The WHO’s recommended C-section rate is fake news

fake news and misinformation concept

Another day, another piece demonizing C-sections.

How the C-Section Went From Last Resort to Overused was written by Rebecca Onion and appears on Slate. We don’t even get to the body of the piece before the first falsehood appears. The subtitle is: The history of the surgery is rife with horror, but today, 1 in 3 American babies are delivered via the procedure, twice what the World Health Organization recommends.

There’s just one problem. The World Health Organization’s recommendation is fake news.

It is this fake news that forms the heart of Onion’s piece:

The WHO’s optimal C-section rate less than 15% is no different from Wakefield’s claim that vaccines cause autism. Both are lies in the service of ideology.

C-sections remained extremely rare throughout the 19th century. Even after the mid-20th-century advent of antibiotics and blood transfusions, which rendered the surgery much safer, the national rate of C-sections remained low. Then, the procedure exploded. Between 1965 and 1987, it rose 455 percent. Today, despite the work of the birth-reform movement of the ’70s and ’80s, 1 in 3 babies are still delivered by C-section. That’s twice the recommendation set by the World Health Organization, which states that a 10–15 percent rate is the ideal, since a rate higher than that has been assessed to have no effect on mortality rates, even as it pushes up medical costs and increases other risks for both mother and baby.

We live in a world where we have stopped battling over ideas, and started battling over facts themselves. Facts no longer inform beliefs; ideology begets lies masquerading as “facts” in service to a predetermined conclusions. We call this fake news.

One of the original examples of fake news is the World Health Organization’s recommended C-section rate. The WHO “optimal” C-section rate of 10-15% is a bald faced lie. It was fabricated from whole cloth apparently by a single physician; there was NEVER any evidence to support the lie when it was first released in 1985 and it has been thoroughly debunked repeatedly in the past 30 years. No matter.

The WHO’s claim that the optimal C-section rate is less than 15% is no different than Andrew Wakefield’s claim that vaccines cause autism.

I don’t say that lightly.

Wakefield’s claim has been used, as he intended, to call the safety, efficacy and desirability of vaccines into question and to demonize them. The WHO’s optimal C-section rate has been used, as Marsden Wagner its fabricator apparently intended, to call the safety, efficacy and desirability of C-sections into question and to demonize them.

Both claims were made up to serve the interests of the individuals who fabricated them.
Both NEVER had any support in the scientific evidence.
Both have been repeatedly debunked.
Both are fervently believed by some people despite the lack of evidence.
Both cause serious harm and very little good.

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 the fake news optimal C-sections rate. Wagner, without any evidence of any kind, convened a conference of like mind health professionals in 1985 and they simply declared the optimal rate of less than 15% by fiat.

Many years later, Wagner inadvertently acknowledged that the “optimal” C-section rate was simply made up. 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. (my emphasis)

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 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 unacceptable 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 …

In 2015 researchers from Harvard and Stanford — including Neel Shah, MD and Atul Gawande, MD, put a stake through its heart in the paper Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality.

They found:

The optimal cesarean delivery rate in relation to maternal and neonatal mortality was approximately 19 cesarean deliveries per 100 live births.

According to the press release that accompanied the paper:

“This suggests on a policy level that benchmarks for C-section rates on country-wide level should be reexamined and could be higher than previously thought.”

The graphs they created are quite impressive:

05810C12-DEB5-437B-84D8-9732AA3D4BFA

D1412974-3586-4E26-9272-64859387BCAB

These graphs show that C-section rate below 19% lead to preventable maternal and neonatal deaths. In other words, they show that the WHO “optimal” rate, far from being optimal, is actually deadly. They also show that C-section rates above 19% are NOT harmful. There appears to be NO increased risk of either maternal or neonatal mortality for rates as high as 55%.

Why is the WHO continuing to disseminate fake news? Why are they demonizing C-sections?

Because they honestly believe — in the absence of any scientific evidence and in the face of their claims having been debunked — that C-sections are “bad.” It’s the same reason that anti-vaxxers disseminate fake news about vaccines and demonize them. They honestly believe — in the absence of any scientific evidence and in the face of their claims having been debunked — that vaccines are “bad.”

Both are wrong. Sadly, it is women and babies who pay the price for their fake news.

