A recent article in the British Medical Journal (click here for an abstract, and here or here for a summary of and commentary on the contents – BMJ don’t let you read for free!)

In short, the article says that too many Caesareans are being performed on women in emergency situations where these are unnecessary. Surprise!!

Over a third of all Caesareans, for example, are carried out because of a failure to progress, and in more than half of these cases the obstetrician did not even attempt a vaginal delivery using forceps or ventouse. Many consultants will reverse the decision of a more junior doctor to go for a Cesaerean and will then successfully deliver the baby using forceps or ventouse.

What can we conclude from this?

The authors conclude that more experienced, more skilled obstetricians are needed because the junior doctors are letting their patients down. There is almost certainly some truth in this – and I would not argue about whether junior doctors are letting their patients down if they routinely promote Cesaerean delivery without first exploring the option of assisted vaginal delivery properly.

However, I think what may be more interesting is what the authors did not conclude. For example, there was no discussion it seems of whether “failure to progress” is even a proper ground for surgical intervention. What does “failure to progress” mean, anyway? Only that the delivery is not proceeding quickly enough for the liking of the doctors. If a relatively junior obstetrician doesn’t have the time to let labour take its natural course, what hope would mothers have relying on the even busier, even more self-important consultants?

Why not try getting rid of the doctors altogether, for a while at least, to let the mother relax somewhere peaceful with a patient, calm midwife to encourage and support her, and to guide her journey with respect? Why, if doctors are getting it so badly wrong, is the “obvious” solution that we just need more and better doctors? Don’t many (most?!) of these women just need more time, and more space, and a better environment in which to bring forth a miraculous new person?

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