Elective Cesareans: A Women's Rights Issue or
Florida Swampland?
Following is a transcript of a Good Morning America
segment where the implementation of routine, elective
cesarean section is argued between two reputable
doctors (the interviewer is Diane Sawyer). Then
Suzanne Arms and Henci Goer- renowned midwifery
supporters- write in response.
Thanks to Anita at ICAN
Kansas City (ICAN- International Cesarean
Awareness Network) for providing this transcript.
Find more rebuttals here.
From the "Good Morning America" television
show
SAWYER: There is a great debate beginning to
emerge in the medical community. Each year, one
in every five babies in America today comes into
the world through a cesarean section, the country's
most common surgery.
It's also fast becoming the country's most controversial
procedure because the conventional wisdom that
women should avoid cesarean section may in fact
be shifting and some obstetricians are now calling
the cesarean section preferable to vaginal births.
And they believe that women should at the very
least have the option to choose between the two
and that insurance companies should basically
pay for the same equally and treat them equally.
Well joining us now, Dr. W. Benson Harer, the
president of the American College of Obstetricians
and Gynecologists, who is in favor of giving women
the choice to have c/sections. And with an opposing
view, Dr. Marsden Wagner, former director of Women's
& Children's Health at the World Health Organization.
Good to have you both here, it's like weighing
in on each side here. And I want to say Dr. Harer
that you are not speaking for the American College
of Obstetricians and Gynecologists....
HARER: Thank you. It's my personal views.
SAWYER: ...you are speaking for yourself. One
in five now have cesarean sections but you say
cesareans are safer and in fact better, and that
in the future, women should be able to choose
and in fact that maybe they should be routine.
HARER: That's not quite exactly it, but what
I say is that women should be given the facts
and then given the choice.
SAWYER: But you said that there are 3 to 4 times
more problems...
HARER: Yes.
SAWYER: ...a higher rate of problems, with vaginal
birth than with cesarean section.
HARER: For the baby, the risks are far higher
for vaginal delivery than for an elective cesarean
section at term. For the mother, the immediate
risks for a cesarean section are a little higher,
but the longer term risks of pelvic dysfunction,
urinary incontinence, anal incontinence, pelvic
dysfunction--those risks are higher for vaginal
birth and over the long time I think that the
risk balance out that there really is no big difference.
SAWYER: What about this, Dr. Wagner, if it's
better for the baby, if over the long term, it
balances out to better for the mother, why shouldn't
women at least be able to choose it?
WAGNER: Because in fact if you really study the
scientific literature carefully, there can be
no doubt, that to say that cesarean section is
perfectly safe for the baby has to be labeled
a lie. It is absolutely not true.
SAWYER: Why? What is the risk?
WAGNER: Well, let me give you the risk. First
of all, when the surgeon picks up the scalpel
and cuts open the woman's belly, in 2 to 6 percent
of cases, he also cuts into the baby. There's
a risk. Secondly of all, there's good scientific
data that if the baby is born by cesarean there
is a much greater risk of something called Respiratory
Distress Syndrome, which is a big killer of babies,
and....
SAWYER: It's because when the baby comes vaginally
it presses the lungs and forces...
WAGNER: There you go.
SAWYER: ...the mucous out of the lungs.
WAGNER: There you go.
SAWYER: [to Harer] What about this?
HARER: The difference is with most of the statistics
for cesarean come out of emergency cesareans where
there is a problem with the mother. What I'm talking
about is an elective cesarean section at term
with a healthy baby where she's had good prenatal
care and we know that the baby's condition is
good. In that case this condition is extremely
rare.
SAWYER: But why change...
WAGNER: All of what I am saying about risk for
the woman and baby I am using elective cesarean
not emergency cesarean. The cutting of the baby
happens, the Respiratory Distress Syndrome does
happen more often with cesarean than with vaginal
birth and so does prematurity which is another
big killer of babies.
SAWYER: I don't know whether we can solve these
statistics here although we'll look into them
and try. [to Wagner:] But I want to ask you this--you
think the motive is a little suspicious. You think
that doctors want surgeons present at every birth.
