Letter to the Editor: "Oh, Snap!" Edition
Wednesday, December 29, 2010 at 7:50AM
By Jill
In response to a commentary in the October edition of ObGyn News by David Priver (summarized on Birth Sense here), Dr. Katharine Morrison wrote the following gem, which was published in the December edition.
C-Section Rate is Insane
Yes! Dr. Davis M. Priver has correctly identified all the major issues in our insane cesarean section rate in his commentary (“The Cesarean Section: A View from the Trenches,” October 2010, p. 18).
- The drift away from inducing at 42 completed gestational weeks or earlier, which is not supported by any scientific study.
- The unwarranted fear of the vaginal breech.
- A lack of understanding that spontaneous labor is infinitely superior to any form of induction.
- The demise of the operative vaginal delivery—those who are experts are not asked to teach the residents this very valuable skill.
- Hysteria around vaginal birth after cesarean, which is most often a safer alternative than the repeat cesarean.
I would add to these the reliance on electronic fetal monitoring, which has not changed the cerebral palsy rate one iota and has never been shown to be superior to intermittent auscultation. We are not following our own literature, the American College of Obstetricians and Gynecologists Practice Bulletins. Or common sense, and yet seem unable to stop.
Dr. Priver also gives voice to the most important points; we have not helped women or their infants in any way by delivering them by cesarean section. On the contrary, we have a generation of young women with scarred uteri whose future deliveries will be at higher risk for placenta accreta, cesarean hysterectomies, bowel and bladder injuries, and death.
We must stop making excuses, stop blaming litigation and patient, and return obstetrics to safe, scientifically supported practices.
Katharine Morrison, M.D.
Buffalo, N.Y.
Reader Comments (20)
What can I say? BRILLIANT! :)
It's wryly amusing to consider women's uteri as "scared" rather than "scarred". Particularly when it's fear that drives most of the conventional approach to birth.
Love this! After a horrible "the works" hospital birth, I have vowed to never birth in the hospital unless someone I trust looks me straight in the face and says "you and/or baby will die if we don't go now." If that were to ever happen, I want one of these people to be the doctor waiting for me at the hospital.
Even at our university funded hospital (which caters more towards the poor side of town), the c-section rate is over 30% (or was last time I checked). While they boast a 'birth center' and offer doulas free of charge to any patient who wishes to sign up for one, almost every mom I know who's gone there has been augmented with pit for PROM or labor slowing at the end, and OBs still fear VBACs if they don't deliver before or on their due date. One friend actually took blue or black cohosh unsupervised to avoid a RCS.
While a lot of it is doctors fearing litigation and the ever present "dead baby/mom" threat, some of it is that most moms aren't educated on 'the system', how to work it to their advantage, and get a good birth outcome in a hospital.
Agree with all points!
Snap! And Sweet! Muy nice!
Not to mention, we have never asked the question, how likely is a daughter born by C-section to be afraid to deliver her own babies vaginally? OR...are we damaging our own genetic codes with all of these C-sections so that our daughters will have currently unknown, new complications with their own births? It sounds Sci-fi now, but so did our current technology one hundred years ago.
Wow, she is awesome. I heart her.
BRAVO!
PS-I wish I had a way to read the full text of the original article. Does anyone have it?
OR...are we damaging our own genetic codes with all of these C-sections so that our daughters will have currently unknown, new complications with their own births? It sounds Sci-fi now, but so did our current technology one hundred years ago.
Er, yeah... But no, evolution doesn't work that quickly. I agree that daughters of mothers who had C/S are probably more psychologically "prepped" to accept C/S themselves, but not physically.