  • Kim

    Not entirely off topic: the obstetrician in the case of the baby who was decapitated has been giving evidence to the GMC about the reasons for her decision to try to deliver the baby vaginally. http://www.dailymail.co.uk/news/article-5756487/Senior-NHS-gynaecologist-accused-causing-baby-decapitated-birth-gives-evidence.html

    • Mel

      The argument that the baby would have died even if there was a C-section rubs me the wrong way.

      I believe that the kid could have been fatally compromised from the cord prolapse and extreme prematurity – but nothing in a CS or even the first steps of neonatal resus are nearly as horrific as death by decapitation. Neonatologists are solid at quickly deciding if a baby can be revived – or if they should be allowed to pass comfortably.

      And – bluntly – if the baby was doomed, the doctor’s choice to aggressively pursue a breech vaginal birth on the mother makes even less sense. A c-section would have done less damage to the mother’s body as well as the baby’s corpse if the mother didn’t want to wait for her cervix to dilate to finish labor. I’m sure the mother had a lot of recovery time from the cervical incisions as well as some vaginal tearing – which she might have accepted as a side-effect of trying to save her baby – but her math might have been different for a baby who could not survive.

      • Sarah

        It’s not a good look to say the baby was going to die anyway, so that’s a mitigating factor for my decision to ensure it happened in one of the most horrific ways possible and at greater risk to the mother.

        • kilda

          If I were in her place, I can see telling myself the baby would have died either way, to make herself feel a little less awful. In fact if I were somehow in her place I’m sure I’d cling to that idea. Not that it would justify her bad decision, just that it would allow her to think she didn’t kill a baby who would otherwise have survived.

          I also think that this is behind her curious assertion that the baby had already died before the decapitation. She states this as a fact, but how could she possibly know it? I think it just feels less horrific to her that she accidentally decapitated a baby’s body, than that she accidentally killed the baby by decapitation.

          • Kim

            I think you’re right.

          • Mel

            I agree. My assumption was that the argument that the baby was going to die anyway was mainly for the psychological protection of the doctor. In fact, that’s the only reason for it; if the baby was already dead, the entire series of actions becomes macabre instead of a bad choice made during a time of panic.

      • Kim

        She’s quoted as saying: “But at some point between the general anaesthetic and the decapitation, the baby died – I’m not sure when.” So she seems to think the baby had already died by the time it was decapitated.

        She seems to have believed that by attempting a vaginal delivery there was a small chance of saving the baby, whereas there was almost no chance if she’d carried out a caesarean, because the particular circumstances made a caesarean very complex and time-consuming.

        It is unbelievably horrific. To a layperson like myself it seems like an extraordinarily bad decision but I’m interested to know whether medical people think there is any logic to it.

        • kilda

          I don’t see any way she could know the baby died before the decapitation and I think she is probably just telling herself that to decrease the horror of what happened. “At some point between the general anaesthetic and the decapitation…” – it just sounds like wishful thinking to me.

      • Hey Mel, thanks for the intelligent, sourced responses on Slate. (I’m assuming that’s you.) They add much value to the discussion.

        • Mel

          Thanks! I enjoy the articles on Slate, but the comments sections feel like the Wild West.

      • Madtowngirl

        Jesus H Christ. If this pregnancy makes it to birth, I’m having a MRCS. Period.

  • Sue

    If we know, from good data, that a Cesarean rate of at least 19% is needed to reduce mortality, then a higher rate is clearly needed to avoid injury, including hypoxia. Maybe even 30% ! (Faints at the thought!)

  • Who?

    OT but the Lisa Barrett roadshow continues to move through the Australian court system:

    http://www.abc.net.au/news/2018-05-22/midwife-pleads-not-guilty-to-manslaughter-charges/9788206

    • Gene
    • Anna

      Glad to see shes no longer smirking. Also glad to see she didnt plead guilty. I want to hear it all come out. What she did to those women and their babies and families is heinous.

    • Sue

      Now she’s studying law? Cos, of course, the Law needs more law-breakers?

      • Who?

        Yes my profession does not always acquit itself well.

        However, even these days I’d suggest someone with a couple of convictions for manslaughter might struggle to get admitted.

        I suspect she doesn’t want to do anything so mundane as be a lawyer, but rather (somewhat in the style of a homebirth midwife) peddle half-baked support to those who think they need it. While being paid in the coins down the back of the settee and jars of jam. Or, equally likely, seek ‘justice’ for herself from somewhere in the books.

  • Thanks for commenting on the Slate article.

  • Who?

