In a masterpiece of shoddy journalism, New York Times writer Tina Rosenberg published a ridiculous piece in yesterday’s edition: In Delivery Rooms, Reducing Births of Convenience. It is a sad illustration of what happens when a writer falls down the natural childbirth rabbit hole and utterly ignores scientific evidence and even common sense.
The piece begins with a bang:
San Francisco General is largely a hospital for the poor. It’s the city’s safety net hospital, known for providing free care for all who can’t afford it, and for its display — while you wait and wait — of the parade of humanity in all its glory.
It might be surprising, then, that according to data compiled by the state (pdf) it is probably the safest place in California to have a baby. Not the most luxurious, certainly — the labor and delivery ward in the famously dilapidated complex of buildings is strictly industrial. Since the hospital doesn’t accept money from formula companies — the usual providers of baby swag — mothers go home with blankets and baby caps made by volunteers from the Baby Love Ministry at Grace Episcopal Church in Napa, and diaper bags filled with breast pads the hospital purchased using money from a grant.
Really? San Francisco General Hospital has the lowest perinatal and maternal mortality rates in the state of California? No, silly, Ms. Rosenberg didn’t assess safety by how many babies and mothers lived and died. She measured it by the preferred metric of the natural childbirth community, by C-section rate.
While San Francisco General’s maternity ward does not provide luxury, it does something else very well: evidence-based medicine.
The evidence says doctors should do far fewer cesarean sections — the American College of Obstetricians and Gynecologists sets a target rate of 15.5 percent for first-birth low-risk C-sections.
Sometimes C-sections are necessary. Most are probably not. They are done (very rarely) for the convenience of the mother, or, far more commonly, for the convenience of the doctor…
Who says that the C-section rate should be 15.5%? According to Ms. Rosenberg, that information comes from ICAN (International Cesarean Awareness Network) a group of lay people with no training in obstetrics or epidemiology, which quoted a press release from the American College of Obstetricians and Gynecologists that DID NOT recommend any optimal C-section rate, let alone one of 15.5%.
And how do we know that most C-sections are done for convenience? Because the Childbirth Connection, the premier lobbying group for the natural childbirth community insists, without even the tiniest shred of evidence, that they are.
In other words, Rosenberg’s piece is predicated on two claims made special interest groups, neither of which is true. What’s next, Ms. Rosenberg, a piece on evolution predicated on the claims of creationists?
Rosenberg should have known better than to rely on special interest groups for her factual claims, but even if she didn’t, basic logic should have alerted her to the fact that safety can ONLY be measured by outcomes, not by procedures. Would Rosenberg judge a cancer center by how much chemotherapy is “necessary” or “unnecessary” or would she judge it by how many cancer patients survived? I doubt it. Would she judge the treatment of heart disease by how many people got angioplasty vs. how many had surgery, or would she judge it by how many people survived and thrived after hospitalization. Almost certainly not.
The goal in obstetrics is NOT to maximize vaginal deliveries. The goal is to maximize babies’ lives and brain function and mothers lives. Apparently Ms. Rosenberg falls into the same trap the natural childbirth crowd does: assuming that a live, healthy baby and a healthy mother are guaranteed. Nothing could be further from the truth.
What are the perinatal and maternal mortality rates at San Francisco General Hospital? I don’t know and I can’t find out. The mortality rates for all California hospitals used to be available on line, but now are available only by request to individual hospitals.
How did Rosenberg come to write such a foolish piece and how did The New York Times come to publish it. Apparently they fell down the rabbit hole of natural childbirth where process matters more than outcome, where a healthy baby is assumed to be guaranteed, and where scientific “evidence” is fabricated to serve the whims of an interest group with absolutely no reference to actual scientific evidence.
Rosenberg and The Times should be embarrassed by this. A reporter allowed herself to be manipulated by a special interest group and wrote an entire piece about childbirth safety without ever mentioning any safety parameters.
Rosenberg should correct her errors, source her medical facts from medical providers, not lobbyists, and find out the mortality rates at San Francisco General Hospital.
Does San Francisco General have the lowest perinatal and maternal mortality rates in the state? If not, it is not the safest hospital.