An industry devoted to demonizing C-sections


Slate has published a terrific piece about C-sections written by Dr. Chavi Eve Karkowsky entitled Sorry You Were Tricked Into A C-section; What disapproving friends don’t understand about cesarean births.

Dr. Karkowsky perfectly captures the disdain and pity faced by women who have undergone a C-section:

You’d think any woman who has recently had major abdominal surgery and has a newborn to care for would have enough to deal with, but too often there’s more… A woman who has had a cesarean birth gets comments from her friends—online friends, IRL friends—mostly congratulations, but also messages of regret…

…[H]er friends and relatives tell her, outright or through subtext, that she must have been snookered. She was fooled and then underwent some shady butchery…

Dr. Karkowsky goes on to explain why these well meaning friends and relatives are often wrong. C-sections save tens of thousands of live in this country alone, each and every year.

I enter an operating room to do an unscheduled cesarean birth with gratitude… How lucky are we—how lucky is this mother and this baby, but also, selfishly, me—that we have another way. How lucky that I walk into that operating room reasonably sure that all three of us will come out, breathing, at ease.

So where did these “well meaning” friends and relatives get the idea that C-section are unnecessary? If you want to know the answer, follow the money. The money will lead you to an entire industry devoted to demonizing C-sections for its own economic benefit: the natural childbirth industry.

“Big Birth” is a multi-billion dollar industry, comprised of midwives, doulas, childbirth educators, and lay people who offer dubious services like placenta encapsulation. They have industry foundations and groups, complete with lobbyists and public relations people, devoted to promoting the economic well being of their members. Recognizing that it is rather crass to straightforwardly promote your own employment prospects, “Big Birth,” like other industries, presents itself as piously concerned with what is best for its customers. Big Oil just wants its customers to have access to the “best” method of heating their homes; Big Pharma just wants its customers to have access to the “best” medications; and Big Birth just wants its customers to have access to the “best” form of birth, vaginal birth.

There are plenty of goods and services that Big Birth can provide, but there are two that it cannot and both, therefore, threaten its economic bottom line. Those services are epidurals and C-sections and both are demonized with passion.

“Big Birth” demonizes epidurals despite the fact that there is no evidence – zip, zero, nada – that pain relief in labor is anything but beneficial for those who want it. But the effort to demonize pain relief in labor (“It’s good pain!” “Real women embrace the pain!” You won’t bond with your baby if you don’t feel the pain!”) pale in comparison to the frantic efforts to demonize C-sections.

C-sections dramatically cut into the profits of Big Birth so they must be caricatured as unsafe, unnecessary and positively harmful. When friends and relatives tell a C-section mother “outright or through subtext, that she must have been snookered. She was fooled and then underwent some shady butchery,” they are channeling the propaganda of Big Birth. Big Birth has been so successful in promoting their own economic self-interest, that their propaganda has become “conventional wisdom,” despite an almost complete dearth of scientific evidence to support their claims.

Birth Birth has been aided immeasurably by two factors. The first is the alliance with those who wish to save money by denying care, whether that care is necessary or not. Cesareans cost more than vaginal birth. Big Birth provides public relations cover for those who want to reduce the cost of obstetric care. Demonizing C-sections serves the economic bottom line of cost cutters and of Big Birth.

The second factor is that the late Marsden Wagner, MD, a diehard partisan of Big Birth, managed to gain a position of influence in the World Health Organization back in the 1980’s. Dr. Wagner almost single handedly engineered the now discredited WHO claim that the optimal C-section rate is between 5-15%. The claim was withdrawn in 2009 when the WHO acknowledged that there was no evidence and there HAD NEVER BEEN ANY EVIDENCE to support any optimal C-section rate, let alone the one decreed by Dr. Wagner. Indeed, international data shows that C-section rates under 15% are accompanied by unacceptably high levels of maternal and perinatal mortality.

Apparently the WHO was embarrassed by the way that it had been snookered and therefore buried its retraction in the middle of a large document leaving most people unaware of the retraction. Hence the claim continues to be repeated despite the fact that it was never true and has since been disavowed.

Are there too many C-sections? Possibly, and we should always be researching ways to lower C-section rates as far as we can without compromising safety. But the fact is that the countries with the best maternal and perinatal mortality rates have an average C-section rate of 22%, and very high C-section rates (up to 42% or more in the case of Italy) are completely compatible with excellent maternal and perinatal outcomes.

Some people have been snookered, but it isn’t the mothers who give birth by C-section. It is those who promote the idea that most C-sections are unnecessary, done for doctor convenience and harm mothers and babies, who have been fooled.

Follow the money. Those whose bottom line is threatened are the most vocal in demonizing C-sections. Big Birth is a huge industry, and like any industry, we should take their claims with not simply a grain of salt, but an entire shaker.