Marsden’s Mendacious Mansplaining: the “optimal” C-section rate

Earlier this week, by rescinding and abolishing C-section rate targets, the UK finally acknowledged two things we have known for decades:

1. there is NO optimal C-section rate
2. C-section target rates lead to preventable DEATHS

Why did anyone think that there was an optimal C-section rate?

Because of Marsden’s Mendacious Mansplaining.

In 1985 Marsden Wagner, a World Health Organization official, simply announced, and then got the WHO to ratify his personal belief that the optimal C-section rate should be between 5-15%.

Wagner, a pediatrician who served as the European Head of Maternal and Child Health, appears to have been the driving force behind fabricating and publicizing it an optimal C-section rate. 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 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 “optimal” C-section rate 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 …

Yet despite this acknowledgment, the WHO to this day has CONTINUED to promote a C-section target that was an utter fabrication without any corroborating scientific evidence.

And the ultimate tragedy is that babies and mothers continue to die preventable death to support what is ultimately nothing more than one man’s personal prejudice.

Finally the UK recognized and admitted it.