At first glance, the graph above appears to represent an indictment of contemporary obstetric practice. From 1970-1980, the C-section rate rose precipitously, and the neonatal mortality rate also dropped precipitously. Since then, the C-section rate has continued to rise ever faster, but neonatal mortality, although continuing, has declined at ever slower rates. Yet this is exactly what we would predict if the C-section rate were following the law of diminishing returns.
According to Wikipedia, the law of diminishing returns (also known as the law of marginal utility) means:
… in a production system with fixed and variable inputs (say factory size and labor), there will be a point beyond which each additional unit of the variable input (i.e., man-hours) yields smaller and smaller increases in outputs, also reducing each worker’s mean productivity. Conversely, producing one more unit of output will cost increasingly more (owing to the major amount of variable inputs being used, to little effect).
In the case of Cesarean sections, the law of diminishing returns would predict that there will be a point beyond which each addition increase in C-section rate yields smaller and smaller decreases in neonatal mortality rate.
Imagine a hypothetical first world country that has 1 million births per year. In this hypothetical country, we are able to analyze the number of lives saved by C-sections and we are able to analyze it in hindsight so that we know which C-sections were necessary. As the C-section rate rises, the numbers of lives saved drops off (diminishing returns). In our hypothetical country, we can chart how many lives are saved for each percentage point of the C-section rate. Each percentage point of the C-section rate represents 10,000 C-sections. Our chart might look something like this:
| C-section rate | lives saved/10,000 C-sections |
| 0-5%% | 20,000 (every mother and baby) |
| 6-10% | 10,000 (every baby) |
| 11-15% | 5,000 |
| 16-20% | 500 |
| 21-25% | 50 |
| 26-30% | 5 |
| 31-35% | 0.5 |
| 36-40% | 0.05 |
We can see the law of diminishing returns in action here. At a C-section rate from 0-5%, every C-section is necessary, and every C-section saves the life of both mother and baby. From 6-10% every C-section is necessary and saves the life of the baby. From 11-15% half the C-sections are necessary, resulting in a savings of 5000 lives. At rates higher than 15%, retrospective analysis reveals that far fewer C-sections are life saving. By the time a C-section rate of 35-40% is reached, only one additional baby will be saved every other year.
The results can be expressed another way. We can determine retrospectively how many C-sections were unnecessary. Here’s that chart:
| C-section rate | unnecessary C-sections/10,000 |
| 0-5% | 0 |
| 6-10% | 0 |
| 11-15% | 5,000 |
| 16-20% | 9,500 |
| 21-25% | 9,950 |
| 26-30% | 9,995 |
| 31-35% | 9.999.5 |
| 36-40% | 9,999.05 |
So the law of diminishing returns tells us that, beyond a certain point, we will have to do more C-sections to save one neonatal life. In other words, beyond a certain point, we will have to do more unnecessary (in retrospect) C-sections for each life we save.
Of course, that tells us about C-sections in the aggregate, but the decision to perform a C-section is made on a case by case basis. Moreover, in court, the decision to find an obstetrician guilty of malpractice for not performing a C-section is also made on a case by case basis. The parents and the court really don’t care how many unnecessary C-sections you have to do to save one baby, if that baby is their baby.
Yet the C-section rate can be too high. When you get to the point that you are saving 1 baby every 10 years, the C-section rate is clearly too high. However, a tremendous premium is placed on the life of each and every baby. That societal value is reflected in the fact that our judicial system operates as if we believe that if a C-section had even a remote chance of preventing the death or disability, that C-section should have been done, and because it wasn’t done, the parents should be compensated.
The above graph represents what we appear to believe about the value of the life of each baby. Personally, I think the standard should be different. The number of unnecessary C-sections done to save one baby every decade should not be unlimited. The standard for determining fault in an obstetric malpractice case should not be to show that a C-section “might” have prevented a baby’s death or disability; the standard should be that the doctor could have reasonably foreseen (based on the evidence available) that a C-section was necessary to prevent the baby’s death or disability.
C-sections come with costs. We have not even talked about the financial costs, because, in my judgment, these are secondary. However, very large numbers of unnecessary C-sections will result in unnecessary complications and unnecessary deaths. If the C-section rate continues to rise, these unnecessary complications and unnecessary deaths will increase from relatively uncommon occurrences, to occurrences that far outweight the number of babies’ lives saved.
We, as a society, need to think about where we draw the line, because we, as a society, through our punishments and incentives, determine how high the C-section rate should be. The graph above is not an indictment of obstetrics. It is a warning to us to consider what we truly value. Do we really believe that it is worth any number of C-sections to save one baby’s life? We certainly act as though we do.
