Updated Saturday February 19, 2011 07:26 PM
Consortium for the
Evidence-based practice of Obstetrics
The primary purpose of maternity care
is to preserve the health of already
healthy mothers and babies
(1) American College of Community Midwives
(2) California College of Midwives
New Email addresses ~
Attention: We are upgrading our computer system & will be off-line starting
March 28th, 2010
Position Paper ~ May 9, Mothers' Day, 2004C.E.O White Paper 2004 Reading time 35 min
Reading time 25 min
(1) Scientific Literature on medical & physiological management
(2) Historical Background Material ~How normal birth became a surgical procedure
The C.E.O web site provides an opportunity for dialogue between childbearing women and obstetricians and between obstetricians and other providers of childbirth services. The goal of C.E.O. is to promote public debate on improving our national maternity care policy.
CEO also provides information on evidenced-based birth care for healthy women with normal pregnancies. Information on the CEO web site provides background information to protect the ethical and constitutional rights of competent adult women to have control over the manner and circumstances of pregnancy and normal birth.
~ Consortium for the Evidence-base practice of Obstetrics
CEO is dedicated to bringing science-based
maternity care to all childbearing women and promoting public debate on our national maternity care policy ScienceBasedBirth.com
hosts two organizations
CEO for is for consumers
and childbirth professionals.
Cytotec // maternal-fetal death
The goal of CEO & A_CEO is national maternity care policy reform that would:
(a) End the routine use of potentially-harmful obstetrical practices
(b) Establish a single, science- based or ‘physiological’ model of childbirth as the universal
standard for all practitioners providing care to healthy women w/ normal pregnancies
Medicine Gone Mad ~
The Death of Normal Birth
Mar 06 ~ San Francisco State University's Holistic Health Program – Future Health Conference 2006
April 06 ~ Info for Bloggers
** A popular Michigan hospital is remodeling its maternity wing. It is building operating rooms, in anticipation of a 50% CS rate by the time the new unit opens in 2011.
Read more about the 29.1% Cesarean section rate for 2004 and the annual 14.6 Billion dollar bill for CS in 2003 in the race to see who can be first to put normal birth on the list of 'extinct' forms of biology
A_CEO -- for physicians who provide obstetrical services.
~ Consortium for the
C.E.O. White Paper 2004 ~ an in-depth exploration of the issues & a plan for rehabilitating obstetrical care for healthy women
Physiological management is the evidenced-based model of maternity care. It is associated with the lowest rate of maternal and perinatal mortality, is protective of the mother's pelvic floor, has the best psychological outcomes and the highest rate of breastfed babies. Dependence on physiological principles results in the fewest number of medical interventions, lowest rates of anesthetic use, obstetrical complications, episiotomy, instrumental deliveries, Cesarean surgery, post-operative complications and delayed or downstream complications in future pregnancies. Physiological management is both safe and cost-effective.
Conventional obstetrics as applied to healthy women (i.e. "flat earth" obstetrics) is the opposite of evidence-based, physiological management. Its associated with a high level of medical interventions, obstetrical complications, anesthetic use, instrumental deliveries, Cesarean surgery and post-operative complications including emergency hysterectomy, delayed complications such as stress incontinence and pelvic organ prolapse, downstream complications in future pregnancies, long-term psychological problems such as postpartum depression, lower rates of breastfeeding and increased asthma in babies born by cesarean section. Conventional obstetrics for healthy women is neither safe or cost-effective. [see "What Every Pregnant Woman Needs to Know about Cesarean Section", a systemic review of the scientific literature by the Maternity Care Association of NYC available at www.maternityWise.org]
A long over-due and much needed reform of our national health care policy would integrate physiological principles with the best advances in obstetrical medicine to create a single, evidence-based standard for all healthy women. Physiological management should be the foremost standard for all healthy women with normal pregnancies, used by all practitioners (physicians and midwives) and for all birth settings (home, hospital, birth center). This “social model” of normal childbirth includes the appropriate use of obstetrical intervention for complications or at the mother’s request.
Flat earth obstetrics is a 21st century version of a medical Dark Ages, in which contemporary
medicine has forgotten or ignored the traditional knowledge base and physiological
principles necessary for normal labor and safe, spontaneous birth.
Flat Earth Obstetrics is the belief that medical and surgical interventions are necessary
in every normal childbirth, despite evidence that such a policy is harmful. The
term is derived from the insistence by religious and political leaders during
the Dark Ages that the earth was flat despite evidence to the contrary.
The problem with the current form of obstetrical care in the United States is
the uncritical acceptance of an unscientific method -- the routine use of
interventionist obstetrics for healthy women with normal pregnancies.
Medicalizing normal childbearing in healthy women makes
childbirth unnecessarily and artificially dangerous.
"Obstetrics has been rated as the least scientifically-based specialty in medicine"
[Dr. Ian Chalmers 1987].
"... The hallmark of obstetrical quality is the prevention of the rare disaster
rather than the optimal conduct of the many normal cases"
[Dr. Brody 1981]
Obstetrics is an “expert” system that has failed most in the very area
it was supposed to have the most mastery and expertise --
preserving the health of already healthy mothers and babies.
The 2-minute scoop on CEO // A_CEO
"Motherhood ~ 24/7 on the front lines of humanity.
