Routine Pelvic Exams Lead to Unnecessary Hysterectomies, Experts Say

It's been quite a while since I've written anything about the ongoing scandal of unnecessary hysterectomies. I've been spending my time working locally in my home town of Huntington, NY to create community gardens and grow-to-give gardens via my organization LICAN. This is my way of fighting giant agri-businesses in a way that will eventually mean their demise as people realize that communities can become self-sufficient and supply their own vegetables and eggs.

But a Jane Brody article in the April 30 NY Times has brought me back to the subject. Brody, a vastly experienced and reliable reporter, quotes experts who say that those annual, invasive pelvic exams that gynos have told us forever that we need to have--well, we don't need them unless we have troubling symptoms, or it's been more than 3 years since we've had a Pap smear to test for cervical cancer. (And, by the way, if your cervix has been removed, no need for the Pap smear either.)

According to an article quoted by Brody, "frequent routine (pelvic) bimanual examinations may partly explain why U.S. rates of ovarian cystectomy (removal) and hysterectomy are more than twice as high as rates in European countries where the use of the pelvic examination is limited to symptomatic women."

The scenario is that if a woman with no symptoms undergoes a pelvic exam,  the doctor may find something suspicious that can lead to unnecessary surgery and other procedures, not to mention high anxiety and costs.

Indeed, there is no good medical evidence to justify routine pelvic exams in the absence of troubling symptoms, the experts told Brody.

But this, of course, doesn't mean that most of the gynecologists we see will stop recommending them any time soon. The doctors' trade group, the American College of Obstetricians and Gynecologists. endorses them even though they acknowledge the lack of medical evidence.

And, when 250 doctors were asked about doing routine pelvic exams, nearly all said they would do them routinely on women without symptoms, whether they were 18, 35, 55 or 70. This included a 55-year old who had no ovaries, uterus or cervix.

Yes, women's treatment by this branch of medicine is a scandal, and it's all about the money. Since these doctors get paid for an estimated 63.4 million pelvic exams and about 600,000 hysterectomies a year, I surely don't expect them to stop voluntarily.

Tell your friends!

Let the Gynecologists Hear from You

I've been receiving comments from women who are outraged about the continuing epidemic of avoidable hysterectomies, and it's time the doctors took the heat directly.

The place to voice your feelings is the American College of Obstetricians and Gynecologists, ACOG for short. This is, essentially, the governing body for the doctors, and when they change their standards of practice to say that no healthy ovaries should be removed; that there are organ-conserving alternatives to the vast majority of hysterectomies; then the epidemic will stop.

That's because once the standard is changed, the doctors and hospitals become vulnerable to lawsuits they win now because they always fall back on the defense that, hey, this is the accepted way to deal with women's problems.

So, let them hear from you.

You can call them at 202-638-5577. Either voice your feelings to the person who answers the phone, or ask for the press office and see if you can get through.

You can also send email to: communications@acog.org

Gynocologist's Professional Org Ignores Heart Attack Risk

The professional organization that sets the standards of care followed by gynecologists has just released a new patient education booklet on hysterectomy. While this new version from the American College of Obstetricians and Gynecologists is something of an improvement (I'll get to that later), it leaves out completely the most serious risk facing women who are hysterectomized and/or lose their ovaries: heart attack.

I brought that very subject up with my cardiologist recently (yes, I have heart problems), and this is what he said:

"If they're taking out their ovaries, they're giving these women heart attacks. And you can quote me." Dr. Pavel Romano, Huntington, New York.

The "they," of course, is gynecologists. It's brave of Dr. Romano to put his name on a quote like this, but he's really not going out on a limb on the science. As I blogged about recently, solid research has now established that losing your ovaries greatly increases a woman's risk of heart attack; losing your uterus alone also increases that risk, but not by as much.

So I carefully read ACOG's new patient education booklet, expecting to find mention of this risk. Remember, heart attack is the leading cause of death of American women.

And is that risk mentioned? No, it is not.

I asked the spokesperson for ACOG just who is responsible for the contents of the pamphlet, and she ascribed it to "ACOG Fellows" who base the content on the College's Practice Bulletins and Committee opinions.

I've asked to interview one or more of these Fellows, but in the meantime I've now had the pleasure of reading ACOGs "Guidelines for Women's Health Care," published in 2007. Nowhere in that very long description of how doctors should respond to women's various gynecological problems is any mention of the increased heart attack risk brought about by hysterectomy and oopherectomy.

