I’m back to reading Optimal Care in Childbirth and it starts out discussing “The Cesarean Epidemic”. Let me preempt this by saying I have nothing inherently against c-sections; they can and do improve outcomes and save lives when truly medically necessary. If you had a cesarean birth, please do not read any judgement in these lines. 💛
As I’ve mentioned, I love the academic nature of this book; everything is backed by thoughtfully- and scientifically-interpreted data and #evidence - and as an engineer, sometimes I just really like numbers. 🤓
After a detailed discussion of outcomes, liabilities, autonomy, and indications, the chapter discusses what is really driving the cesarean rate (which is generally higher than necessary): money and power. (Please bear in mind that this is an extremely condensed version! I’m just trying to sum up the general flavour of the chapter).
💰 Obstetrics is a business. Cesareans cost more (/doctors are paid more than for attending vaginal births); surgery increases other billable services such as anesthesia, and lengthens postpartum stays. When hospitals reduce CS rates, their revenues fall. (Worth noting that this is written from an American perspective. For example, a California survey found CS to be 17% more likely at a for-profit hospital than a non-profit one). Planned CS also reduce overhead by introducing staffing predictability.
⚡️Obstetricians have attained a high status in the medical hierarchy with accompanying financial rewards, prestige, and control. Using the idea that it is impossible to diagnose a birth as “normal” except in hindsight, obstetric leaders honed in on the pathological potential of birth. It is implied then that only OBs - qualified to deal with pathology - are qualified to deliver babies. There is a power inequity between a layperson and a medical professional. How often do you hear that someone was “allowed” to birth vaginally “Permitted” to do what the female body is designed to do.
(Continued in comments)...
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