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Updated ~ Wednesday February 16, 2011 01:34   

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Consortium for the Evidence-base practice of Obstetrics

C.E.O. is dedicated to bringing science-based maternity care to all childbearing women


Action Plan



A-C.E.O ~ The American College of Evidence-based Obstetrics ~

For physicians who wish to re-establish
 the scientific foundation of their profession

and reclaim their expertise in the use of physiological management for normal birth


Call to arms   Who, What, Where & When   Action Plan & Purpose   Topics for Letters   For Homebirth Parents   Directions/ Mailing Address

Mothers' Day letters to Maria Shriver
Call to Arms -- A thousand letters in a hundred days
Campaign starts on Mothers' Day, May 9th, 2004 thru August 19th, 2004

"In a crisis, people need to feel like soldiers, not victims..." CJ Cregg, press secretary on "The West Wing".

attention ~ citizens of California, taxpayers, employers, childbearing women and their loved ones:  Now is the time to be a " warrior " for rehabilitating our maternity care system!  

(1) Members of League of Women Votes, National Organization of Women (N.O.W), International Cesarean Awareness Network (I.CAN), Citizens for Midwifery, La Leche League, professional midwifery organizations,  National Advocates for Pregnant Women, the Association of Nurse Advocates for Childbirth Solutions, any & all politically active groups, church groups, etc....

(2) Physicians/obstetricians who want to re-establish the central role of scientific principles in their practice of medicine & reclaim the classical expertise required for managing non-surgical births, spontaneous vaginal delivery of twins and breech babies.

(3) Home birth families who want to be assured of access to physiologically-based care should they desire or require hospitalization for a future labor and birth. 

(4) Parents that want to be sure that their daughters will have appropriate access to the social model of childbirth and physiological management when they come of childbearing age

C.E.O. is urging Californians in any of the above categories to write a letter to Maria Shriver (wife of the current California governor).


Skip ahead for writing Instructions and
 the address California First lady Maria Shriver


Designated Ambassadors  -- Like the US Marines, C.E.O. is looking for a 'few good men and women'  to carry the banner forward. We want to sign up a hundred people as Ambassadors" -- folks that will promise to ask someone everyday for the next hundred days to visit the web site, become familiar with our message and write letter to First Lady Maria Shriver.

If you are interested in being acknowledged as "Designated Ambassador", please send an email to so we can list your name on our website directory. If you don't want to be publicly associated with the Consortium but are still interested in being an ambassador, just let us know your out there but don't want to be listed.


  Who, What, Where & Why.. 
Reading time approximately 2 minutes

The only way our healthcare system can meet the needs of our healthy childbearing population,
while remaining competitive in the global economy, is to implement the social model for
pregnancy and childbirth care as the basis for our national maternity care policy.     

In order to bring science-based maternity care to all childbearing women, we must bring an end to "flat earth obstetrics". As a part of that goal, we are embarking on a campaign to educate Maria Shriver about this dismal state of affairs and ask for her help in reforming our maternity care policies and  rehabilitating our maternity care system. 

Plan, purpose and Goal

We are starting this campaign on May 9th, Mother's Day. Our goal is a thousand letters in the next hundred days (thru August 19th).

For the last hundred years the obstetrical care system in the United States has been irrational, unscientific and deeply distrustful of female biology. It rejects out of hand the "social" model of childbirth used world-wide to the great advantage of childbearing families. Instead the obstetrical profession categorically refuses to teach, learn or utilize physiological management. By inappropriately using Interventionist obstetrics on healthy women with normal pregnancies, it categorically introduces unnecessary and unnatural harm. Without truly informed consent, healthy childbearing women have been unwitting subjects in an unregulated medical experiment for more than a century.

While publicly promoting itself as virtuous beyond compare, the profession conducts itself in a condescending and elitist manner. It 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.

Hospital protocols and self-serving policies of malpractice insurance companies also conspire to deny childbearing families even the smallest opportunities for true choices in regard to the manner and circumstances of their normal labor and birth. Few obstetricians practicing today know how to delivery a baby who is in a breech position. Most are afraid of providing normal care to women carrying twins or who want a normal labor after cesarean section. Post-cesarean mothers and those carrying twins or a breech baby are being forced into non-consensual treatment via medically unnecessary and unwanted cesarean surgery.

A public ‘reality check’ in regard to the actual dangers of normal childbirth for healthy women is long overdue. It is a serious misunderstanding to assume that normal biology is itself dangerous.

