Reply to So what exactly is the problem with C-Sections?

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[quote=Anonymous][quote=Anonymous][quote=Anonymous]
Your argument seems to be that whatever birth happens more frequently, that is the birth doctors are skilled in. But despite the fact that c sections only account for 1 in 3 births now you don't seem concerned that doctors don't have adequate skills to perform them. Even if it became 50/50 (which I do not think it will be) that would mean doctors would see vaginal births just as frequently as c sections and would of course be skilled in managing them.

You have no idea if those options would have been available to you with a younger doctor, that is purely hypothetical. And you seem to be extracting logical conclusions based on no real evidence. [/quote]

Every C-section is the same. It's a standardized procedure.  Every vaginal birth is different, and there are dozens of maneuvers that exist to deliver the baby.  Even if vaginal births may constitute two-thirds of an ob's workload, he or she may not encounter the same technique more than once or twice a month.  In that same month, he or she would have performed dozens of C-sections that differ little from each other.

That forceps may not have been offered to me with a younger doctor who isn't skilled in using them is what my 50+ yr old ob said, and I have no reason to doubt her.   But it's OK if you don't trust the opinion of the doctor you've never met.  Let's look at an authority no one doubts.

https://www.newyorker.com/magazine/2006/10/09/the-score

".....[b]Forceps have virtually disappeared from the delivery wards, even though several studies have compared forceps delivery to Cesarean section and found no advantage for Cesarean section.[/b] (A few found that mothers actually did better with forceps.)...

....The question facing obstetrics was this: [b]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—the Woods corkscrew maneuver for the baby with a shoulder stuck, the Lovset maneuver for the breech baby, the feel of a forceps for a baby whose head is too big. You do research to find new techniques. 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. You begin to wonder whether forty-two thousand obstetricians in the U.S. could really master all these techniques. You notice the steady reports of terrible forceps injuries to babies and mothers, despite the training that clinicians have received. After Apgar, obstetricians decided that they needed a simpler, more predictable way to intervene when a laboring mother ran into trouble. They found it in the Cesarean section.
[/b]
....This procedure, once a rarity, is now commonplace. [b]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. [/b]Every obstetrician today is comfortable doing a C-section. The procedure is performed with impressive consistency.

....[b]We have reached the point that, when there’s any question of delivery risk, the Cesarean is what clinicians turn to—it’s simply the most reliable option.[/b] If a mother is carrying a baby more than ten pounds in size, if she’s had a C-section before, if the baby is lying sideways or in a breech position, if she has twins, if any number of potentially difficult situations for delivery arise, the standard of care requires that a midwife or an obstetrician at least offer a Cesarean section. [b]Clinicians are increasingly reluctant to take a risk, however small, with natural childbirth.[/b]

I asked Dr. Bowes how he would have handled obstructed deliveries like Rourke’s back in the sixties. His first recourse, as you’d expect, would have included forceps. He had delivered more than a thousand babies with forceps, he said, with a rate of neonatal injury as good as or better than with Cesarean sections, and a far faster recovery for the mothers. Had Rourke been under his care, the odds are excellent that she could have delivered safely without surgery. But Bowes is a virtuoso of a difficult instrument. When the protocols of his profession changed, so did he. “As a professor, you have to be a role model. You don’t want to be the cowboy who goes in to do something that your residents are not going to be able to do,” he told me. “And there was always uncertainty.” Even he had to worry that, someday, his judgment and skill would fail him.
[b]
These were the rules of the factory floor. To discourage the inexpert from using forceps—along with all those eponymous maneuvers—obstetrics had to discourage everyone from using them[/b]. When Bowes finished his career, in 1999, he had a twenty-four-per-cent Cesarean rate, just like the rest of his colleagues. He has little doubt that he’d be approaching thirty per cent, like his colleagues today, if he were still practicing.

...And yet there’s something disquieting about the fact that childbirth is becoming so readily surgical. Some hospitals are already doing Cesarean sections in more than half of child deliveries. It is not mere nostalgia to find this disturbing. We are losing our connection to yet another natural process of life. And we are seeing the waning of the art of childbirth. The skill required to bring a child in trouble safely through a vaginal delivery, however unevenly distributed, has been nurtured over centuries. In the medical mainstream, it will soon be lost."

https://www.newyorker.com/magazine/2006/10/09/the-score  [/quote]

I am the PP you are responding to. I haven't been back until now. Reading this I see a stunning lack of awareness of what you are reading. Primarily this paragraph:

[quote][i]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. You begin to wonder whether forty-two thousand obstetricians in the U.S. could really master all these techniques. You notice the steady reports of terrible forceps injuries to babies and mothers, despite the training that clinicians have received. After Apgar, obstetricians decided that they needed a simpler, more predictable way to intervene when a laboring mother ran into trouble. They found it in the Cesarean section.[/i][/quote]

You seem to have fondness for the 'art' of delivering a baby. But the very physician in question who was labeled a forceps 'virtuoso' realized that when faced with trying to train residents knowing the people who suffer while they learn are mothers, that it was more ethical to move to c sections. These techniques were learned and honed over centuries of childbirth assistance from mothers, doulas, women, doctors. All delicate procedures trying to stave off tragedy in childbirth through the centuries. All practiced on women and babies who ended up dying or injured until they had some reliability.

Do you really believe that the 'artisanship' of medicine should be prioritized over the 'reliability of safe outcomes'? Because I think that is what you believe based on that essay. And you must know that it would come on the backs of injured and dead women and children. Because as the article notes itself, rampant reports of severe maternal and fetal injury due to the inability to train all physicians in all of these arts is what led to the rise of the c section. Grievous injuries to mothers and babies led to the rise of the c section. I don't think I've ever read such a compelling argument in FAVOR of c sections than this essay.

I'd also like to agree with PP that not every c section is the same, particularly emergency c sections, and to act like they are shows such ignorance on the subject matter as to question your ability to have an opinion worthy of consideration.
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