Absent any other explanation, this seems to be a case of a medical truth that's inconvenient for business. Acknowledging the heart attack risk might force the gynos to confront their tendency to just yank out a woman's organs, and that would leave many of them unable to earn their usual fees. It takes a lot more skill than many gynecologists have, and a lot more time, for apparently no bigger reimbursement from Medicaid, for example, to remove only a woman's fibroids instead of her entire uterus. Fibroids are the most common reason for hysterctomizing a woman, and they are never a good reason for a hysterectomy, much less removal of ovaries. Apparently, learning to do the more difficulty surgery is a problem for many gynecologists, who prefer instead the quicker, more lucrative and simpler job of just cutting out entire organs.

As I said earlier, there is some new information in the pamphlet that is helpful to women deciding whether to consent to a hysterectomy. The pamphlet now admits that the menopausal symptoms caused by ovary removal "may be more intense" (oh, yeah, make that will be horrendous) than if a woman went through menopause naturally. And that there is an increased risk of bone fracture due to osteoporosis.

But most of the pamphlet is still devoted to explaining the different ways surgeons can cut out a woman's organs and the details of how a woman is prepped for surgery.

A woman reading this pamphlet would still come away with only a partial understanding of the functions of her organs and of the consequences of surgery that may very well shorten her life.

It's an outrage that complete information is still absent from this booklet, and no woman agreeing to the surgery based on it is giving truly informed consent.

The Truth--and Myths--About Home Births

When I told my women friends that my older son's first baby--and my first grandchild--would be born at home, most of them looked shocked. They immediately voiced fears, saying that they thought it was much safer to have the baby in a hospital because things can go wrong, and in that case, an operating room would be immediately accessible.

It didn't change their minds when I told them that this was a low-risk pregnancy, that my son's girlfriend had been healthy throughout, and that everything showed that the baby--a boy--was doing well. Nor were their minds changed when I said she would have a birth assistant (a certified doula) to help her through the labor, and then a highly experienced midwife to deliver him.

Well, he was born a week ago today, and came into the world with eyes open wide, pink and healthy and calm.

I know exactly how he looked because I saw him within moments of his birth. All four of his grandparents, his uncle and aunt, were there at home waiting. We suffered along with Nicole as we listened to her cry and yell during the last throes of childbirth. But once we heard his cry, we ran upstairs, applauded, cried, hugged and poured champagne. I'll never forget that morning.

Baby Henry began nursing like a champ immediately, and has been calm and content ever since. When he wakes up to nurse, his eyelids flutter and he frowns as if all that light is still a shock to him.

And then I remember the hospital nurseries with fluorescent lights glaring, 24 hours a day. No wonder the nurseries are usually ringing with the howls of the newborns!

So the outcome for my grandson was perfect. The midwives--a second one came at the end to help--called it a beautiful birth. They should know. For one of them it was the 251st. birth she had attended.

The birth assistant, by the way, was with Nicole throughout her labor, coaching her on changing positions, massaging her, using aroma therapy, accupressure, a birth chair, etc. to help her.

But what of my friends' fears? Justified or not?

Not.

Here's the evidence, culled from the best and most recent study of home births. It comes from a study of 7,600 births in the U.S. and Canada, published in the British Medical Journal in 2005, that were planned to occur at home with certified midwives attending. All of the births studied were low-risk, meaning that the mothers were healthy, with no chronic health problems, and that all pre-birth exams showed the babies in good health as well. The outcomes of the home births were compared to low-risk births that occurred in hospitals.

• Infant mortality was 1.7 per 1,000 births, a rate as low as occurs in hospitals with low-risk births.
• Medical interventions occurred at less than half the rate as in hospitals. For example, only 2.1% of the women at home suffered an episiotomy, compared to 33%--yes, one in three--in the hospital. Only 3.7% of the women at home ended up delivering by caesarean section, compared to 19% in the hospital.
• None of the mothers died. Some of the women--12%--were transferred to a hospital when problems developed. If a woman is within 20 minutes of a hospital, she is likely to be under care in an operating room as quickly as a woman who labors in the hospital. That's because it takes some time to mobilize the equipment and staff needed, and that mobilization can get started just as quickly with a phone call from home.
  

The study concluded: "Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar (infant)...mortality to that of low risk hospital births in the United States."

The bonus, of course, in this era of soaring health costs, is that a home birth is far less expensive than one that takes place in a hospital.

Meanwhile, the American College of Obstetricians and Gynecologists continues to oppose home births while infant and maternal mortality rates for the U.S. continue to be far worse than those in other western countries where medical interventions, like cesaereans, occur far less often.

Which leads me to believe that opposition to home births is rooted in the desire of the medical establishment to protect their income stream, and not out of concern about the safety of women and babies.

Yet, American women are so frightened of childbirth at home that less than 1% choose to stay out of the hospital. A pity. For them, their families and babies.##