@neel_shah @AJOG_thegray @everymomcounts @WRAglobal @AWHONN @ACNMmidwives @acog @DONAIntl @childbirth @MHTF @Unnecesarean @katybkoz THREAD 1. I’ve been sitting on this tweet for awhile because, I have to say, I’m really angry about the Clark et al opinion article. Facts are scant in this editorial and there’s a lot of wishful thinking.
@neel_shah @AJOG_thegray @everymomcounts @WRAglobal @AWHONN @ACNMmidwives @acog @DONAIntl @childbirth @MHTF @Unnecesarean @katybkoz 2. I respect my colleagues and the folks doing this work well before I stumbled into it a couple decades ago, but…
@neel_shah @AJOG_thegray @everymomcounts @WRAglobal @AWHONN @ACNMmidwives @acog @DONAIntl @childbirth @MHTF @Unnecesarean @katybkoz 3.Yesterday I had a conversation with the *3rd* hospital who has been making GREAT progress with reducing CS who feel like they have “hit a wall” and the “Clark article is really having an impact.”
@neel_shah @AJOG_thegray @everymomcounts @WRAglobal @AWHONN @ACNMmidwives @acog @DONAIntl @childbirth @MHTF @Unnecesarean @katybkoz 4. UGGGH [resists urge to stick pen in eye]
@neel_shah @AJOG_thegray @everymomcounts @WRAglobal @AWHONN @ACNMmidwives @acog @DONAIntl @childbirth @MHTF @Unnecesarean @katybkoz 5. First, there’s a certain “tone” here isn’t there? Translation: “I’m tired of people talking about made up misogyny and the completely ridiculous goal of a medication free birth.” Got it. Message received. Yes, all that stuff is made up. 
@neel_shah @AJOG_thegray @everymomcounts @WRAglobal @AWHONN @ACNMmidwives @acog @DONAIntl @childbirth @MHTF @Unnecesarean @katybkoz 6. Secondly, as this section points out, well-intentioned but clearly gullible people like me, @neel_shah, and others who are selling this snake oil concept of cesarean reduction have made a huge mistake! What idiots to make this our actual work!
@neel_shah @AJOG_thegray @everymomcounts @WRAglobal @AWHONN @ACNMmidwives @acog @DONAIntl @childbirth @MHTF @Unnecesarean @katybkoz 7. That isn’t even the most offensive part of this section. The most offensive thing is “problem.” In quotes. IN QUOTES. Let me tell you about this “problem.”
@neel_shah @AJOG_thegray @everymomcounts @WRAglobal @AWHONN @ACNMmidwives @acog @DONAIntl @childbirth @MHTF @Unnecesarean @katybkoz 8. Last year, during a small group call with about 6 hospitals, all trying to reduce their CS rates, I brought up the fact that I had stumbled across a GoFundMe page posted by a woman’s family. She died in a southern CA hospital from complications arising from placenta accreta.
@neel_shah @AJOG_thegray @everymomcounts @WRAglobal @AWHONN @ACNMmidwives @acog @DONAIntl @childbirth @MHTF @Unnecesarean @katybkoz 9. I said it bc it was a real-world reminder of the reason we were all doing the painstaking work of reducing CS in the first place. I knew it was possible that I was talking to the very hospital this happened at, so I was careful with how I phrased everything.
@neel_shah @AJOG_thegray @everymomcounts @WRAglobal @AWHONN @ACNMmidwives @acog @DONAIntl @childbirth @MHTF @Unnecesarean @katybkoz 10. Sure enough, one of the RNs volunteers “this happened at our hospital. Still processing what happened. We tried our best. We were prepared. Still didn’t work out.” BTW, no one is required to volunteer this kind of info, but she did likely bc was a safe place to do so.
