Tuesday, 18 August 2015

C Section Rates - The Economist Edition

So I was going to take a break from blogging this month. It's the school holidays and I've been trying to juggle childcare, work and my new sideline reviewing festivals (check out the fab Festival Kidz website btw). Frankly, I'm exhausted.

But, MrSB sent me an article in the Economist and now I'm sneaking back in here for a bit of a rant. Actually, it didn't make me all that cross, it was more a despairing sigh than anything. I'll fess up to not being a regular reader of The Economist. Frankly, if I had any interest in economics I wouldn't be working part time in a lab. So I had always assumed it was a pretty serious publication and would likely deal with numbers and data in an intelligent and non sensationalist way.

oops, my bad!

Essentially it is (yet another) story about how there are far too many C sections going on and it could have been cut and pasted from any of the many similar pieces. In fact, let's play a little game shall we?




HOUSE!!  This article has the lot.

There is nothing new or insightful here in fact I'm a bit puzzled as to how it is news at all as it seems to be based on a Lancet article and subsequent WHO statement that I (among others) wrote about back in April.

The only novel thing is an interactive infographic which plots C section rate against maternal mortality. From which the writer concludes that where the Cesarean rate is above 10-15% (so basically the entire developed world) the extra c-sections don't save any mother's lives so must have been unnecessary.

But, fancy and interactive though that graph is, it tells us nothing about the optimal C-section rate. Firstly it says nothing about infant mortality, which is y'know kind of important (the Lancet piece shows a similar effect to maternal mortality but that's barely mentioned here). But it also gives no information about other bad outcomes. Death isn't the only thing that is worse than a C section. Certainly cesareans have serious down sides, but I'm guessing that women who've suffered for years with obstetric fistulas, or who have dedicated their lives to caring for a brain injured child, would probably think that one off surgery was the lesser evil. So without the data on these outcomes we can't say that 10%, 15% or any other figure is optimal (blimey, how many times have I said that on here?!)

The piece also tries to prove the pointlessness of all these C-sections by comparing the rates in economically similar countries - if there weren't loads of unnecessary C-sections going on how come there are twice as many in Mexico as in Costa-Rica? Or in Italy compared to the Netherlands?

But for me, that just hints at the point that has been so widely missed in this piece and so many like it. Certainly there are women who are coerced into C sections they didn't want and probably didn't need but what if in addition- just maybe, some women are making rational, reasoned decisions about their own bodies? You know, like proper grown up human beings? What if the differences between Italy and the Netherlands aren't entirely due to women doing what they are told by doctors but because there are considerable cultural differences between these countries and that may apply to women's attitudes to birth as well?

I'm speculating here of course but is it so utterly inconceivable that women should think a bit sometimes that it doesn't occur to the Economist to mention the possibility? Well except to trot out the same old tales of wealthy women choosing C sections to fit conveniently in their schedules or just to avoid traffic jams (seriously they say this)!

Like so so many articles it starts with the assumption that "as nature intended" is the best thing for all women's bodies. But in a world where we can eliminate diseases that once killed millions, where a woman might just be the next president of the most powerful country on earth and where a magazine can add an interactive infographic to the greatest and most accessible pool of human knowledge ever imagined, why is it so inconceivable that nature might not always know best on this one little thing and that choosing to do the unnatural might actually be ok for some of us?

Rant over, I need sleep, I'm taking MissE to Hamley's tomorrow (yay!!)
SBx


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