For healthy a woman who are enjoying a normal pregnancy with a healthy baby, the typical “risk” she faces today is not normal labor but the routine use of uterine stimulants to accelerate progress, narcotic drugs and the use of anesthesia so that surgical procedures or instruments can be used. Nearly three million healthy childbearing women with normal pregnancies are being exposed to these unnecessary obstetrical interventions each year.

Action Plan

A thousand letters in a hundred days
Campaign starts on Mothers' Day, May 9th, 2004 thru August 19th, 2004

Reading time approximately 10 minutes

In response to these problems we are asking mothers and others who have borne the brunt of "Flat Earth Obstetrics" to recount their less-than-satisfactory experiences with interventionist obstetrics in a Mothers' Day letter to California First Lady Maria Shriver.

Particularly useful are letters from families who had unexpected and unwelcome interventions thrust upon them or for whom the obstetrical care system failed to meet their physical, psychological or social needs. Address issues such as a failure to be informed about or offered alternatives, lack of appropriate informed consent (for example, if you'd known labor induction would take 2 1/2 days of misery, you'd have happily waited for labor to start naturally). List any surgical complications (both short -term and downstream), neonatal problems and trouble (perhaps the impossibility!) of arranging for a vaginal birth after cesarean (V.B.A.C.)  Please note the inflated cost of medicalized care or refusal of health insurance to cover many of the expenses.

Families that used midwives of all backgrounds should recount their experience and report any discrimination by the medical profession against them or their midwife. For those planning home-based midwifery care, describe any refusal by obstetricians to provide necessary perinatal services because the mother was receiving care from a community midwife.

The purpose of the Mothers' Day letter-writing campaign is three-fold:

1. To create a cohesive, broad-based and effective constituency made up of consumers, taxpayers, childbirth and public health professionals committed to reforming our national maternity care policy, which includes a recognition of the ethical and constitutional rights of competent adult women to have control over the manner and circumstances of pregnancy and normal birth.

2. To bring about legislative hearings on the  issues identified in the CEO White Paper and in this document, including the off-label use of Cytotec for labor induction, the ever-climbing cesarean section and maternal mortality rate, the danger in promoting the maternal choice cesarean as the so-called "ideal' form of childbirth and the physically damaging effects on the healthy of the pelvic floor and pelvic organs associated with medical management of vaginal birth

3.  To facilitate passage of legislation mandating that obstetricians obtain fully informed consent before substituting medical and surgical interventions in place of the safer, evidence-based principles of physiological management -- this would include the off-label use of Cytotec, use of other 'cervical ripening' agents, non-medical inductions or those based post-dates or "big baby", routine use of IVs and continuous electronic fetal monitoring and other procedures or policies that keep a laboring woman confined to bed, the use of artificial hormones to stimulate or accelerate labor, narcotics and epidural anesthesia, requiring the mother to labor or push in anti-gradational positions, episiotomy, vacuum extraction, Cesarean, especially the 'elective' or 'maternal choice CS       

General Topics for Letters:

The following list contains 19 of the most egregious circumstances relative to normal obstetrical care and hospital labor and delivery. Pick anyone that applies as a topic for your letter:

  1. Fear-based pregnancy care or 'Nocebos': The 'no-cebo effect' is the opposite of the 'placebo effect', Placebos are  'fake' drugs (sugar pills) given by a doctor or nurse and accompanied by an enthusiastic assurance of their effectiveness. The fake drug works approximately 30% of the time in research trials. Nocebos are transactions between healthcare provider and patient in which the doctor or nurse expresses doubt or trepidation by negatively presenting the outcome  with comments prefaced by "probably won't work, won't turn out OK".                                                                                                               In prenatal care, nocebos are often repeated worries or doubts such as how "big" the baby is, how small the mother's pelvis, how impossible it is for women to go into labor naturally or cope without drugs, how they think you might need a CS. If nocebos, like placebos,  work about 30% of the time, it may  explain our 30+% operative rate. If franchised, the web address for this type of obstetrical care would be

  2. Unwanted, dubious, repetitive or expensive testing during last weeks of pregnancy -- repeated ultrasound and/or non-stress tests (NST), etc -- with little or no medical indication, patient information or informed consent   

  3. No acknowledgement or informed consent relative to medical interventions and procedures that abnormally limit mobility or confine the laboring women to bed and greatly increase the likelihood that additional interventions will become necessary

  4. Non-medical induction of labor or induction for dubious reasons without full information and truly informed consent

  5. Off-label use of Cytotec induction/cervical ripening w/o truly informed consent -- known complications include: Uterine hyperstimulation / tetonic contractions (less than 2 1/2 minutes between contractions or lasting longer than 75 seconds, can occur up to 12 hours later); fetal distress or amniotic embolism due to prolonged hyperstimulation uterine rupture, hemorrhage, emergency hysterectomy, maternal or fetal death/disability, neonatal brain damage at birth, admission to NICU, cerebral palsy (drug also called misoprostol , given as a 1/4 of a small tablet placed in the vagina. Misoprostol is an ulcer drug that is contra-indicated in pregnant women, not approved for induction of labor, associated with increased uterine rupture and maternal/fetal/neonatal death)

