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Hi
Mary, Yes it
is an interesting article of opinion; it makes me feel sick that there is not
one word about safety, outcomes, maternal morbidity, maternal mortality… And then the statement: “the cesarean rate is a consequence of individual
value-laden clinical decisions, and that it is not amenable to the methods of evidence-based
medicine.” Is reflective of the lack of professional accountability
within the obstetric field – they are unable and unwilling to perform to recommended
standards, particularly when the rewards are financial and legal security. It
worries me that an opinion paper can be published in a journal of strong
influence and yet omit these serious and important details. What is also interesting is that many lay people are quite
aware, even before they attend classes, of the above concerns. In a group
situation, there is always an interesting mix of people from all sorts of different
backgrounds, and once they start talking specifically about medical
interventions, within minutes the above issues emerge, so in my opinion unethical
Obstetricians and their unethical supporters, can avoid the truth of the matter
as much as they like, but it will only serve in the long term to completely
undermine the respect that the community has had for them in the past and
replace it with distrust. Warm hug Julie www.julieclarke.com.au From: owner- CLINICAL
OPINION American Journal of Obstetrics and Gynecology
(2006) 194, 932–6 Myth
of the ideal cesarean section rate: Commentary and
historic perspective Ronald
M. Cyr, MD* Department of Obstetrics and Gynecology, Received
for publication July 10, 2005; revised September 12, 2005; accepted October 8,
2005 KEY
WORDS Cesarean
section rate Myth History
of cesarean section John
Whitridge Williams Evidence-based medicine Attempts
to define, or enforce, an ‘‘ideal’’ cesarean section
rate are futile, and should be abandoned. The
cesarean rate is a consequence of individual value-laden clinical decisions,
and is not
amenable to the methods of evidence-based medicine. The influence of academic
authority figures
on the cesarean rate in the indices,
the cesarean section rate is an indirect result of American public policy
during the last century.
Without major changes in the way health and maternity care are delivered in the
the
rate will continue to increase without improving population outcomes. _ 2006 Mosby, Inc. All rights reserved. Since
the earliest days of the modern cesarean sectiondthe 1880sdthere has raged
within the profession a
debate about the appropriate indications for this operation.1,2 For
several decades after the availability of antibiotics
and blood banking, the cesarean section rate in
the 1968
and 1978, the rate tripled to 15.2%, and discussion of
cesarean section moved permanently into the public domain.
A 1981 report commissioned by the National Institutes
of Health (NIH) expressed concern about the
rising rate, and its recommendations for reducing cesareans included
qualified support for VBAC.3
By the 1990s,
individual hospital cesarean section and VBAC rates
were being published, and interpreted by consumer groups
as indicators of obstetric care quality. In 1991, the
Healthy People 2000 initiative advocated a 15% cesarean rate
as a year
2000.4 Despite
expert and lay opinion that many cesareans are
unnecessary, the rate continues to increase in the USdexceeding 27% in 2004dand shows no sign of abating.5,6 Indeed,
there is growing discussion and acceptance of
patient-choice cesarean section as a legitimate birth
option.7,8 A recent editorial opined that ‘‘It’s
time to
target a new cesarean delivery rate.’’9 It
is the premise of this essay that attempts to define, or enforce,
an ‘‘ideal’’ cesarean section rate are futile, and should
be abandoned. It will be argued that the cesarean rate
is a consequence of individual value-laden clinical decisions,
and that it is not amenable to the methods of evidence-based
medicine. The influence of academic authority
figures on the cesarean rate in the placed
in historic context. Like other population health indices,
the cesarean section rate is an indirect result of American
public policy during the last century. Without Dr
Cyr is the 2003 ACOG/ORTHO-McNEIL Fellow in the History
of American Obstetrics and Gynecology. *
Reprint requests: Ronald M. Cyr, MD, Department of Obstetrics and
Gynecology, Drive,
E-mail:
[EMAIL PROTECTED] 0002-9378/$
- see front matter _ 2006 Mosby, Inc. All rights reserved. doi:10.1016/j.ajog.2005.10.199 |
- [ozmidwifery] interesting article 2 Mary Murphy
- RE: [ozmidwifery] interesting article 2 Julie Clarke
