have cast a bad light on the medical profession. And they criticize Harvard as being less vigilant than other leading medical schools in monitoring potential financial conflicts by faculty members.

    Dr. Flier says that the Harvard Medical faculty may lead the nation in receiving money from industry, as well as government and charities, and he does not want to tighten the spigot. “One entirely appropriate source, if done properly, is industrial funds,” Dr. Flier said in an interview.

    And school officials see corporate support for their faculty as all the more crucial, as the university endowment has lost 22 percent of its value since last July and the recession has caused philanthropic contributors to retrench. The school said it was unable to provide annual measures of the money flow to its faculty, beyond the $8.6 million that pharmaceutical companies contributed last year for basic science research and the $3 million for continuing education classes on campus. Most of the money goes to professors at the Harvard-affiliated teaching hospitals, and the dean’s office does not keep track of the total.

    But no one disputes that many individual Harvard Medical faculty members receive tens or even hundreds of thousands of dollars a year through industry consulting and speaking fees. Under the school’s disclosure rules, about 1,600 of 8,900 professors and lecturers have reported to the dean that they or a family member had a financial interest in a business related to their teaching, research or clinical care. The reports show 149 with financial ties to Pfizer and 130 with Merck. (article continued.)

    ***Harvard provides training for OBs, Perinatologists, Pediatricians, Anests. and Nurses does it not? They like to use pharmas for birth, c/s, and post birth do they not? How influenced by Pharma are those professors and their grads, and how might it be influencing the crisis in maternity care? Thank goodness for those ethical students out there!

  4. […] from Woman to Woman Childbirth Education wrote about the CIMS press release on the Need for Transparency regarding the rising C/S […]

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