Letter to the NYT Editor

September 7, 2016By 11 Comments

To The Editor of the New York Times:

RE: “America’s Shocking Maternal Deaths”

Your editorial passed over the real reason behind the unconscionable rise in deaths among child-bearing women in the United States — American Obstetric practices.  As a Board Certified Obstetrician-Gynecologist, I see first hand that pregnant women are subjected to multiple unscientific physician and hospital protocols — inductions prior to 42 completed weeks, continuous electronic fetal monitoring, refusal of food and drink in labor, drugs and procedures to speed up labor, Cesarean Delivery for “non reassuring fetal tracings” and labor that “takes too long,” and Vaginal Birth After Cesarean Section policies that discourage or deny women the right to a vaginal birth.  All of this, forced on women despite copious scientific evidence that it does not help babies but harms their mothers, has led to an insane Cesarean Section rate AND the increasing mKVMaternal death rate and “near misses” (i.e. women that don’t die but come close).  The American College of Obstetricians and Gynecologists and their peer review journal, Obstetrics & Gynecology, initially denied the rise, then blamed it on women (too old, too fat, too unreasonable), and now blame it on regressive politics and preexisting conditions such as heart disease and the opioid epidemic.  As your editorial points out, Great Britain has a maternal mortality rate that is a fraction of ours in the United States. They have the same problems with diet, obesity and opioids, but they do not have a 25% induction rate or a 40% Cesarean Section rate.  If you travel 20 minutes north of my city, Buffalo, into Canada, you will find a population with all the ills cited as justification of the terrible US maternal mortality rate — obesity, pre-existing conditions such as diabetes and heart disease, drug use and a diverse population — but their maternal mortality rate is substantially lower than ours.  Their induction and Cesarean Section rate is also far less than ours.  No amount of hand-wringing by ACOG changes this reality. Until the real culprits are identified and Obstetric practice changed to benefit women and babies rather than physicians and hospitals, the maternal mortality rate will continue to climb.

Katharine Morrison, MD, FACOG
2500 Main Street
Buffalo, NY 14214

Filed in: Media CoverageNews Tags:

Comments (11)

Trackback URL | Comments RSS Feed

Sites That Link to this Post

  1. Wednesday Wrap Up Sept 14 | Andrea Lythgoe Doula Salt Lake City Utah | September 14, 2016
  1. Susan Greene says:

    Well said. Amen. Thanks.

  2. Thank you, Dr. Morrison.

    I am a chiropractor and specialize in working with pregnant women and children in Northern Virginia. Even after almost 20 years in practice, I am regularly floored by the rate of women who come to me after their births, their “deliveries”, with true evidence of birth trauma. I am perpetually gobsmacked by the depth of providers’ belief that it is acceptable, and even necessary, to speak to and treat patients in the way they do just to have things go their way in labor and delivery.

    They use every form of persuasion, including intimidation and belittling simply to have mothers do what they want- despite the fact that it leaves the woman shattered physically and emotionally. The only explanation for all this is that “the most important thing is that the baby is healthy”. This explanation is so lacking in depth that it would be comical except for how damaging explaning the trauma away really is to the family.

    The arrogance and the shaming is beyond my wildest comprehension. One would think that having a female OB would make it better, but I’ve found that to be false and that the female physicians are often worse. Here is the sad part for me. The patients almost never speak up. They become so involved in caring for their new little charges that they just “put it behind them” and keep going without ever making a provider accountable for the deep trauma caused or getting help for themselves. They don’t know about resources available to them or they are afraid to pursue them. I find husbands or partners so angry and disconnected by their wife or partner’s experience that they simply shut down and are unable to listen or to act. There is almost never any accountability for having acted outside of any established standards of care (nevermind any of those that include compassion as a baseline). I am convinced that for as long as the birthing mother remains unempowered, nothing will change in medical birth in America.

    Meanwhile at-home and birth-centered midwifery, birth assistants and doulas are making a mighty go of things in my area. And the hospitals, with their brand-new, enormous c-section wings (and itty bitty entrances for regular labor) are starting to notice.

    I pray for change for women and I thank you for your thoughtfully written, evidence-based article. I hope it is read and appreciated by many.

  3. Carolyn Wildman says:

    Thank you Dr. Morrison for your eye opening letter. After witnessing the phenomenol care my daughter received through both her pregnancies and deliveries under your care, I only wish more American women would opt out of the hospital setting. Thank you for your wisdom and enlightenment.

  4. Teresa Blair DNP, WHNP-BC, CNM says:

    I would like to point out that both of the countries mentioned also have a high rate of births with a Certified Nurse Midwife in attendance. We, midwives, have the philosophy that birth is normal and should be attended, not controlled, forced, induced, or meddled with unless there is a serious, documentable reason to do so.

    • Gillian Daley, CPM says:

      A more accurate statement would be “…a high rate of births with a Registered Midwife” as neither of these countries require training and licensure as a nurse as a prerequisite to midwifery training. Canada and the UK both consider Nursing and Midwifery separate disciplines which considerably decreases the time, and cost, spent on schooling and with excellent outcomes as referenced by the Letter to the Editor above.

    • birthingcenter says:

      At the Birthing Center of Buffalo, we absolutely agree! The midwifery model of care, which is standard for most families in other countries, is vital to improving our maternity statistics in the United States. Though training varies by state and country, we wholly support ALL midwives in their important work, including CNMs, CPMs, CMs, and direct-entry midwives. Unfortunately, here in Buffalo, most midwives are employed as doctor-extenders and have little opportunity to practice low-intervention, family-centered care.

      • Yes! Support all midwives! We need MORE midwives. We need the true midwifery model of care in all settings. Let’s cast aside the arrogance of hierarchy which leaves mothers with no voice and put women back in the center of birth care, where they belong.

        Then watch how our numbers change. We must do better.

        Kathy Talbott
        Maryland Families for Safe Birth

      • Yes. Thank you Dr. Morrison and the Birthing Center of Buffalo. There is a place for all midwives as all women deserve options that best meet their needs. So happy to see your site and hear your perspective.

  5. Sister Myrtle E Keller, SCMM, MD, FACOG says:

    Shame on us!
    I am a retired Ob Gyn MD who practiced many years (in less than optimum conditions) in Uganda, Tanzania, Ethiopia and Malawi. After leaving Africa I began practice with a wonderful team of CNMs and MDs in Las Cruces, New Mexico in 1988. Our first patients were mostly Spanish-speaking women who were poor and unable to access obstetric care. Their
    immigration status was not our concern. Their care was our concern! Over the years that I was there (retired end of 2000) our statistics were outstanding primarily due to the excellent CNMs who provided patient patient care. Interventions were kept to a safe minimum and when needed, were promptly and skillfully provided by our co-management approach.
    I realize that it is now 1 1/2 decades later and I do not know the current statistics of that Las Cruces Clinic. But I do know that CNMs are game-changers when it comes to skillful women’s care. As MDs there are many demands on our time and availability but to compromise the type of safe care that our patients have a right to expect from us, is surely not a solution to these shameful and frightening outcomes.

  6. Natalie Watson says:

    THANK YOU for speaking out!!!! We need more OB/gyn’s like you in order to change the system and stop blaming the victims. We need to stop demonizing midwives and homebirth as well. Options like birth centers, hospital CNM care and home birth with a trained CPM can go a long way towards lowering these rates and empowering women.

Leave a Reply