By Marsden Wagner. M.D.
Recently a woman in Iowa was referred to a university hospital during her labor because of possible complications. There, it was decided that a cesarean section should be done. After the surgery was completed and the woman was resting post-operatively in her hospital room, she went into shock and died. An autopsy showed that during the cesarean section the surgeon had accidentally nicked the woman’s aorta, the biggest artery in the body, leading to internal hemorrhage, shock and death.
Cesarean section can save the life of the mother or her baby. Cesarean section can also kill a mother or her baby. How can this be? Because every single procedure or technology used during pregnancy and birth carries risks, both for mother and baby. The decision to use technology is a judgment call-it may either make things better or worse.
We are living in the age of technology. Ever since we succeeded in going to the moon, we have believed that technology can do everything to solve all our problems. So it should come as no surprise that doctors and hospitals are using more and more technology on pregnant and birthing women. Has it solved all the problems that can arise during birth? Hardly. Let’s look at the recent track record.
Has the recent increasing use of technology during pregnancy and birth resulted in fewer damaged or dead babies? In the United States there has been no decrease in the past thirty years in the number of babies with cerebral palsy. The biggest killer of newborn babies is a birth weight that is too low, but the number of too-small babies born has not decreased the past twenty years. The number of babies who die while still in the womb has not decreased in over a decade. While the past ten years has seen a slight drop in the number of babies who die during their first week after birth, the scientific data suggest an increase in the number of babies who survive the first week but have permanent brain damage.
Is the increasing use of technology saving the lives of more pregnant and birthing women? In the United States the scientific data show no decrease during the past ten years in the number of women who die around the time of birth (maternal mortality). In fact, recent data suggest a frightening increase in the number of women dying during pregnancy and birth in the United States. So it may be that the increase in use of birth technologies is not only not saving more women’s lives but is killing more women. This possibility has a reasonable scientific explanation: cesarean section and epidural anesthesia have both been used more and more in this country and we know that both cesarean section and epidural block can result in death.
We should not be surprised with the recent poor track record of high tech birth. For many decades in the middle of the twentieth century the number of babies dying around the time of birth was decreasing but this was due not to medical advances but mainly to social advances such as less severe poverty, better nutrition, better housing and, most importantly, to family planning resulting in fewer women with many pregnancies and births. Medical care also was responsible for some of the decreasing mortality of babies but not because of high tech interventions but because of basic medical advances such as the discovery of antibiotics and the ability to give safe blood transfusion. There has never been any scientific evidence that high tech interventions such as the routine use of electronic fetal monitoring during labor decrease the mortality rate of babies.
What this means is that putting yourself in the hands of a high tech doctor and a high tech hospital does not guarantee you the safest birth. You must yourself take responsibility for your own birth, including the decision to have technology used on you and your baby. Remember, technology is not good or bad. How technology is used can be good or bad. Airplanes can be used to carry you to visit your family or can be used to drop bombs on women and children. How technology is used on you during pregnancy and birth is of great importance because it can help you and your baby or harm you and your baby.
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