The high rate of Caesarean sections (one in every five births in the UK and in Sweden; one in three in the US) is probably of more interest to me than to you.
One of the reasons for these high numbers is women’s preferences: half of the Caesareans in the UK are elective. Choosing to undergo major surgery rather than to go through a natural process is an odd choice in my opinion. But I guess those women may have greater faith in modern technology than I do, or be more averse to pain and hard work, or put greater value on convenience. Anyway, that’s not why I’m posting – other women’s reasons for elective Caesareans are relatively irrelevant to me because I’m not even considering that option.
What I find more interesting right now is the other half of Caesarean sections, and why they are performed. It appears that doctors’ inexperience is one major contributing factor: junior doctors are more likely to opt for a Caesarean because they do not have sufficient experience in other assisted methods of childbirth
An article in the New Yorker highlights a related reason: the standardization of childbirth. Teaching all obstetricians to perform one standardized procedure well is easier than teaching them the numerous more “manual” alternatives. And Caesarean section is a standardizable procedure – it is a technical process that doesn’t vary much from patient to patient. Using the forceps, on the other hand, is more of a craft – it requires the doctor to develop a “feel” for using the right amount of force, etc.
The question facing obstetrics was this: Is medicine a craft or an industry? If medicine is a craft, then you focus on teaching obstetricians to acquire a set of artisanal skills. You accept that things will not always work out in everyone’s hands.
But if medicine is an industry, responsible for the safest possible delivery of millions of babies each year, then the focus shifts. You seek reliability.
Whereas before obstetricians learned one technique for a foot dangling out, another for a breech with its arms above its head, yet another for a baby with its head jammed inside the pelvis, all tricky in their own individual ways, now the solution is the same almost regardless of the problem: the C-section. Every obstetrician today is comfortable doing a C-section. The procedure is performed with impressive consistency.
Found via Salon.
I agree that elective C-sections are popular these days, but I beleive that litigation dominates the motivation away from natural birth. eg:
http://www.adelaide.edu.au/news/news7741.html
“The threat of litigation is one of the major reasons for obstetricians leaving obstetrics and for a huge escalation in caesarean section births.” “The threat of litigation is one of the major reasons for obstetricians leaving obstetrics and for a huge escalation in caesarean section births.”
Yeah, that would also make sense. I can see why a patient would believe that doing something hi-tech must be better than not doing it – and blame the doctor if it wasn’t done.