Why does The Lancet use an optimal C-section rate that has been debunked? Truthiness!


I’ve written many times about the obstetric lie that will not die: the unsubstantiated “optimal” C-section rate of less than 15%.

  • 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 officially debunked in 2015 when it was shown that a minimal rate of 19% was necessary for safety.

Nonetheless, a series on C-sections just published in The Lancet uses the thoroughly discredited “optimal” rate of 10-15% as a benchmark. This despite the fact that the World Health Organization, which fabricated the “optimal” rate has acknowledged there was NEVER any evidence to support it.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]They feel in their gut the optimal C-section rate must be 10-15%, damn the absence of evidence and the existence of research that shows they are wrong.[/pullquote]

Buried deep in its 2009 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 …

Indeed Marsden Wagner, the WHO official who appears to be behind the fabricated rate acknowledged in a paper he wrote in 2007:

…[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…

In that paper Wagner found that nearly every country with a C-section rate less than 15% had appalling levels of maternal and neonatal mortality.

A 2015 paper Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality found that a minimum C-section rate of 19% is required for low levels of maternal and neonatal mortality.

National cesarean delivery rates of up to approximately 19 per 100 live births were associated with lower maternal or neonatal mortality among WHO member states. Previously recommended national target rates for cesarean deliveries may be too low.

Ironically, the press release accompanying The Lancet series was followed by this correction:

The level of C-section use required for medical purposes provided in the press release below is no longer a recommendation from the World Health Organisation (WHO). In the 2015 Statement on Caesarean Section Rates, WHO stated that “Every effort should be made to provide caesarean sections to women in need, rather than striving to achieve a specific rate”.

The 10-15% C-section use is still used as a practical indicator of underuse and overuse.

This line has now been corrected from:
It is estimated by the World Health Organisation that 10-15% of births medically require a C-section due to complications, suggesting that average C-section use should lie between these levels.

It is estimated that 10-15% of births medically require a C-section due to complications, suggesting that average C-section use should lie between these levels.

Why is The Lancet still using the never empirically supported, withdrawn and now discredited “optimal” rate of 10-15%?

They have replaced scientific truth with truthiness.

Steven Colbert coined the term “truthiness.” According to Wikipedia:

Truthiness is the belief or assertion that a particular statement is true based on the intuition or perceptions of some individual or individuals, without regard to evidence, logic, intellectual examination, or facts. Truthiness can range from ignorant assertions of falsehoods to deliberate duplicity or propaganda intended to sway opinions.

In an out of character interview with the Onion’s A.V Club Colbert explained:

Truthiness is ‘What I say is right, and [nothing] anyone else says could possibly be true.’ It’s not only that I “feel” it to be true, but that “I” feel it to be true. There’s not only an emotional quality, but there’s a selfish quality.

For reasons that I do not fathom, the authors of The Lancet series, as well as many others working on the issue of C-sections, feel in their gut that the optimal C-section rate must be 10-15%, damn the absence of evidence and the existence of research that shows they are wrong.

The insistence on using a discredited optimal C-section rate puts the entire Lancet series in question. According to the press release:

Globally, the number of babies born through caesarean section (C-section) almost doubled between 2000 and 2015 – from 12% to 21% of all births – according to a Series of three papers published in The Lancet and launched at the International Federation of Gynecology and Obstetrics (FIGO) World Congress in Brazil. While the life-saving surgery is still unavailable for many women and children in low-income countries and regions, the procedure is overused in many middle- and high-income settings.

The authors insist that this is a crisis, but if they were to use the actual scientific evidence that a minimal C-section rate of 19% is necessary for low rates of maternal and neonatal mortality there wouldn’t be a crisis at all. The current C-section rate would be only slightly higher than the minimally acceptable rate, a reason for satisfaction not alarm.

By replacing truth with truthiness, the authors have ignored science in favor of personal belief. That is an unpardonable sin for anyone claiming to be a scientist.