Making sense of rising caesarean section rates: Reducing caesarean section rates should not be the primary objectiveBMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7476.1240-b (Published 18 November 2004) Cite this as: BMJ 2004;329:1240
EDITOR—So long as the studies suggested by Anderson in his editorial on rising caesarean section rates take into account the sole conventional criteria,1 a caesarean section without procrastination will always seem the most advantageous attitude in well equipped obstetric units. But we as doctors must also think long term, given the wide research on the life long consequences of prenatal and perinatal environmental factors. We must also learn to think in terms of civilisation.2
Meanwhile the most dangerous guidelines would be those recommending a limit to the rise in caesarean section. The first effect would be (and in some places already is) to increase the rates of difficult instrumental vaginal deliveries, which should become exceptionally rare in the age of the safe caesarean. The priority, after millennia of culturally controlled childbirth, is to rediscover the basic needs of labouring women. These needs are easily expressed in terms of physiology. Labouring women need to be protected against any sort of neocortical stimulation (privacy, silence) and to maintain a low level of adrenaline (feeling secure in a warm enough place). Today very few people can imagine how easy the birth of a baby and the delivery of its placenta can be when there is nobody around but an experienced, motherly, and silent midwife sitting in a corner and knitting (knitting as an example of repetitive tasks that help to maintain a low level of adrenaline).
Decreasing caesarean section rates should be a consequence of a better understanding of the physiological processes: it should not be the primary objective.3
Competing interests None declared.