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Dick Morris Doesn't Understand Birth or Health Care

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On the June 24 edition of The O'Reilly Factor, Dick Morris said that "right now the government is telling people, cut back on cesarean sections, go through natural childbirth. It's a lower cost." Aside from the simple fact that this is false, there's a lot wrong with this picture, given that he chose the example of cesarean sections.

It would be understandable that Americans are worried about the rationing of health care, except that private insurance companies do a lot more rationing of care than single-payer systems in other developed countries. But it's especially interested that Morris made his false claims about childbirth, since American maternity care is unnecessarily expensive and has very poor results. The U.S. pays twice as much per birth as other developed nations. The American infant mortality rate is the second-worst in the developed world and ranks 37th in the world, behind South Korea and Cuba. Maternal mortality rates have been rising since 1982 in the U.S., which currently ranks 41st among 171 countries. In August 2007, the CDC reported that the number of women dying in childbirth in the United States increased in 2004 for the first time in decades. National data on infant mortality rates in the U.S. also reveal an increase in 2005 and no improvement since 2000. In fact, countries with universal health care systems have much better maternal and infant outcomes, as well as lower cesarean rates.

The correlation between poor outcomes of the American maternity care system and high cesarean rates, which have risen from 4.5% of U.S. births in 1965 to 31.8% in 2007, is not spurious. Morris implies that cutting back on cesareans and encouraging natural childbirth would do a disservice to the health of mothers and babies -- an implication that is patently false. Cesarean can be a lifesaving procedure, but it also increases the risk of neonatal respiratory problems and carries a much higher risk of maternal complications and a four times higher risk of maternal death than vaginal birth. Based on scientific evidence, the World Health Organization (WHO) recommends a cesarean rate of 10-15%: below 10% the benefits of the surgery outweigh the risks to the health and life of mothers and infants, while over 15% the risks of surgery outweigh the benefits. According to the WHO, the rate of cesarean section should not exceed 15% in any country because maternal deaths increase at higher rates. However, the cesarean rate in the contemporary United States is more than double this recommended upper-limit.

As Media Matters reported with respect to Morris' absurd claims, the AMA and five other health care organizations issued proposals to address the overuse of certain procedures on June 1. "In its attachment to the letter, the AMA stated that the 'AMA-convened' Physician Consortium for Performance Improvement (PCPI) recommended addressing 'the overuse of certain services or procedures,' including 'Induction of labor/Caesarean Sections.'" The proposals addressed overuse, and it is clear from the medical research literature are that labor induction and cesarean sections are over-used in the United States, and that this overuse is detrimental to the health of women and babies. If health care reform in this country leads to fewer c-sections, it will save money and lives. Aside from a few obstetricians who prefer the surgical route, whatever its ultimate health consequences, who can really complain about that?