A favorite parlor game among natural childbirth advocates is determining whether a stranger’s C-section was necessary. Figuring it out is only half the fun. Once you decide that the woman had an unnecessary C-section, you express ostentatious sadness and distress that she, poor thing, is not as educated as you are.
Gina Crosley-Corcoran, the Feminist Breeder, demonstrates how it’s done:
It’s incredibly difficult for me to overhear a pregnant woman talking about how she had to have a cesarean last time because her baby was “too big” and now they’re giving her an “automatic” repeat cesarean at 38 weeks. I have no judgment about this individual woman, it’s just so painful to hear this story again and again. I say this as a maternal child health scholar and as a woman who vaginally delivered 2 nearly 10 lb babies after a cut-happy OB gave me a cesarean the first time for a “big” 8 lb baby. Why don’t more women know about the overuse and abuse of cesareans? Why are some doctors still doing this shit?
Determining that the stranger’s C-section was unnecessary ✓
Expressing distress ✓
Bemoaning the stranger’s lack of education ✓
Mentioning your own ample pelvis and how many babies passed through it? That’s the cherry on top.
Well, I’m here to tell you a secret and considering that I am an obstetrics “scholar” (the relevant discipline, not public health) I ought to know.
Come closer and I’ll whisper in your ear exactly how you can tell that another woman’s C-section was unnecessary.
Here’s the secret:
No one, least of all someone who isn’t even a medical professional can determine whether another woman’s C-section was necessary or unnecessary.
First of all, the woman may not be disclosing the real reason that she had the C-section. Thousands of C-sections are performed each year for active genital herpes. The herpes virus can easily be transmitted to the baby as it passes through the vagina, leading to encephalitis, sepsis and death. For obvious reasons, not many women are comfortable announcing to their mother-in-law, their boss, and their next door neighbors that the reason they had a C-section was because of active genital herpes, so they make up some other reason, including claiming that they simply preferred a C-section to a vaginal birth.
Second, even an obstetrician cannot tell if a woman’s prior C-section was unnecessary unless he or she has access to the medical records and can examine the patient. Unless you put your fingers inside her vagina and measure the diagonal conjugate, intertuberous diameter and prominence of the ischial spines, you have no idea whether her pelvis can accommodate a large baby or not.
Third, while public health information about large populations can inform treatment of individual patients, it tells us nothing about the appropriate treatment for a specific patient. So even if we were to conclude that the contemporary C-section rate is “too high,” we cannot draw any conclusion about whether a C-section was necessary or unnecessary for a particular patient.
There’s another aspect to this that is equally important and generally overlooked by natural childbirth advocates. Sometimes I can tell (or I think I can tell) that a procedure a patient has undergone was not necessary. I do not share that information unless it is directly relevant to planning future treatment. Who benefits when you tell a patient that you would have cared for her differently? Certainly not the patient. Now she distrusts her previous provider and her own judgment in choosing that provider. Now she has to wonder whether things could have been different, but she has no way to fix what happened. Sure, when I was practicing, I could make myself a hero and tell a mother that my C-section rate was so much lower than many other obstetricians, but what does that do for her? Nothing.
Who benefits when a random stranger tells a woman that her C-section was unnecessary. Certainly not the woman. The only person who gets something out of it is the one who imagines that she is superior and would never have been duped.
And when it comes to accurately assessing whether an a specific C-section was necessary for a specific woman, a self-proclaimed public health “scholar” is no different from a random stranger. Studying health on the population level has NOTHING to do with treating individual patients. It makes about as much sense as a military history “scholar” telling a soldier on the ground in Afghanistan how to react when an insurgent starts firing on him. The fact that the historian has studied the battles of Thermopylae and Waterloo is not particularly relevant in an emergency situation.
The bottom line is that only an obstetrician can tell you whether a C-section was unnecessary, and then only after he or she has reviewed your records and examined you.
Random strangers can’t tell at all.