I'm tired of blogging- but Arnie said he'll take over for a little while... Here's what he has to say-
(Editor's note: I typed while he talked, so pay no mind to grammar... )
So, uh- a sociologist friend of mine and his wife are big advocates of steering clear of the medical establishment as much as possible. And all three of their children were birthed at home or in birthing centers through doulas, and in one of our conversations about this, in criticizing the medical establishment, he said:
"Look at the rate of Cesarian sections given by doctor's today. (Editor's note: Something like 27% of all births in 2003 were by cesarian section.) Certainly before the advent of these being common procedures, 27% of women weren't dying from the complications that currently justify the procedure."
Before I get to my point, I accept that it's unlikely that 27% of childbirths resulted in maternal mortality- that's not to say that a quarter of women didn't die from childbirth at some point in history, but that we have to remember that women have multiple births in their lifetimes.
One caveat is that a lot of these C-sections today are voluntary and requested.
Nonetheless, I'll accept that the rate of C-sections is probably higher than the counterfactual mortality due to childbirth. While I certainly think that there are legion criticisms available of the current medical establishment, I would like to throw out the hypothesis that the rate of C-sections being higher than the erstwhile rate of mortality is not a legitimate criticism of the establishment per se.
Hypothesis: Given that C-sections are a preventive procedure (even emergency C-sections are in a sense preventive), they are turned to to minimize a risk due to some risk posed by a vaginal delivery. In other words, the doctor is responding to some higher than normal probability of complications due to regular delivery. The key here is that it's a probability. For example, if a doctor decides that for a mother to continue with her regular delivery, she would face a 50/50 chance of an adverse outcome to her health, whereas 90/10 for a C-section (the bad of the C-section just being future complications from childbirth or a post-surgical infection) then he or she will opt for the C-section. The point is that even in the simple 50/50 case, half the mothers have no adverse outcome (e.g. mortality) but because of the high possibility of it, C-section is chosen- and this justifies a higher rate of C-sections than a historical rate of maternal mortality through regular childbirth. It's likely that there's not something pernicious going on on the part of doctor's recommending C-sections.
Molly's translation: So it's doctor's playing the odds each time over and over again, not necessarily saying "You would have died without a cesarean section." They say, "You might have died." Thus, it makes sense there would be more today. A more legitimate fear/question: are doctor's assessing the odds properly?
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3 comments:
Hello,
I just told Bill I needed more blogs to read, so he pointed me in your direction. Hooray, another blog to read...don't tire of blogging yet. You have a new reader!
Anyway, to my comment...c-sections are also performed to save babies, perhaps more often even. Speaking as a baby saved by c-section myself, I wanted to point out infant mortality as an important factor in the discussion. I wonder what the specific relationship is between an increase in c-sections and the decrease in both maternal and infant mortality.
Kelsey (Benac)
Good point- I forgot about infant mortality. I believe the same logic applies ie. many newborns were not necessarily 'saved' by the c-section. Their probability of survival was improved by it (perhaps approaching 1 in some cases). Ex post we may feel like saying that they were saved but that won't be the case for all of them if probabilities are not equal to 0 or 1. We don't know the counterfactual. And that is why I claim that it is perfectly normal for the rate of c-sections today to be higher than the rate maternal + infant mortality in the good old days. Physicians seldom work with perfect certainty.
Arnie
I read an article last year entitled "Too Posh to Push." It was about the growing trend of c-sections simply for the mother's convenience. In Brazil it is almost a sign of low status to actually push your own baby out. I think a lot of that mentality has crept into our own culture as well. It's impossible to explain to someone why my 24 hours of contractions and 4 hours of active pushing would actually be more desirable then just a short, simple surgical procedure should the doctor be willing. But I think it is.
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