Maternity system in crisis?

Amy Romano is at it again.

Romano, like everyone else at her employer the Childbirth Connection, has a vested interest in portraying the maternity system in crisis. This is a classic tactic in “alternative health.”

As I wrote in The playbook for challenging conventional medicine:

The first step is to portray the particular discipline as “in crisis”. [According to Paul Wolpe in the paper The Holistic Heresy: Strategies of Ideological Challenge in the Medical Profession]:

“… Modern medicine’s conquering of infecious disease set up a quasi-religious belief in its ability to reduce suffering and disease now seems stalled by a of medical economic, organizational, and social problems. [Critics try] to portray the biomedical orthodoxy as responsible for the problems confronting organized medicine .., and suggests that orthodoxy is ill suited to solve the developing challenges to care…”

This is certainly the tactic adopted by homebirth midwifery. The “crisis” is the rising C-section rate, which is portrayed as unjustified, intolerable, unaffordable and injurious. A secondary “crisis” (which is fabricated) is the rate of infant mortality (the wrong statistic) and the rate of maternal mortality (which is falsely portrayed as rising).

And this is the tactic Romano uses in the piece she wrote for The Health Care Blog, A Mother’s Day Manifesto: Blood, Toil, Tears, and Sweat. Romano tells the story of “Near Miss Mom” who suffered a late postpartum hemorrhage (9 days after birth), a rare postpartum complication. Near Miss Mom went to the emergency room, but the doctor who saw her there failed to recognize the seriousness of her condition and therefore failed to refer her immediately to an obstetrician. Indeed, Romano acknowledges the problem was quickly diagnosed by an obstetrician:

When she finally reached Near Miss Mom’s bedside, it didn’t take her long to call a Code Red and assemble the team for the emergency hysterectomy.

Romano presents the error of the emergency room doctor as a Mother’s Day parable on the “crisis” in maternity care. There just one teensy, weensy problem. This was NOT a near miss maternity event and it is unfortunate that Ms. Romano has chosen to misrepresent it as such.

This is an example of a patient presenting to the emergency room with a rare complication who should have had an immediate specialist consult, but did not. Late postpartum hemorrhage is typically due to sub-involution of the placental bed. Most physicians, like this ED doc, have never seen a case and therefore may fail to recognize it.

This was a mistake on the part of one physician (failure to obtain immediate specialist consultation) and not a systemic failure. If an emergency room doctor failed to recognize a complaint of jaw stiffness and drooling as tetanus, we would not conclude that it was a “neurology near miss” and indict the neurology care “system.”

That’s not to say that there isn’t room for improvement in maternity care, but it is deeply cynical to use the case of an emergency room doctor failing to diagnose a rare postpartum complication as a failure of maternity care and deeply cynical to use it as a Mother’s Day parable.

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