You think that at the end of the day that it's
less litigation for the doctor. Right?
WAGNER: Anybody who thinks that those obstetricians
that promote cesarean are promoting it because
they suddenly discovered women's rights, well,
I'm ready to sell some swampland in Florida to
those people because that's extremely naive. Because
there are compelling reasons why obstetricians
prefer more cesarean. First of all, it means....excuse
me.
SAWYER: I was just going to let Dr. Harer answer
you to these charges.
WAGNER: First of all, it means that there is
convenience. You see, an obstetrician--the average
birth is 12 hours, a cesarean is 20 minutes!
SAWYER: Dr. Harer, what about this, is this for
your convenience?
HARER: No, not at all, I really believe that
physicians are motivated to do what's best for
their patients and I believe that the average
patient can make her own decision about what's
best for her.
SAWYER: Don't you worry that something has worked
well for, well, 50,000 known years at least in
the species, has a reason?
HARER: Until this last century, 1 out of every
100 women who got pregnant died and its still
that way today in Nigeria, or in Gambia, and the
third world nations.
SAWYER: And you have also said that today babies
are bigger and that that is increasing.
HARER: That's true. The weight of babies has
been going up and as the babies get bigger the
risk of damage to the mother is very high. Six
percent will have fecal or urinary incontinence
after deliveries today.
WAGNER: There is no scientific evidence that
doing over 10 percent of births with a cesarean
improves the outcome for the woman or improves
the outcome for the baby. There's data from all
over the world, including the US and Germany and
France...
SAWYER: Here's my promise to our viewers out
there since we have, as I say, these irreconcilable
positing of the facts here. We're gonna see if
we can reconcile them and we'll come back to you
later on and let you know what we conclude. But
we appreciate you setting up this debate for us.
'Cause it's not gonna end, it's just beginning.
Reply by Suzanne Arms
Suzanne Arms, author of Immaculate Deception,
wrote this letter to ABC news after the airing
on Good Morning America.
Tuesday, June 20/00
Dear producers,
First, thank you for airing a brief but important
piece on the huge controversy of Cesarean surgery
in this country: it's benefits, hazards (both
immediate and longterm). And thank you, Diane
Sawyer, for managing to insert an accurate fact
about one of the risks of cesarean surgery for
the baby.
As a consumer advocate (with no professional
ties to nursing, medicine or midwifery) who's
read the research and studied birth and maternal-infant
health practices in this country and worldwide
for 25 years, and who has authored and illustrated
7 published books in the field (one of which was
named a "Best Book" of the year by the
NY Times), may I offer a few words of feedback
and a suggestion for a future piece?
Give it a few more minutes of time, as the subject
greatly deserves it. Recognize that birth is a
50 BILLION dollar a year industry (we spend on
just birth 1/3 of what this country spends on
all of education from nursery school through college)
and more than 50% of all hospitalizations in the
US are for birth - which is not, by nature's process,
a medical event at all - making birth big profit-making
business Understand that this is not a debate
between 2 different ways of reading the literature.
Those who believe cesarean is equal to or better
than vaginal birth have no good science to back
their claims. There has been for a decade serious
international analysis of research in this field-
coming first from Oxford University Department
of Epidiomology and more recently the Cochrane
Data Base, separating out "well-done"
studies from poor studies.
The debate in terms of science is over and the
results are in: as Dr. Wagner said, there is no
evidence that a cesarean rate higher than 10%
(actually 7%) yields any benefit to mothers or
babies. There is ample data that cesarean surgery,
especially done electively (without benefit of
any labor) hinders the development of mother and
baby and places each of them at immediate and
long-term risk of numerous problems. What you
ended up airing looked to the American public
as if it were just a matter of 2 equal arguments,
each based in good science, the type that leads
people to say "Science can prove anything!"
and to be cynical about all research.