  6. Non-consensual / mandated cesarean for breech baby or twins or post-cesarean pregnancy (VBAC)

  7. Doctor/hospital policies forced laboring woman to be admitted or stay in hospital before onset of  active labor and/or forced the mother to stay in bed during labor / prevented walking 

  8. No true informed consent for medical/surgical procedures described as "necessary" during labor  -- IVs, bladder (foley) catheter, epidural, episiotomy, use of instruments or 'elective' cesarean surgery

  9. Doctor/hospital policies that required routine use of continuous electric fetal monitoring (EFM) and or IV fluids through out labor & birth expressly against mother's wishes,

  10. Imposition of artificial time limits -- Pitocin stimulation of labor or use of operative delivery because phase of longer labor was longer than the statistical average

  11. No access to non-pharmaceutical pain relief (not allowed to walk, use hot shower/deep water, etc)

  12. Inability to make right use of gravity or forced to push or give birth in anti-gravitational positions

  13. Unexpected/unwanted operative/instrumental delivery (episiotomy, forceps, vacuum extraction) especially related to a failure to progress after induced labor &/or epidural anesthesia

  14. Emergency CS performed for "fetal monitor distress" --- "non-reassuring" EFM strip triggered CS but baby's Apgars were normal at delivery, no other problems discovered

  15. Immediate post-operative complications -- hemorrhage, emergency hysterectomy, blood clots to lungs, infections, surgical accident (tied off wrong artery, missed bleeder, cut ureter from kidney, etc)

  16. Unwanted/unwarranted medicalization of the baby after the birth, admission to NICU, prolonged treatment such as prophylactic antibiotics due to maternal fever associated with epidural anesthesia

  17. Serious postpartum pain after episiotomy, other operative delivery, interference in establishing breastfeeding or inability to breastfeed

  18. Threats (such as reporting the parents to Child Protective Service), forced treatment or refusal of requested care because the parents made a medically unpopular choice (declined medical advise, wanted discharge from hospital, had home-based birth plans, etc)

  19. Post-episiotomy pain or painful intercourse 6 or more months after delivery

  20. Post traumatic stress disorder and/or serious postpartum depression after medicalized or surgical birth

  21. Delayed or downstream complications of common obstetrical interventions -- incontinence/other pelvic floor problems after prolonged pushing due to anti-gravitational postures or epidural, delivery by forceps/vacuum extraction, infertility after post-CS infection, unexplained stillbirth, placenta previa or percreta (abnormal placental growth over cervix or grows deeply into or through the uterus) in a post-cesarean pregnancy, refusal of doctor/hospital to "permit" normal labor for planned VBAC

  22. Excessive expenses for childbirth services (average normal birth in California is about $6,000, labor induction, operative delivery, NICU admission of baby can drive up cost from $20,000 to $80,000 for a 'normal' case)

  23. Inability to pay hospital/doctor bill  -- no health insurance, or restrictive policies or non-coverage for procedures used during pregnancy and birth / forced into bankruptcy, work outside the home/2nd job

A letter-writing topic for homebirth families ~ promoting the 'Relocated Home Birth' as used in Holland, which describes access in a hospital to the same standard of physiological management normally employed in domiciliary settings. Families who plan home-based care for a future pregnancy may find themselves with risk factors that preclude such an option and so it is important that physiological management be made available in hospitals.

People who have had good experiences with the social model of normal maternity care and little or no experience with interventionist obstetrics may wonder whether they should write a letter or if so, what the appropriate topic would be.

We suggest that these families speak to the topic of "relocated home birth". A relocated home birth is a strategy made available in many parts of the world to pregnant women who have identified risk factors. While these pregnancy-related conditions do not benefit from routine medical treatment, mothers-to-be are still at increased risk of a complication developing during labor. In order to have immediate access to appropriate medical and surgical services, a decision is made for them to be hospitalized for active labor. Even though the laboring woman is physically in a hospital room, the nature of the care provided during labor in a relocated home birth is basically the same as they would receive in a domiciliary setting -- the social model of non-medical / physiological management.

