Dear Childbirth Connection …

Dear Childbirth Connection

The email is entitled Reducing the c-section rate could save $5 billion annually and it was sent out by the Childbirth Connection, a group that lobbies on behalf of “natural” childbirth professionals like childbirth educators, doulas and midwives.

According to the email:

…For the benefit of public health – for the 4 million women who give birth every year…

What is at stake for payers? Not only do unwarranted c-sections create greater health risks for women and babies, this study shows that they also dramatically increase costs for employers and, through Medicaid programs, state and federal budgets. Medicaid programs paid nearly $4,000 more for c-sections than vaginal births, while for commercial insurers the difference topped $9,500…

Here’s my response:

Dear Childbirth Connection,

I’d like to reduce the C-section rate and associated expenditures. Please tell me exactly which specific C-sections of the more than 1 million performed last year are the unnecessary ones.

You do know, don’t you? Otherwise you wouldn’t blithely advocate that obstetricians reduce the C-section rate arbitrarily because that would result in preventable perinatal deaths, right? So don’t wait, tell me because I am breathless with anticipation. I, like most obstetricians wish I knew in advance which C-sections were unnecessary and which were not. You think you know so please share your incredible insights with the profession.

Wait, what? You have absolutely no idea which C-sections are necessary or unnecessary except in hindsight? And you have no intention of taking responsibility for determining which C-sections are unnecessary?

What methods have you developed to determine in advance which C-sections are unnecessary? None, you’ve developed none. Well it is a tough problem to solve, but surely you’ve spent millions supporting studies that will answer that question. What? You haven’t spent a penny researching methods to determine in advance which C-sections are definitely life saving and which are not?

Okay, but surely you’ve been researching technology that will demonstrate which babies will have shoulder dystocia, which breech babies will have trapped heads, and which babies aren’t getting enough oxygen. What? You haven’t spent a penny on that, either.

So let me get this straight:

The Childbirth Connection has absolutely no idea which C-sections are necessary and which are unnecessary, but they are sure that too many unnecessary C-sections are being done?

Why should we pay any attention to people who bleat about a problem they make no effort to solve?

And while I’m asking questions, I have a few more. Your letter claims:

…Maternal infections, prolonged pain, life-threatening complications, and childhood chronic illnesses…

First of all, there is no evidence that C-sections cause chronic childhood illnesses. I realize that the folks at the Childbirth Connection are desperately hoping that is the case, because then they could brandish it against those who point out that C-sections save literally tens of thousands of lives each and every year. But since is hasn’t been proven, why are you pretending that it has?

Second, how many lives are saved by C-sections and how many might be lost by arbitrarily aiming for a lower C-section rate. Let me guess: you have no idea about that, either.

You write:

The World Health Organization recommends a c-section rate of 15% or less for any country.

That’s not true, either. The WHO withdrew that recommendation more than 3 years ago, acknowledging that there had NEVER been any data to support ANY specific C-section rate. Why are you deliberately misrepresenting the position of the WHO, or do you simply fail to keep current with the latest recommendations in obstetrics?

And you say:

… [W]e must target the areas where we can reduce cost while simultaneously improving health and safety.

That’s about as helpful as saying that we should stop all violence and bring about world peace. Everyone wants it, but no one is sure how to reliably accomplish it.

Finally, I must ask:

Why are you obsessed with process? Isn’t the goal a healthy mother and a healthy baby? Shouldn’t the outcome be focus of our efforts?

Oh, right, I remember now. Your members can’t make any money from C-sections and you are promoting their economic interests. That’s why you concentrate on procedures and entirely ignore outcome.

I guess that’s why you complain about a problem that you are sure can be solved without having a clue as to the solution.

8 Responses to “Dear Childbirth Connection …”

  1. February 23, 2013 at 3:23 am #

    I love you Captain Obvious… you care about you patients that is for sure!!


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