Élan McAllister's Remarks
Press Conference Called by Betsy Gotbaum
Public Advocate's Office
July 13, 2005

My name is Élan McAllister and I'm here representing the public interest group, Choices in Childbirth.

In 2003, 123,412 babies were born in New York City hospitals. Of those births (as the Public Advocate has stated) 26.4% were delivered surgically via cesarean section. This rate is the highest in New York City's history. It is also an indication that New York City is in step with a growing national trend. Increasingly the American health care system is relying on medical interventions to deal with what is, in the majority of cases, a normal and safe physiological process.

Choices in Childbirth is deeply concerned by this trend. We are concerned that the rates of obstetrical interventions (including c-sections, inductions, episiotomies, epidurals, and other routine practices) continue to climb despite the release of multiple studies indicating the need for moderation. We are concerned that women are not being fully informed about all of the risks associated with these commonly performed obstetrical interventions. And we are concerned that hospitals are not releasing their rates of interventions despite the fact that New York law requires them to do so.

Choices in Childbirth is dedicated to educating the public about women's rights and options in childbirth. We believe that women have the right to know all of the information available to them when choosing where, how and with whom they will birth. The city-wide non-compliance to the Maternity Information Act denies women access to critical information that would allow them to make fully informed maternity care decisions.

For instance:
  • In 2003 37.3% of births at New York Hospital, Cornell Weil, ended in cesarean section. This is despite the fact that a cesarean section is major abdominal surgery that poses many risks to both mother and child. And despite the fact that the World Health Organization recommends a safe c-section rate of no more then 15% for any hospital, including those treating high risk populations. I'm quite certain that women going to Cornell Weil, hoping for a vaginal birth, have no idea that they have chosen a birthing environment that condones such an appallingly high rate of surgical births. How would they know, the pamphlet that would give them this information isn't made available to them.

  • In 2003 61% of women who gave birth vaginally in Staten Island's St. Vincent's Hospital were given an episiotomy, or a cut to the perineum to broaden the vaginal opening. This despite the fact that multiple studies over the years have proven that routine episiotomies cause more harm then good and should be used in less then 15% of births. Yet I'm sure that the thousands of women birthing at St. Vincent's every year don't realize that they're choosing a birthing environment that clearly condones the practice of routine episiotomies. How would they know? This pamphlet isn't made available to them.

  • In 2003 41% of women birthing at Brooklyn Hospital had their labors artificially induced. This despite the fact that none of the drugs used for elective induction has ever been approved by the FDA for such use. And despite the fact that all of the drugs and procedures used for elective induction can cause adverse effects, including a higher risk of cesarean section. You can bet that women birthing at Brooklyn Hospital don't realize that they run such a high risk for being induced. How would they know? This pamphlet isn't made available to them.

The Maternity Information Act provides women with a valuable tool. At the very least, having a pamphlet listing her hospitals rates of obstetrical interventions will encourage a woman to ask a few questions: Why is the cesarean rate 37% at this hospital? What is your cesarean rate, Doctor? When do you consider a cesarean to be justified? Will you support my decision to avoid a cesarean section unless clearly medically justified? Should I consider going to a different hospital where cesarean sections are not so routinely practiced?

Women are pretty smart. Most of us, when given all of the facts, know that we don't want unnecessary abdominal surgery. We know that we don't want to be given drugs that are untested and could negatively impact ourselves and our babies. We know that we don't want anyone going anywhere near our perineum with a pair of scissors!

The problem is that most of us are not being given all of the facts. Most of us do not have access to all of the information that would allow us to make fully informed maternity care decisions. Give women this information. Trust that we are intelligent enough to know what to do with it.

Thank you for coming and thank you Public Advocate Gotbaum for realizing the importance of this issue and for committing yourself to improving maternity care for the women of New York City.

Thank you.
www.choicesinchildbirth.org

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Childbirth Connection is a national not-for-profit organization founded in 1918 as Maternity Center Association. Our mission is to improve the quality of maternity care through research, education, advocacy and policy. Childbirth Connection promotes safe, effective and satisfying evidence-based maternity care and is a voice for the needs and interests of childbearing families.
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