Trackbacks/Pingbacks
virtual card buy
[…]just beneath, are quite a few entirely not connected web sites to ours, nonetheless, they’re surely worth going over[…]
https://happyruck.com
…
NMD News
[…]Here are some of the web pages we advise for our visitors[…]
happyruck
[…]Sites of interest we’ve a link to[…]
Gorilla Trekking in Bwindi Impenetrable national park
[…]below you will locate the link to some web sites that we consider it is best to visit[…]
CableFreeTV News
[…]The info talked about inside the post are a few of the best readily available […]
Buy Alaskan Thunder Fuck Strain Online
[…]usually posts some quite exciting stuff like this. If you are new to this site[…]
bitmain antminer d7 1286gh brand new for sale
[…]we came across a cool site that you simply could love. Take a look should you want[…]
Website
…
Rent a car Bar, Montenegro
[…]here are some links to internet sites that we link to because we believe they are worth visiting[…]
stiizy carts
[…]Sites of interest we have a link to[…]
buy 100% undetectable counterfeit money
[…]please stop by the web sites we stick to, such as this 1, because it represents our picks from the web[…]
MUT
[…]we came across a cool website that you just could love. Take a search in the event you want[…]
thc vape carts for sale
[…]although web sites we backlink to beneath are considerably not connected to ours, we really feel they are really really worth a go as a result of, so possess a look[…]
about
…
glo blue dream
[…]Here are a number of the sites we recommend for our visitors[…]
Rolex Datejust
…
polish ak 47 for sale
[…]we came across a cool web site that you simply could delight in. Take a look if you want[…]
Apetamin Syrup 200ml Online
[…]check below, are some absolutely unrelated internet sites to ours, nevertheless, they are most trustworthy sources that we use[…]
strokers
[…]please visit the internet sites we adhere to, which includes this one, as it represents our picks in the web[…]
pocket masturbator
[…]just beneath, are many completely not related web pages to ours, nonetheless, they’re surely worth going over[…]
heryerimi sikin benim
[…]we came across a cool web site that you simply could take pleasure in. Take a appear in case you want[…]
sig sauer firearms
[…]just beneath, are many totally not associated internet sites to ours, nevertheless, they’re surely worth going over[…]
live resin cartridges
[…]Wonderful story, reckoned we could combine some unrelated data, nonetheless genuinely worth taking a appear, whoa did one learn about Mid East has got extra problerms also […]
beretta pistols
[…]we came across a cool web page which you might get pleasure from. Take a look in case you want[…]
savage grow plus ingredients
[…]please visit the web-sites we stick to, including this a single, as it represents our picks through the web[…]
Uganda Tour
[…]Wonderful story, reckoned we could combine a few unrelated information, nevertheless truly worth taking a look, whoa did one understand about Mid East has got a lot more problerms too […]
sgr online booking
…
bitcoin
[…]one of our visitors not too long ago advised the following website[…]
vertigo
[…]the time to read or go to the content or internet sites we have linked to below the[…]
Order Sig Sauer Guns Online
[…]always a major fan of linking to bloggers that I really like but really don’t get quite a bit of link really like from[…]
Chatsmore Catholic High School
[…]Sites of interest we have a link to[…]
RissMiner
[…]Here is an excellent Weblog You may Come across Intriguing that we Encourage You[…]
pills for sale in uk
[…]Here is a superb Weblog You may Uncover Exciting that we Encourage You[…]
stocks today
[…]we came across a cool site which you may possibly take pleasure in. Take a appear in the event you want[…]
Benelli SuperSport
…
وكالة تسويق
[…]below you will come across the link to some web-sites that we consider you must visit[…]
bench press sets for sale
[…]very few websites that take place to be in depth below, from our point of view are undoubtedly effectively worth checking out[…]
scan 3xs 3080 gaming pc
[…]that could be the end of this post. Right here you will discover some websites that we assume you will value, just click the links over[…]
Travelmonke Uganda Tours and Travel
…
Capuchin Monkey For Sale Near Me
…
bitcoin mining machines for sale in europe
…
weed for sale in Ireland
[…]here are some hyperlinks to web-sites that we link to simply because we assume they’re really worth visiting[…]
ROVE CARTRIDGES
[…]just beneath, are a lot of completely not related web pages to ours, even so, they are surely worth going over[…]
smith and wesson subcompact 2.0
[…]just beneath, are quite a few entirely not associated websites to ours, having said that, they’re surely really worth going over[…]
armadillo lizard for sale
[…]just beneath, are many absolutely not associated internet sites to ours, however, they are certainly worth going over[…]