    A little off topic, but this was on the radio yesterday. Just guess what a professor of midwifery from Western Sydney and a yoga teacher (love yoga, but honestly, stay in your lane) have to say about birth in Australia.

    http://www.abc.net.au/radionational/programs/lifematters/do-we-need-to-rethink-maternity-care/9767476

    • Anna

      Ugh. Do I even need to listen to it to know what they said?

      • Who?

        Seriously, save yourself the trouble.

        Epidurals cause a cascade of interventions, culminating in Bad Things. You can’t push if you have an epidural because you are numb from the waist down and flat on your back. More midwife led care would be better. Women need to be told What To Expect (though I’m thinking that doesn’t include informed consent about the risks of vaginal delivery).

        Oh and if you have forceps, you didn’t have a normal delivery therefore you can’t blame vaginal delivery for any injury you get. Yes, that came out of the yoga teacher’s mouth. Just before the cascade of interventions.

        I made myself listen to the end, but it didn’t do me much good.

        • Anna

          Yeah thats about what I thought. At the moment theyre desperate to deny anything bad can happen from vaginal delivery. I strongly suspect more women would deliver vaginally if epidurals were more encouraged, especially for first timers but they are so demonised thats its become rare to hear women say that want an epidural from the outset.
          Ive been doing a lot less headdesking since most of the Aussie NCB groups blocked me.

        • Anna

          Hey I looked at the FB profile of the yoga teacher who is also a registered physiotherapist – you guessed it folks, anti-vaxxer!

          • Who?

            That is really annoying. Why is the ABC promoting anti-vaxxers now?

    • lsn

      The ABC need to seriously start screening their guests better. I cannot imagine a situation where a professor of cardiology would be teamed with with a personal trainer to talk about how if you have a heart attack it’s your fault for not eating organic or some such.

  • Kim

    I clicked through from the article to the WHO guidance. It has a list of frequently asked questions, one of which is why caesarean section is so common now. Here’s the answer (or part of it):

    “Some of the most omnipresent reasons behind this rise are the fear of pain during birth including the pain of uterine contractions, the convenience to schedule the birth when it is most suitable for families or health care professionals, or because it is perceived as being less traumatic for the baby. In some cultures, caesarean section allows choosing and setting the day of the birth according to certain believes of luck or better auspicious for the newborn’s future. In many countries, societal consensus has imposed a demand for the perfect outcome and doctors are sued when the results are not as expected fueling the fear of litigation. In addition, in some societies, delivery by caesarean section is perceived to preserve better the pelvic floor resulting in less urinary incontinence in the future or sooner and more satisfactory return to sexual life.”

    It’s a strange list of reasons. I’ve rarely heard of anyone having a caesarean because of the fear of pain during birth, though I’m sure it does happen. Still, it wouldn’t be the primary reason. About half of caesarean sections (in the UK, at any rate) are emergency sections, and are carried out because of an imminent threat to the baby. “Societal consensus has imposed a demand for the perfect outcome”. That’s another odd one, isn’t it? Surely a “perfect outcome” means “healthy mother and baby” – and why wouldn’t you want that?

    Again, “in some societies, delivery by caesarean section is perceived to preserve better the pelvic floor resulting in less urinary incontinence” – surely this isn’t a matter of perception but a matter of fact?

    • rox123

      This (the preservation of pelvic floor function) was my reason for choosing the c section, otherwise I would have been the perfect candidate for VB: good sized baby, healthy me, healthy baby, good presentation. But the implication of WHO is that I should not have been allowed a c section. Who gives a crap what patients actually want? Unless I wanted to give birth at home, then it would have been ‘good job, mama!’

    • Wonder Woman

      Exactly, a weird list. Especially this “convenience to schedule the birth”. First, there’s nothing wrong with it – if births can be planned for everyone’s convenience, why not? Second, that is in my opinion the least important reason of all. And those “perceived” things – baby’s safety and pelvic floor preservation are very real issues yet they are mentioned in such a dismissive manner.

    • MaineJen

      That’s just bizarre. Surely the most common reason for primary c section would be problems during labor, or anticipated problems? The WHO just sounds very judgy.

    • The Bofa on the Sofa

      I’m not going to bother looking at the list, but does it include the improvement in the c-section methods?

      This is a two-sided coin. Balancing the risks and benefits. So as the risks of c-sections become less, the balance will tilt more that way.

      When my sister had her kids, all by c-section, she was completely under. Dad was not allowed in the OR and had to peak through the window. That wasn’t all that much fun.