Go deeper, as our nation's mothers and babies
deserve. There's enormous profit and ego motives,
along with ignorance and denial, compelling many
obstetricians to do unnecessary cesareans and
to be blind to the longterm negative implications
of them (whether or not done for good cause) Understand
it's a women's issue but that American women are
today so frightened of labor and mistrustful of
their bodies and the natural process that they
have handed birth over to doctors and are no longer
thinking deeply about the issues Be aware that
it's also an issue of what is best developmentally
for babies ~ and for our entire species ~ as to
whether they need and benefit from spontaneous
labor and natural birth or not. Scientific evidence
abounds that they, in fact, do.
I get discouraged when I see something handled
so poorly as this segment. Dr Marsden Wagner and
the head of ACOG were not able to give any real
sense of their point of view. And the interview
was hindered by being so rushed that I could literally
feel Dr Wagner's inability to put a cogent argument
into brief enough sentences.
I was interviewed by David Hartman on Good Morning
America in the late 70s (or was it the early 80s?),
given 7 minutes to have a real debate with the
then-head of region 9 of ACOG regarding home birth
and "lay midwives". The debate was genuine
and gave the public some real facts and issues
to grapple with. And before that, in June of 1975,
following the publication of my book Immaculate
Deception: A New Look at Women and Birth, Barbara
Walters interviewed me for 7 minutes on The Today
Show. During that segment huge blowups of 2 black
and white photos of mine (one from a US hospital
birth and one from a Dutch birth) were displayed
behind Ms Walter and me, showing the stunning
obvious differences. And that interview was considered
so strong that the network chose to continue it
for 5 more minutes, after the break, and allow
those stations that wanted to, to run the second
segment in lieu of local news or weather.
I'd like to have a chance to interest you in
the many issues related to birth in this country
that are being ignored or short-changed. Please
understand that the experiences each mother and
baby pair have in birth affect each of them (and
their uniquely symbiotic relationship, which is
the blueprient for all that child's future relationships)
for many years.
Give me a chance to express in brief to the American
public the authentic value of natural, normal
birth. I can show very quicky what is wrong with
a country that, for 75+ years has routinely drugged
and separated mothers and babies and extolled
a medical management model for birth, in the face
of no good scientific or clinical evidence. Our
way of birth continues to be perverted by values
that have nothing to do with either good science
or humane care. I would be happy to debate anyone
on this. However, since the "other side"
already controls birth and is the prevailing belief
of the culture, it seems more than appropriate
that "nature's" side gets a fair hearing.
Some of the issues that might interest you (and
I know would interest the American public) for
future Good Morning America segments include:
the striking differences between the midwifery
model and the medical model in birth pain in labor
and why drugs to deal with pain are not worth
the cost (in public health, in mother-baby attachment,
in money, resources, and women's empowerment)
where feminism has missed the boat in birth by
failing to support either natural normal birth
or midwifery home birth as a rational choice for
healthy women, and why many intelligent women
go to huge lengths to avoid hospitalization for
birth today (there being, in fact, no good scientific
evidence from any country that supports routine
hospitalization for birth and much evidence about
the negative side of routine US birth practices)
what happened to the alternative birth movement,
that was burgeoning in the mid 1970s to cause
today's pregnant woman to be such a passive, compliant
"patient"?
Finally, does it seem strange to any of you that
in this day and age two men should be the ones
debating the issue that is of such intense, private
and intimate concern to 4 million women per year?
Sincerely,
Suzanne Arms
Producer of the BirthingThe Future Series and
Giving Birth: Challenges & Choices
PS May I send you a copy of my first film on
video, which lays out many of the issues very
plainly and which includes extraordinarily and
evocative live footage of a natural, normal birth
at home to a well-educated attractive woman in
her 30s. It is one that all America would feel
comfortable seeing on morning television (Her
birth attendant is a licensed midwife, the "delivery"
occurs while the mother is seated on a European-style
birthing stool, wearing a lovely silk kimono).
Reply by Henci Goer
Cesareans:
Are they really a safe option?
Please refer to the above page for Henci's
brilliant dismissal of every argument Harer had.
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