While looking at the newly updated Lamaze web site, I came across their video library. Birth by the Numbers, which features the research and commentary of Eugene Declercq of the Boston University School of Public Health is one of my favorite videos.
Excerpt beginning at 10:41
Now to get a cesarean rate over thirty percent, you’re going to have to start doing cesareans on lower risk mothers and that’s where the cost-benefit issues start to become more important. What do I mean by that?
On the one hand, there are risks associated with cesarean section. There are risks with complications of surgery; higher rates of infection would be associated with any major surgery. On the other hand, if a mother or a baby is at great medical risk, then those risks clearly outweigh any problems that might be associated with the cesarean.
OK, let’s take it to the current situation. You still have those risks associated with cesarean section—they’re still there—but now the mother doesn’t have a countervailing risk. There’s nothing on the other side to weigh against that. So she now carries all of the risks of the surgery without the benefits to her or her baby.
Now let’s look at the rates for these individual conditions in 1996 and again in 2005. What do we see? Look at the rates in 1996. For every single condition, the cesarean rate went down [Conditions= diabetes, eclampsia, pregnancy associated hypertension, chronic hypertension, prolonged labor, birthweight over 4500g] between 1991 and 1996.
Now let’s look at the present. When you do that, what you see is that the rates went up for every single condition in this last decade. In other words, when there’s a trend to reduce the cesarean rates generally it isn’t a function of any one condition—it’s a function of all conditions. It’s about practice.
[Reads this quote]
“If there’s even a 1% chance of a terrorist act occurring, we must treat that as if it were a certainty.”
This is a perfect description of the philosophy of contemporary maternity care because when you set up a system that focuses on the one percent of problems that might occur, you undermine the care of the 99 percent of mothers who don’t need those services.
A few quotes from the author of Williams Obstetrics in the 1930’s”:
Cesarean rates by state:
I would love to have an inch-high Gene Declercq to sit on my shoulder and answer questions for me.
Birth by the Numbers is on the Video Library page under the “Online Community” tab at the top of the home page along with The Six Lamaze Healthy Birth Practice videos and more.