      But with our kids, I was in the OR and my wife was awake through them. That was a joyful time, in fact. The atmosphere was casual and bright.

      So if we had the option of complete anesthesia and me out of the room, or being awake and me in the room, it’s obvious that the second situation is more attractive.

      And I’m not qualified to comment on surgical methods, but I know that they have also changed for the better.

      So how have the benefits and risks of the vaginal birth changed? Have they changed as dramatically? If one side of the coin doesn’t change and the other changes for the better, of course you are going to see more of the other way.

      If that isn’t included in their list, then it is completely worthless.

      • fiftyfifty1

        Yep. This is the crux of the matter.

        CS have become much better. And as you say not just the surgical technique, the anesthesia too. And not just the anesthesia during, the anesthesia after too. I was given Duramorph in my CS spinal, and it was a dream. It provides pain relief even after the spinal has worn off. I can honestly say I was never in pain post-op, just sore. I have been more sore after doing a hard abdominal workout. And the Duramorph helped so much with the afterpains- I could feel them but they didn’t hurt one bit. The whole thing didn’t slow me down at all. I delivered at lunch time and a couple hours later I was sitting up in my hospital bed getting caught up on my work dictations. I ate right away with good appetite, never a hint of post-surgical ileus. This is not the way CS used to be even in the 1990s much less in the 1960’s back in the “good old days” before the rate went up.

        And at the same time, vaginal birth has become worse. Women are delivering their first babies later and later. When is a woman’s chance of having a spontaneous vaginal birth the highest? When she is in her teens. Teen birth used to be common, although few realize it thinking that “teen births” are a recent thing. But teens in the past were married, so nobody paid it any mind. During the baby boom, women commonly married right after highschool graduation and had their first baby by 19. And women are having fewer babies now. It used to be common for a woman to have 4+ babies and complete her childbearing, all before the age of 30. The first birth is the hardest and after that it gets easier (as long as a woman is still young and healthy). Many fewer of these predictably easy births still exist.

        I can’t believe they aren’t talking about these reasons. Or rather I can believe it and it shows their bias.

        • Sue

          This sums it up beautifully – vaginal births getting riskier, Cesareans and epidurals less risky, and forceps being recognised as causing injury -> makes sense that Cesareans would become more common.

    • Jessica

      What a bizarre list. Among people I know who have had C sections, the reasons were (1) breach position; (2) prior spinal fusion making VB high risk; (3) repeat CS due to high risk associated with VBAC after original emergency CS; and (4) failure to progress on post term pregnancy with evidence of fetal distress. Not that it is wrong to plan for other reasons, but I don’t think they are commonly used “just” for convenience.

      • Wonder Woman

        I think what they refer to is what’s behind the increase in c-sections, beyond what’s considered medically necessary.

        • Jessica

          That makes somewhat more sense but how do they determine whether or not it is medically necessary? In some of the above cases it could have gone the other way (choosing VBAC had risks but wasn’t impossible, spinal surgery didn’t make Csection impossible, just likely to be more painful and have complications). It seems unlikely that the delta between a 10 percent rate and a 30 percent rate is purely elective C sections.

          • Sarah

            Trick question. None of them are medically necessary.

          • Anna

            Grade 4 previa and vasa previa is a “good enough” excuse according to the Vag Police BUT of course you dont have evil ultrasounds to diagnose. Your MW will pick it up either by pinnard or intuition!!

        • The Bofa on the Sofa

          I still want to hear of an example of a c-section that anyone knows was not necessary.

          I’ve presented this challenge many times, and no one has ever come up with one.

          For good reason: it’s impossible to do.

          It is logically impossible to look at a c-section that was done and to claim that it was not necessary. The problem is that you can’t know that the birth would have been successful had the c-section not been done.

          But let’s get away from the “unnecessary c-section” and look at the question of “non-medically indicated” c-sections. How common are they, really? How much of the 33% c-section rate is due to completely non-indicated c-sections? Is it 1% of it? Maybe. But look at some of the reasons for c-sections: breech? Of course not. Yeah, you CAN do vbacs in many cases, but is it really right to require women to try a VBACS? Or should it be left up to the woman? (my wife would have never wanted a vbacs, even if the local hospital were equipped to do them safely; she would have declined; should she have been forced to do it?)

          Post-dates with failure to progress? Yeah, let’s not give women the ability to opt out. Force them to sacrifice their babies, right?

          No, once you start talking “medically necessary” you end up begging the question big time.