@neel_shah @AJOG_thegray @everymomcounts @WRAglobal @AWHONN @ACNMmidwives @acog @DONAIntl @childbirth @MHTF @Unnecesarean @katybkoz 11. Fast forward a couple hours. She calls me. “Holly I looked at the GoFundMe page. That wasn’t our patient. Same day, but not our patient.” Then the crazy notion hit us. 2 women died the same day from a morbidly adherent placenta, separate hospitals, just miles apart. Same day.
@neel_shah @AJOG_thegray @everymomcounts @WRAglobal @AWHONN @ACNMmidwives @acog @DONAIntl @childbirth @MHTF @Unnecesarean @katybkoz 12. It gets worse.
@neel_shah @AJOG_thegray @everymomcounts @WRAglobal @AWHONN @ACNMmidwives @acog @DONAIntl @childbirth @MHTF @Unnecesarean @katybkoz 13. A few days later I’m telling this crazy story to others I work with on our usual monthly team call. Before I could get to the part about the RN volunteering that it happened at her hospital, my colleague cuts me off and says “it was here. It happened at my hospital."
@neel_shah @AJOG_thegray @everymomcounts @WRAglobal @AWHONN @ACNMmidwives @acog @DONAIntl @childbirth @MHTF @Unnecesarean @katybkoz 14. Then I explained this was a patient in southern CA, she is in northern CA. (!!??)
@neel_shah @AJOG_thegray @everymomcounts @WRAglobal @AWHONN @ACNMmidwives @acog @DONAIntl @childbirth @MHTF @Unnecesarean @katybkoz 15. From what I can tell from my amateur sleuthing, all of these women died on or around the same day. I’ll let the reader of this thread decide if this cesarean & accreta thing is a “problem” or a PROBLEM.
@neel_shah @AJOG_thegray @everymomcounts @WRAglobal @AWHONN @ACNMmidwives @acog @DONAIntl @childbirth @MHTF @Unnecesarean @katybkoz 16. Finally, I know the writers of this article know this next part, and that’s why this is so infuriating that they would print it and not expect to be called out… But we have *not* spent decades trying to reduce cesarean in any deliberate way.
@neel_shah @AJOG_thegray @everymomcounts @WRAglobal @AWHONN @ACNMmidwives @acog @DONAIntl @childbirth @MHTF @Unnecesarean @katybkoz 17. Yes, there have been decades of research, commentary, and potential strategies for reducing the trend that astute MDs/midwives/RNs were noting.
@neel_shah @AJOG_thegray @everymomcounts @WRAglobal @AWHONN @ACNMmidwives @acog @DONAIntl @childbirth @MHTF @Unnecesarean @katybkoz 18. And surely some people, who might be inclined to write such articles, are starting to get annoyed now that we are a couple decades in to noticing and talking about this trend, and they just want it to stop already for Pete's sake!
@neel_shah @AJOG_thegray @everymomcounts @WRAglobal @AWHONN @ACNMmidwives @acog @DONAIntl @childbirth @MHTF @Unnecesarean @katybkoz 19. But they know as well as I do that no serious mainstream implementation effort has been undertaken to reduce cesarean in any real way, minus a few forward-thinking departments and hospital systems here and there over the years…
@neel_shah @AJOG_thegray @everymomcounts @WRAglobal @AWHONN @ACNMmidwives @acog @DONAIntl @childbirth @MHTF @Unnecesarean @katybkoz 20. Sure, decades of work have been devoted to convincing everyone that this is a problem. But that’s not *doing* the actual work! Certainly not like the focused nationwide & other efforts like what’s being done by folks at @cmqcc @ariadnelabs @acnmmidwife, #AIM, and others.
@neel_shah @AJOG_thegray @everymomcounts @WRAglobal @AWHONN @ACNMmidwives @acog @DONAIntl @childbirth @MHTF @Unnecesarean @katybkoz @cmqcc @AriadneLabs 21. We are just getting started! But as the article’s authors say, it’s unfortunate that many within “the obstetric community have fallen for this fallacy.” Clearly, the only fallacy being fallen for is the straight up lunacy printed in this article. /
