Letter to the Editor: "Oh, Snap!" Edition
In response to a commentary in the October edition of ObGyn News by David Priver (summarized on Birth Sense here), Dr. Katharine Morrison wrote the following gem, which was published in the December edition.
C-Section Rate is Insane
Yes! Dr. Davis M. Priver has correctly identified all the major issues in our insane cesarean section rate in his commentary (“The Cesarean Section: A View from the Trenches,” October 2010, p. 18).
- The drift away from inducing at 42 completed gestational weeks or earlier, which is not supported by any scientific study.
- The unwarranted fear of the vaginal breech.
- A lack of understanding that spontaneous labor is infinitely superior to any form of induction.
- The demise of the operative vaginal delivery—those who are experts are not asked to teach the residents this very valuable skill.
- Hysteria around vaginal birth after cesarean, which is most often a safer alternative than the repeat cesarean.
I would add to these the reliance on electronic fetal monitoring, which has not changed the cerebral palsy rate one iota and has never been shown to be superior to intermittent auscultation. We are not following our own literature, the American College of Obstetricians and Gynecologists Practice Bulletins. Or common sense, and yet seem unable to stop.
Dr. Priver also gives voice to the most important points; we have not helped women or their infants in any way by delivering them by cesarean section. On the contrary, we have a generation of young women with scarred uteri whose future deliveries will be at higher risk for placenta accreta, cesarean hysterectomies, bowel and bladder injuries, and death.
We must stop making excuses, stop blaming litigation and patient, and return obstetrics to safe, scientifically supported practices.
Katharine Morrison, M.D.