01/25/2013 11:22 am ET Updated Mar 27, 2013

Here's One Way to Make Childbirth Safer

Kudos to Nathanael Johnson for highlighting the urgent need to make births safer for American women in the Wall Street Journal. Johnson points to, among other things, the rising cesarean section rates and the dangers associated with them. His solution: Use midwives who are more low-tech and high-touch instead of doctors who tend to be high-tech and low-touch. Johnson, the author of the forthcoming All Natural: A Skeptics Quest to Discover if the Natural Approach to Diet, Childbirth, Healing and the Environment Really Keeps us Healthier and Happier, has a point.

Nearly one in three babies these days are delivered by cesarean section -- in some hospitals the rate approaches 40 percent. But while Johnson suggests that midwives may be the solution, there are other steps, some already in progress, that can reduce surgical births and perhaps the morbidity that goes along with it -- without kicking doctors out of the delivery room.

Deborah Kotz, a medical reporter for the Boston Globe, reported in October that Massachusetts General Hospital initiated a plan to stop elective inductions. That's when a woman and her doctor decide on the date to deliver and then use drugs to start labor. Elective inductions, for one reason or another, have been shown to up the odds of cesarean sections. And cesarean sections have been linked to increased childbirth complications. When a group of hospitals in Utah started the same elective induction ban, their surgical birth rate dropped from 28 percent to 21 percent over a 10-year study period, Kotz reported. MGH is hoping for the same downward slide.

I am glad that Johnson renewed the much-needed attention to the dangers of childbirth. But I hope that his piece does not reignite the overly-simplistic midwife vs. doctor debate. What we need is a healthy dialogue between these two groups of experts. Midwives rely on doctors when complications arise. And doctors can learn a thing or two from midwives about how to offer their patients the best of both worlds: high-touch and low tech along with state-of-the-art technology when it's needed.

And one more thing: I can't help but slip in a little history: In 1933, a New York City report highlighted what they called an epidemic of cesarean sections: The rate then was 2.2 percent. [1]


Hooker, R. S. Maternal Mortality in New York City: A study of All Puerperal Deaths. New York: The Commonwealth Fund, 1933.

For more by Randi Hutter Epstein, M.D., MPH, click here.

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