C-sections: One size fits all

In this week's New Yorker, Atul Gawande looks at changes in childbirth practices over the past hundred years. His clear explanation made me understand why doctors perform so many C-sections; part of me had assumed the rise in C-section rates was some patriarchal plot for taking control of women, but Gawande suggests that the increase is more due to a lack of a set of skills on the part of doctors. Whereas in the past, doctors and midwives had to learn a variety of techniques for dealing with a wide range of childbirth complications, now they have one straightforward surgical operation that they can use to address many different difficulties. Although he expresses some regret, Gawande doesn't seem to think the "industrialization" of childbirth is going to change any time soon. At the end of the article, though, he suggests that perhaps a score similar to the Apgar score is needed to evaluate women's outcomes after birth and determine which practices are in their best interest.

Of course, the midwifery model of care provides an alternative to industrial childbirth, but it's only used by a small percentage of women. And midwives are also constrained by liability issues; although with a skilled practitioner it probably would have been possible for me to give birth normally to a breech baby, I was not allowed that option.