Relocated home birth provides for continuity of care, full-time presence of the primary caregiver during active labor, social and emotional support, appropriate psychological privacy, patience with nature, upright and mobile mother during active labor, non-pharmaceutical pain management such as showers & deep water tubs, judicious use of drugs and anesthesia when needed, absence of arbitrary time limits, vertical postures, pelvic mobility, mother-directed pushing (no valsalva maneuver, i.e., prolonged breath-holding), right use of gravity for second stage, birth position by maternal choice unless medical factors require otherwise and physiological clamping/cutting of umbilical cord-- after circulation has stopped.

In a relocated home birth appropriate medical interventions are only resorted to if a complication is detected. Even then, physiological management is not abandoned.  A fundamental dependence on physiologic principles continues, with the goal of using them as much as circumstances permit. Examples of situations that would call for prophylactic hospitalization while maintaining physiological principles are moderate increases in blood pressures, insulin-dependent diabetes, pre- or post-term labors, GBS+ mothers who need prophylactic antibiotics, twin or breech pregnancies or vaginal deliveries after a Cesarean (VBAC).

Even experienced homebirth families might find themselves with one of these risk factors in a future pregnancy. In the present dysfunctional system, these families would be forced to chose between non-consensual medicalization or turning their back on medical advise.  It is vitally important that  all childbearing women, including those with risk factors or complications, have access to physiological management. 

Twins born at UCSF                  

This is the message we need to communicate to First Lady Maria Shriver. The issues are universal access to physiologically-based care in both domiciliary and institutional settings and if the mother so chooses, to the care of midwives regardless of the setting chosen for labor and birth.    

Topics for midwives and other childbirth professionals:

Professionally-licensed midwives (LMs and CNMs) should address the "fatally-flawed nature" of California licensing laws which mandate that midwives have physician supervision but does NOT mandate that physicians provide supervision. This puts total control of the profession of midwifery into the hands of an economic competitor.  Besides, doctors do not have 'super' vision, only the ordinary kind.

 In addition, there is the inherent insanity of identifying doctors, who are neither trained or experienced in physiological management (i.e., the midwifery model of care) as the proper source of "supervision" for practitioners who provide physiologically-managed care. Since obstetricians have no education, training and experience in physiological management, they should be required to be supervised by professional midwives whenever they attempt to provide care to healthy women with normal pregnancies.

Other topics of political discourse are the impossibility of MediCal reimbursement and the recommendations of the Pew Charitable Trust report on the mainstreaming of professional midwifery care. The Pew report reiterates what midwives the world over already know -- that professional midwives can only function as guardians of normal birth (and a braking system to prevent run-away obstetrical intervention) when midwifery is an autonomous profession.

Reading time approximately 2 minutes

         Mothers' Day Letters to Maria        
  ~ a thousand letters in a hundred days 

Campaign starts on Mothers' Day, May 9th, 2004 thru August 19th, 2004

Maria Shriver -- Office of the First Lady,
State Capital Building, Sacramento, CA 95814

Think of this -- A 1000 letters in a hundred days
only TEN letters per day!

If 10 political activists -- midwives/mothers/ and others -- take turns making sure that an average of ten letters per day get written and sent to Maria Shriver, we will easily meet our goal.   Suggestions: Ten facilitators each identify one day a week (say every Tuesday) during which they are responsible for making phone calls, contacting email and clients lists and politically-active groups to confirm that 10 people have agreed to write and mail a letter to Maria Shriver in the following 7 days. 

Ten facilitators X 10 daily letter writers X 10 weeks is a 1000 letters in less than a 100 days.

Click here for printable copy of the following: "Suggestions & Mail Address"

     Suggestions for writing letters to California First Lady Maria Shriver

  1. Read the position paper to get an idea of the general topics targeted by C.E.O.  Pick one or make up a new topic.

  2. Date your letter for Mothers' Day 2004.

  3. Limit yourself to only one or two topics. Letters should be no longer than 1 1/2 pages -- one page is ideal. 

  4. Type anything longer than one page.

  5. Mail original to the Office of the First Lady (full address below),

  6. Forward an email copy of your letter to to be posted in an archive on the  web site.

  7. Call Donna Russell at 1- 530-534-9758 if you have questions to complex for email

        Maria Shriver ~ Office of the First Lady, State Capital Building, Sacramento, CA 95814   

To become a member of the Consortium, or a "designated ambassador",
email your name or your organization's name to

Printable Info and request for membership in CEO / A_CEO



Go on to the following "position paper" for the
 "proof of principle".

It is designed to give people the specific type of information needed to write informative letters to California First Lady Maria Shriver and work for political change.  


    Position Paper
~ May 9,
Mothers' Day, 2004

Reading time
approximately 25 minutes

            Click on the twins' picture to return to the Index Page   for

Wednesday February 16, 2011 01:34