Intended for healthcare professionals

Education And Debate

Has the medicalisation of childbirth gone too far?

BMJ 2002; 324 doi: (Published 13 April 2002) Cite this as: BMJ 2002;324:892

Re: Re. Go bang and moving with the times

Might I suggest to Marie L Tyndall that such a forceful
tirade of words as "arrogance and revengefullness is
unprofesional (spelt wrongly), anti (should be un)-
ethical and anti-(should be un)-scientific", that she
chooses to use publically is a display of bitterness and
aggression that is more befitting of text for a local
woman's magazine from the last century rather than an
eminent journal such as the BMJ which is moving into
the 21st century. There is no need to get personal in a
scientific forum. Clearly, her destructive attitude is aptly
demonstated in Phyllis Chesler’s book Woman's
Inhumanity to Woman and this destructive attitude as
Chesler states in her book is independent of race,
class and country. Nowhere is this inhumanity better
demonstrated than women’s intimidating attitudes to
other women in fertility, childbirth and lactation. Is it not
a coincidence that the majority of negative electronic
comments have come from women in their capacities
as biologists, anthropologists and childbirth writers
most of whom have no idea about the management of
labour let alone about being proactive in the difficult
ones before they end up as disastrous emergencies.
As for the few midwives who write in, whilst their skills
are invaluable, they do not have the scientific and
surgical training to continue managing the difficult
labours which often and inevitably end up in a
disastrous emergency requiring urgent medical
intervention (reactive management). The key to
modern obstetrics is to be proactive and the reality is
for those who care to face it, that medicalization has
rescued the imperfections of nature. Furthermore, the
reality is that there are very many happy women today
living quality lives who in times gone by would have
died or been severely damaged. WHO readily quote
that 99% of maternal deaths and perinatal deaths
occur in third world countries. Women in third world
countries through no fault of their own are destined to
what nature dishes out. How is this an offensive
comment? However, for those not trained to accept the
ultimate responsibility for the care of women in labour,
it is offensive to intimidate and adversely influence
women into avoiding medicalization which will help

Lastly, I might also point out to Marie L Tyndall that
there are some very wealthy women in Brazil as well as
poor women. Why don't they sue? It is the wealthy
women who are requesting Caesarean Sections and
their reasons are not only related to their wealth and
ability to afford them but also as to how they perceive
their sexual welfare after childbirth. Indeed these
women have been 20 years ahead of their western
counterparts. As for the poor women, their Caesarean
Section rate is 26% which is more than their western
counterparts. Her statement that poor women “cannot
sue for damages because their social standing,
economic resources and knowledge of their rights is
so low compared to the revered high-class doctors”
only serves to cast another slur on Brazilian doctors
and displays her own anti-doctor bitterness and envy.
Who is “sadly misinformed” Ms Tyndall and whose
“attitude is detrimental to women”?

To Elizabeth M. McAlpine, who referred myself and Paul
Duff to 'Rates for obstetric intervention among private
and public patients in Australia', Roberts, et al. May I
too refer her to a letter I wrote in response to this article
and which the BMJ chose to publish in its letters BMJ
2001; 322: 430. Titles of articles can be misleading.
Try looking at their data with some lateral thinking.
Some of the greatest modern (medicalized)
discoveries in Obstetrics and Gynaecology came from
lateral thinkers seeking the betterment of women’s
health. I think they were men!

Competing interests: No competing interests

24 April 2002
Isidor J Papapetros
Consultant Obstetrician & Gynaecology