          • crazy mama, PhD

            Yup. I was born by C-section. It wasn’t an emergency; I wasn’t in distress. My mother had just been stuck at 9.5 cm for a long time and tried a bunch of different things and when the doctor said “we can keep trying for another hour or we can do a C-section now,” my mom picked the C-section.

            A couple of times when people start going on about unnecessary C-sections, I have directly asked them if they thought this one was unnecessary. Not one has given me a straight answer.

          • Roadstergal

            Yeah, it’s like when I talk about being from the Formula Generation and asking what, exactly, I missed out on. I know what they’re thinking, but they won’t say it out loud.

        • Daleth

          I think what they refer to is what’s behind the increase in c-sections, beyond what’s considered medically necessary.

          Two points:

          (1) Women have the right to choose a c-section even when there is no medical reason for it. It’s her body and her baby (not to mention, statistically c-sections are actually safer for babies than vaginal birth is).

          (2) Some c-sections are unquestionably absolutely necessary–in other words, you know in advance that if the c-section isn’t done, that specific baby will die or be seriously injured. For instance, if the baby is transverse (sideways in the womb), it’s physically impossible to get it out any other way. If mom just had a placental abruption, that baby will definitely die if she doesn’t get a c-section.

          But most c-sections are medically INDICATED. That means that the baby and/or mom are in a situation that, statistically speaking, presents a risk of serious injury or death if you don’t do a c-section. In other words, you don’t know for sure that this specific baby definitely is going to be injured or killed by vaginal birth, but you do know that it’s at high risk. For instance, breech babies are much more likely to die or be brain damaged or otherwise seriously injured if they’re born vaginally than if they’re born through c-section. Same goes for twins and other multiples, and extreme preemies (if for some medical reason there’s no way to prevent the early birth, it’s best to do it by c-section). And some moms are at higher risk due to their own medical issues.

          When it’s medically indicated, there is no way, before or after the c-section, that you can ever be sure that for that specific baby, the c-section definitely was necessary. But you do know that if doctors routinely do c-sections on babies in that situation (breech, twins, etc.), then more babies will survive and be healthy than if doctors routinely did NOT do c-sections in those situations.

          • Wonder Woman

            That’s why I wrote “CONSIDERED medically necessary” (of course, I understand the concept of “medically indicated”) – by those who are in a state of moral panic, as described by dr. Tuteur. I’ve been reading this blog for years, no need to explain to me women’s right to have a c-section for whatever reason important to them. I am also not a native speaker of English, so I may not be expressing myself perfectly 🙂

    • AnnaPDE

      Women these days are sooo unreasonable, wanting their kids to be born under the right horoscope and without any clearly preventable damage to baby and themselves.

    • fiftyfifty1

      The one about fear of pain during birth can actually be a factor in countries where epidurals are hard to access. If getting a CS is the only way to get pain relief then that makes sense. But in most countries this is not a factor at all. Certainly not in the US.

      • Sarah

        Hmm. Yes and no. There are plenty of situations where epidurals do exist and are widespread in a country but a woman might reasonably worry about being able to access one. There’s the UK, for a start. Couldn’t say they’re inherently hard to access but denial or simply lack of resources is a realistic possibility. This is before we add in issues like a history of quick birth: I can see why a woman with a history of fast labour might want a section at least partially because she doesn’t fancy labour without an epidural. I would say fear of birth pain as a reason for CS isn’t limited to countries where CS is the only way to get pain relief.

        • LaMont

          Not to mention, the Venn diagram of people who list “fear of the pain” on such lists, and people with a religious determination to judge women for the functioning of their reproductive organs is a circle.

    • kilda

      >>In many countries, societal consensus has imposed a demand for the perfect outcome and doctors are sued when the results are not as expected fueling the fear of litigation.

      Yeah, some cultures have these weird ideas about it being important for the baby to come out alive. They get all bent out of shape if the child doesn’t live.

      • Merrie
        • Daleth

          If the rate is high because women want c-sections, as is apparently the case in Brazil, then so what? Their bodies, their babies, their decision.

          The plastic surgery rate is super high in Los Angeles. Why do so many people try to guilt-trip women who have c-sections and doctors who provide them (“omg major surgery so unnatural etc.”), while hardly anybody ever tries to guilt-trip plastic surgery patients and doctors?

          • Merrie

            It sounds like women who want vaginal births in Brazil have a hard time getting them. If it were just an issue of it being easy to have either type of birth on demand according to your preference, that would concern me less.