buy top shelf weed online
[…]Wonderful story, reckoned we could combine a handful of unrelated data, nonetheless genuinely really worth taking a look, whoa did one particular master about Mid East has got a lot more problerms too […]
background check service
[…]usually posts some quite interesting stuff like this. If you are new to this site[…]
stizzy battery price
…
magic mushrooms
[…]check below, are some totally unrelated sites to ours, on the other hand, they’re most trustworthy sources that we use[…]
Liquid pentobarbital for sale
[…]one of our guests not long ago suggested the following website[…]
munsters slot machine for sale
…
landor arms tx 801
…
sig m18 for sale
…
winchester pdx1 12 gauge
…
GELATI STRAIN
…
Buy Viagra gold online
[…]just beneath, are quite a few absolutely not related web-sites to ours, nevertheless, they’re surely worth going over[…]
Buy Adderall XR Capsules online
[…]usually posts some extremely intriguing stuff like this. If you are new to this site[…]
lowes kronos server
[…]Here are several of the web sites we recommend for our visitors[…]
sajtovi
Development of websites, mobile applications, portals and online stores
aromatherapy for sleep
[…]Here are several of the web-sites we advocate for our visitors[…]
ارقام بنات
[…]always a major fan of linking to bloggers that I adore but really don’t get quite a bit of link appreciate from[…]
Serengeti African safari
[…]here are some hyperlinks to sites that we link to mainly because we assume they may be really worth visiting[…]
… [Trackback]
[…] Information on that Topic: skepticalob.com/2009/12/cesarean-mortality-and-law-of.html […]
shipping containers for sale
[…]we came across a cool website which you may well enjoy. Take a search if you want[…]
FARMING EQUIPMENT FOR SALE NEAR ME
…
best doc johnson sex toys
[…]we came across a cool web site that you may well delight in. Take a look in the event you want[…]
Uganda adventure safaris
[…]the time to study or check out the content or internet sites we have linked to beneath the[…]
Macbook pro akku schnell leer schmerikon
…
Shipping containers For Sale
[…]just beneath, are various entirely not connected web-sites to ours, nonetheless, they are certainly really worth going over[…]
Pinball Machines for Sale
[…]the time to study or check out the content material or web sites we’ve linked to below the[…]
Mac akku auswechseln bubikon
[…]Wonderful story, reckoned we could combine a few unrelated information, nonetheless really really worth taking a look, whoa did one master about Mid East has got much more problerms as well […]
Best Deals On Sig Sauer
[…]always a huge fan of linking to bloggers that I appreciate but do not get a whole lot of link really like from[…]
IT Services Bristol
[…]one of our visitors not too long ago encouraged the following website[…]
Referencement web
[…]here are some links to internet sites that we link to for the reason that we feel they may be worth visiting[…]
Stiiizy Pods for Sale
[…]The information and facts talked about inside the post are some of the very best accessible […]
download full version pc games
[…]the time to study or stop by the material or internet sites we have linked to below the[…]
free download for windows pc
…
app download for windows 10
…
free app download
[…]Here is a great Blog You may Locate Exciting that we Encourage You[…]
pc games for windows 7
[…]the time to read or check out the subject material or websites we’ve linked to below the[…]
free download for windows 7
[…]always a huge fan of linking to bloggers that I like but really don’t get quite a bit of link adore from[…]
بديل تروكولر
[…]very handful of internet sites that come about to become detailed beneath, from our point of view are undoubtedly well really worth checking out[…]
aranżacja wnętrz Gdynia
[…]check below, are some entirely unrelated sites to ours, on the other hand, they’re most trustworthy sources that we use[…]
anal sex toys
[…]the time to study or pay a visit to the content material or web-sites we’ve linked to below the[…]
Google
…
… [Trackback]
[…] Information to that Topic: skepticalob.com/2009/12/cesarean-mortality-and-law-of.html […]
hollister pas cher
In case Romney haven’t compensated just about any taxation within 10 years, i remember feel the RATES may have already been throughout this?
Title…
[…]we prefer to honor quite a few other internet web-sites around the internet, even though they aren’t linked to us, by linking to them. Beneath are some webpages worth checking out[…]…
Title…
[…]we like to honor a lot of other online web sites around the internet, even when they aren’t linked to us, by linking to them. Below are some webpages worth checking out[…]…
Title…
[…]usually posts some quite exciting stuff like this. If you’re new to this site[…]…
Title…
[…]Here are some of the web sites we advocate for our visitors[…]…