To the Editor:
Re “Doctors Stick With Unreliable Medical Tool to Justify C-Sections” (front page, Nov. 7):
As the president of the American College of Obstetricians and Gynecologists, I found that this article, which ties the use of fetal heart rate monitoring to increases in cesarean procedures, oversimplified the clinical use of a complicated technology. And in doing so, it probably stoked fear in pregnant patients.
Obstetricians care for patients when the stakes are incredibly high. Guidance from our organization is intended to help them accurately interpret, manage and apply fetal heart rate monitoring in the context of each patient’s clinical needs, using the information available to try to keep their patients and their babies safe. Our guidance addresses intermittent as well as continuous monitoring based on the risks of each patient. Monitoring may change as labor changes.
A concerning fetal heart rate should not immediately result in a cesarean. It should set off a series of assessments and evaluations that may end in a cesarean delivery when necessary. They are not always harmful. They often save lives.
There have been efforts within the medical community, some spearheaded by our organization, to lower the cesarean rate and avoid related complications. The decisions made during labor are complex, and both electronic fetal heart rate monitoring and cesarean procedures, when indicated, remain critical tools for saving both maternal and infant lives.
Steven J. Fleischman
Milford, Conn.
To the Editor:
Blaming electronic fetal monitoring for unnecessary C-sections is like blaming kitchen knives for the violence perpetrated by those who use them to kill. Electronic fetal monitoring has made it possible for doctors, midwives and nurses to be made aware of fetal distress and the need to deliver the baby expeditiously — whether by C-section or an instrumental delivery such as a vacuum. Its misuse by those who misinterpret the findings and react inappropriately is the true problem.
Many providers innocently interpret tracings incorrectly; others have a fear (often justified) of hospital oversight committees or eager medical malpractice lawyers, who themselves often misinterpret tracings and react aggressively to every fetal heart rate deceleration.
I use continuous fetal heart rate monitoring for the overwhelming majority of the deliveries that I do, while I both maintain a very low C-section rate and consistently deliver healthy babies.
We must stop the weaponization of these monitor tracings and liberate obstetricians and midwives to practice pure obstetrics and give the fetus and the mother optimal care.
Jessica Jacob
Great Neck, N.Y.
The writer is an obstetrician-gynecologist.
To the Editor:
While I am grateful for this article’s attention to the important and overlooked issue of C-section overuse in the United States, the many interviews with obstetricians belie a crucial aspect of American maternity care largely responsible for these outcomes: the medicalization of childbirth and the marginalization of midwifery.
In spite of all the evidence in our favor, midwives like me attend only about 12 percent of births in the United States. Countries with the best birth outcomes and lowest cesarean rates, like the Netherlands, Scandinavian nations and New Zealand, embrace midwifery as a cornerstone of maternity care. Even within the United States, states with stronger midwifery integration have lower cesarean rates and fewer neonatal deaths.
The medicalization of childbirth substitutes technology for human presence. Yet evidence indicates that continuous labor support — central to the midwifery model — improves outcomes. Greater integration of midwifery into American maternity care offers a proven path to lower C-section rates, healthier moms and babies, and better birth experiences for all.
Ann Ledbetter
Milwaukee
The writer is a certified nurse-midwife.
When Shirley MacLaine Was the Understudy
To the Editor:
Re “A ‘Bittersweet’ Curtain Call for Understudy Slips” (front page, Nov. 3):
The understudy slip in a Playbill for “The Pajama Game” for the week of June 21, 1954, read, “Because of an injury to Miss Carol Haney’s foot, some of the dancing assigned her will be done at this performance by Miss Shirley MacLaine.”
This is a piece of theater lore. Miss MacLaine was spotted by the Hollywood producer Hal B. Wallis, and the rest is history.
At the stage door of the Gershwin Theater, after a performance of “Shirley MacLaine on Broadway” in May 1984, she was astonished to see that slip of paper and signed her name, followed by an exclamation mark.
It is a treasured part of my collection.
Ron Jacobs
Albany, N.Y.
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