I, too, am a physician who had my first child at 41 [“Pregnant doctor finds intense pressure to have a Caesarean delivery,” Jan. 6]. I had a protracted labor both first stage (49 hours) and second stage (four hours) that ultimately resulted in a vaginal delivery.
I had a healthy daughter on the Navajo reservation, where resources are limited and most OB care is provided by midwives. The 2013 C-section rate ranges from 7 to 19 percent despite a relatively high-risk population, but these data are not representative of the whole Navajo Nation. I have since had two more children, the last of them in an academic center. Although the end result in all three cases was a healthy child, the overall experience was much better on the reservation.
Margaret Talley Bartholomew, MD, Bethesda, Md.
The author’s experience reflects the experience of many women in the United States, most of whom lack the medical training and authority to find respect in the delivery room. I read the piece with great interest as an attorney dedicated to the rights and health of pregnant women, focusing particularly on birthing with dignity.
The organization I work for, National Advocates for Pregnant Women, is participating in the case of a woman who was forced to undergo a C-section against her will and over her explicit objection in 2011. She has sued the hospital and the physicians involved. Their response is astonishing. They contend that they are not only justified but required to force unwilling pregnant women into surgery and that they did so pursuant to a hospital policy that lays out the steps by which women should be deprived of their fundamental right to medical decision-making.
Farah Diaz-Tello, New York
On behalf of obstetricians, I apologize. I see patients every week who want to know how they can avoid an avoidable C-section. I recommend they join the midwifery practice, which has a C-section rate of 3 percent. Our midwives and some of our obstetricians routinely deliver twins and breech babies vaginally.
I disagree with the World Health Organization. The global C-section rate should not be 10 to 15 percent. Even with high-risk patients, 5 percent is high enough.
Anthony R. Scialli, MD, Washington
Unfortunately, this story is typical of the current problem in obstetrics. Part of your job as a patient is to ascertain what philosophy your OB/provider has about labor and inquire as to whether all the call-group participants share a similar philosophy. Find a doctor who will listen to you during labor.
First labors are long and fraught with potential complications. The arbitrary and old timelines of labor’s purported progress and the increase in inductions all hinder the normal birth process and lead to C-sections.
We all need to give nature more time. There is no hard and fast rule that says patients need to deliver 24 hours after their water breaks, and the infection risk is directly related to how many vaginal exams occur after ruptured membranes. The 2014 American Congress of Obstetricians and Gynecologists guidelines show that patients need six or more centimeters dilation, with either four or more hours of adequate contractions measured internally or six or more hours of inadequate contractions to call the labor arrested.
We all need to read the new guidelines of induced labor and active labor. We owe American women better care.
Lizellen La Follette, MD, San Anselmo, Calif.
Birth Journal recently published my research about the absence of shared, informed decision-making in maternity care. One woman summed up the experience of many when she said: “I really didn’t feel like I had any choices [in the hospital]. . . . I had to keep moving forward because I had already agreed to the first step of being induced.”
Overall, the study found that the lack of shared, informed decision-making was a barrier to optimal care. As your article noted, the experiences of women have important implications. To help ensure safe, quality care, women should be included as partners.
Jennifer E. Moore, PhD, RN, Washington