It was fabricated from whole cloth in 1985, apparently to suit the prejudices of the man behind it.
There was never any evidence to support it.
It was publicized far and wide in pursuit of a personal agenda.
It is still widely publicized by the childbirth advocates and the mainstream media who have no idea it was disavowed in 2009.
Indeed, it was just recycled in a piece by Andre Picard, Health Writer for the Canadian Globe and Mail.
I like to think of it as Marsden’s Revenge.
It is the claim that:
The World Health Organization suggests that the optimum rate is somewhere between 5 and 15 per cent.
Marsden Wagner, a pediatrician who served as the European Head of Maternal and Child Health for the World Health Organization, appears to have been the driving force behind fabricating and publicizing it. Wagner, without any evidence of any kind, believed that the “optimal” C-section rate was somewhere between 5-15%. He convened a conference of like mind health professionals in 1985 and they simply declared the optimal rate by fiat.
Wagner was yet another elderly white male who felt the need to mansplain childbirth to us benighted women. From Grantly Dick-Read, to Fernand Lamaze, to Frederick LeBoyer, Robert Bradley and Michel Odent, white male doctors, trained in an era of medical paternalism, and with absolutely zero personal experience of childbirth, explained to women how childbirth “ought” to be done.
A bunch of old white men decided that childbirth is “better” when women experience it without pain relief, that vaginal birth is superior to cesarean section, and that foolish women should be taught that the pain of childbirth is all in their heads. Not coincidentally, these men basked in the glow of women without medical training who worshiped and idealized them. They are the superstars of the natural childbirth movement and they are and were bullshit artists of the highest order.
The childbirth lie that will not die is a testament to their talents.
Many years later, Marsden Wagner inadvertently acknowledged that the “optimal” C-section rate was simply made up. According to Wagner himself, in his 2007 paper Rates of caesarean section: analysis of global, regional and national estimates:
… [T]his paper represents the first attempt to provide a global and regional comparative analysis of national rates of caesarean delivery and their ecological correlation with other indicators of reproductive health.
Wagner had been touting an optimal C-section rate under 15% for 22 years before he even bothered to check whether it had any basis in reality. And although Wagner ended up “confirming” the fabricated optimal rate, the actual data showed the opposite. There were only 2 countries in the world that had C-section rates of less than 15% AND low rates of maternal and neonatal mortality. Those countries were Croatia (14%) and Kuwait (12%). Neither country is noted for the accuracy of its health statistics. In contrast, EVERY other country in the world with a C-section rate of less than 15% had appalling levels of perinatal and maternal mortality.
In 2009, the World Health Organization surreptitiously withdrew the target rate. Buried deep in its handbook Monitoring Emergency Obstetric Care, you can find this:
Although the WHO has recommended since 1985 that the rate not exceed 10-15 per cent, there is no empirical evidence for an optimum percentage … the optimum rate is unknown …
For 24 years the World Health Organization touted a C-section target that was an utter fabrication, created to suit the prejudices of its creators, without any evidence to support it.
Pretty embarrassing, no? And that probably explains why the WHO withdrew the target in a way that suggested that they hoped no one noticed their mistake.
However, this reticence to acknowledge that they had been hoodwinked means that a lot of people, including virtually all natural childbirth advocates and most of the mainstream media, never got the message. Andre Picard, Health Writer for The Globe and Mail, is among that group.
So let me make the point clear for Mr. Picard and others:
There is no optimal C-section rate and there was NEVER any evidence to support an optimal rate. There used to be a target, fabricated and publicized by ideologues, that was ultimately withdrawn by the WHO. Indeed, C-section rates of 40% or more are COMPLETELY COMPATIBLE with very low rates of perinatal and maternal mortality.
There’s a take away message for the general public in all this:
If an article, book or website quotes an optimal C-section rate, you can be assured that you are reading woefully outdated, inaccurate information about childbirth. That applies to Mr. Picard’s article as well.