Obstetrics Old and New

I’m a 74-year old male obstetrician, and there are no doubt many who think I’m ready to be turned out to pasture for being out-of-touch with the current medical practice of obstetrics. Obstetrics has become a high-procedure process. Increasingly patients are recognizing the problems, even if the medical profession does not. Michel Odent wrote about the problems with the high-tech delivery over 30 years ago in his book Birth Reborn: What Childbirth Should Be.

I have had a lot of experience in obstetrics. From 1981 through 1988, I delivered about 25 babies per month. In 1985 I became an obstetrical preceptor in the Family Practice Residency program at the University of North Dakota. There I consulted to about 20 physicians in addition to the 20 for which I was already providing consults.

In my first month of private practice in 1981, I delivered 46 babies at 4 hospitals. I continued at this pace for 16 years. In over 6000 births, I’ve delivered no babies with cerebral palsy, had no patients with eclampsia, no mothers with strokes, and no maternal deaths. I’ve delivered breech babies without the knee-jerk C-section reaction. Indeed, I delivered breech twins vaginally. I’ve delivered healthy triplets, and even a set of healthy quadruplets. I managed this by paying attention to the mother and unborn baby. I refrained from rushing into the quick and easy answer, the all-too-often performed C-section. The C-section should not be a procedure of choice.

In the United States, the C-section rate has skyrocketed in the past 20 years. When I began practicing in 1981, a C-section rate of 15 percent was considered normal. Today, the rate is 34 percent. It’s a travesty.

I’ve known medical education coming and going for over three decades. We are all taught the same procedures and the same indications for various procedures. But we all do the procedures differently because we interpret the indications for the procedure differently. The “evidence” of “evidence- based” medicine cannot account for the variation in the human condition or the variation in the ability of the practitioners to read the evidence they have been taught in medical school.

It’s time for common sense to return to obstetrics.