Are you man enough to try it?" - Maria Shriver
To bring the disturbing facts associated with the medicalization and routine over-treatment (and at times, mistreatment) of healthy women to the attention of the public in order to rehabilitate obstetrical medicine for healthy women by insisting that evidence-based practices become the foremost standard for 21st century maternity care.
Reading time 3 minutes (Index page) or total 15 minutes for remainder of document (follow hyperlink @ after last paragraph)
Assume as a given that no one in the obstetrical profession is purposefully making childbirth hard for women. Medicalized childbirth is well intentioned. However, interventionist obstetrics does not properly acknowledge the normal biology of spontaneous childbearing nor meet the practical needs of healthy women and their babies.
Problem: The uncritical acceptance of an unscientific premise -- surgical obstetrics for normal childbirth in healthy women with normal pregnancies
Solution: A science-based care maternity based on physiological management -- safe, cost-effective and mother-baby-father friendly. This would result in a single, evidence-based standard for all healthy women used by all maternity care providers -- family practice physicians, obstetricians, and professional midwives.
Physiological: …"..in accord with, or characteristic of, the normal functioning of a living organism”
(Stedman’s Medical Dictionary definition of “physiological” – 1995)
The scientific basis for physiological management of pregnancy and normal childbirth is supported by a consensus of the scientific literature. Physiological management is actually protective for both mothers and babies, reducing the episiotomy / operative delivery rate (and associated complications), from approximately 72% to approximately 5% with an identical, or even slightly improved perinatal mortality rate. It is efficacious -- that is, both safe and cost effective.
"In the first place, do no harm..." ~ bringing the Hippocratic Oath into the 21st Century
In order to bring science-based maternity care to all childbearing women, we must bring an end to "flat earth obstetrics". True mastery in normal childbirth services means bringing about a good outcome without introducing any unnecessary harm. Our present system of obstetrics for normal childbirth does not do well in this regard. The scientific literature -- vital statistics records, textbooks and published research -- all make it clear that routine obstetrical interventions and conducting normal birth as a surgical procedure are more dangerous for healthy women than the use of normal or 'physiological' principles.
For the last century, an unscientific form of Interventionist obstetrics has dominated maternity care in the United States, to the detriment of childbearing women and the taxpaying public. In spite of spending more money that any other country in the world, the United States is 30th in maternal mortality and 22nd in perinatal mortality. The five countries with the best outcomes spend only a fraction of the money we do. They all have national maternity care policies that depend on physiological management.
Over the last hundred years organized medicine has purposefully dismantled the infrastructure for providing physiologically-based maternity care and replaced it with interventionist obstetrics. Medical and surgical procedures originally intended to treat life-threatening complications are routinely used on healthy women with normal pregnancies, without having been proven safe or more effective than physiological management. This unregulated medical experiment introduces artificial risk and serious complications. In the last three decades the medicalization of childbirth has expanded exponentially. Institutional memory of "normal" childbirth is now absent for obstetricians, the nursing profession and medical educators.
Defensive medicine rules the day. This creates an asymmetrical burden of risk that falls unfairly on the childbearing woman, in which the mother is exposed to the actual pain and potential harm of medical and surgical interventions in order to reduce the risk of litigation for the obstetrician. Premature and/or artificial termination of normal pregnancy through induction of labor, surgical incisions, instruments or cesarean section has become the statistical norm. Childbirth for healthy women in 21st century America is typically accompanied by the routine use of continuous electronic monitoring (93%), inducing or speeding up labor with artificial hormones (63%), epidural anesthesia (63%), episiotomy, instrumental delivery and/or cesarean surgery (72%).
Obstetrical medicine rejects out of hand the "social" model of childbirth used world-wide to the great advantage of childbearing families. While publicly promoting itself as virtuous beyond compare, the obstetrical profession is frequently disrespectful and dismissive of the concerns of childbearing women and their families. It does not provide truly informed consent and resorts to threats of legal force if parents do not quickly comply with obstetrical advice for risky medical and surgical interventions that frequently turn out to be unwarranted.
Click here to continue reading this document and learn more about the C.E.O. Action Plan ...
Table of Contents ~ links to major documents // Position Papers
(1) C.E.O White Paper 2004 Reading time 35 min
Printer-Friendly PDF Version White Paper 2004
(3) Problem Statement
(document begins immediately above)
Reading time approx. 20 minutes
(2) Position Paper ~ May 9, Mothers' Day, 2004
Reading time 25 min
6) table of contents for the Scientific Literature
on medical and physiological management
CEO / A-CEO
To become a
of the Consortium, or a
email names & other information to the above e-dress
Printer-friendly PDF for Info and request for CEO / A_CEO membership
Non-PDF Printable Info and request for membership in CEO / A_CEO
Archive of Letters to
Action Plan, instructions and mailing address
Maria Shriver Total reading time approx. 15 minutes
(5) Archive of
letters to California First Lady
♫ The Bottom Line ~ Five minute short-cut for busy people ♥ Form Letter ♥
Printable copy ~ abbreviated Instructions & Address
Book #1, Chapter One
Book #1, Chapter Two
Book #2, Chapter One
Book #2 Chapter Two