          • Daleth

            I agree about what situation would be concerning. But from what I’ve heard about Brazil, the high CS rate is because private hospitals will provide whatever birth the mother wants and Brazilian women with money overwhelmingly prefer c-sections.

          • The Bofa on the Sofa

            Agreed. Is there any basis for the claim that women who want vaginal births are “having a hard time getting them”?

        • Sarah

          The issue there appears to be with the other nonsense rather than the rate itself. If Brazil had a rate that high because women were making informed choices that were being respected, well and good.

    • Anna

      Thats such crap (not your comment – that reasoning from the WHO site). Most people I know who had c-sections either had a breech baby, long labour not progressing and fetal distress or some other risk factor. It certainly not 33% wanting certain dates or fearing birth. Frankly thats offensive, not just to women but also to health professionals.

      • Sarah

        Being afraid of an inherently dangerous process and wanting the baby to be born at a date that is particularly convenient, perhaps for childcare and family help reasons, are both 100% valid reasons to want an ELCS in any case.

        • The Bofa on the Sofa

          My FIL is going in for a valve replacement surgery today. They wanted to get it done ASAP, but scheduled it at a time that was convenient to the surgeon and the hospital (not so much the patient, in this case, but he didn’t have any problems with it).

          Believe it or not, they didn’t wait until the valve completely failed to do the replacement!

          • Sarah

            He’s a bloke though, so that’s ok.

          • LaMont

            Also, a heart condition is health-related. Having a baby isn’t a health issue, it’s the spiritual creation of a new soul, bringing a new being earthside! The only people who get health problems and need medical intervention are the un-elect, who will go to woo-hell.

          • The Bofa on the Sofa

            I do get a chuckle of out of thinking of my 80 FIL as a “bloke.” For some reason, when I think of a bloke, I always get the image of a beer drinking rugby player (but not necessarily Fosters)

          • Who?

            My then 80 year old dad had five arterial bypasses mid last year-fantastic and life changing surgery. I hope your FIL recovers quickly.

      • Roadstergal

        I mean… I’d freaking well be petrified of a VB if I were having a baby. All of my surgeries have been nice and calm.

  • rox123

    How about those women that want an elective C Section? What women want does not matter at all? Or it matters only if they want midwife assisted vaginal births?

  • Elizabeth A

    I want someone to rewrite all of these articles as concerns about the decrease in forceps deliveries since 1965.

    • MaineJen

      Wasn’t there a midwife here once, bemoaning the loss of forceps skills in today’s OBs? It’s like…yeah, because we can safely do c sections now. Clearly that’s preferable.

      • fiftyfifty1

        Although I gotta admit, it makes me a little wistful anyway. I trained when there were still wizened old forceps-gurus who did have amazing skills. Docs who had delivered babies to women in iron lungs during polio epidemics, docs who had done myriad mid and high forceps, docs who had seen and done it all. I mean the fact that we can just do safe CS instead is an overwhelmingly positive development. I would choose a CS over forceps for myself every time. But every once in a while there is still a woman who wants a huge family and has a wonky pelvis, and then advanced forceps skills are magic.

  • lawyer jane

    I mean, I wonder how horrifying the development of open-heart surgery would sound? Or any surgery, really? The 19th-century history of the c-section is interesting, and likely fertile (heh) ground to discuss all sorts of important things in the history of medicine, like race and gender. But it actually has very little to do with how and why c-sections are performed today.

    Also, the Slate article’s weird insistence that it was improper to value the life of the mother over the baby is discomfiting… I don’t think she actually understands how those ethical issues are navigated today. (Hint: it’s STILL the mother, until the baby is born.)

    And of course, there’s an utter lack of any attempt whatsoever to examine whether the evil “interventions” have actually improved maternal and infant outcomes; just citing to the 70s and 80s “birth reformers” as if it’s self-obvious that they were correct. Perhaps the reason the “birth reform” movement did not change the c-section rate is because c-sections are good medicine; whereas other practices that DID change were not good medicine?

    BLAH. Journalists should have to be certified and registered as competent science journalists before they’re allowed to publish.

  • Jen

    Thank you for posting. I saw the headline on slate and my blood boiled. Didn’t want to click on it and drive up views so I was glad to find it here. Makes me appreciate what you do all the more. It’s exhausting wading through all the dangerous idealist opinion pieces posing as evidence based medicine.