Marsden Wagner, MD
Obstetrician, perinatologist, neonatologist
Takoma Park, Maryland

More about Marsden Wagner

 

How do maternal and infant outcomes (what happens to women and their babies after childbirth) in the United States compare with those in other countries?

Very poorly. The proportion of women who die just before, during, or just after birth is lower in 28 other countries than in the United States. Every year, this happens to at least a thousand U.S. women—three jumbo jets full of our sisters, daughters, and mothers. At least half of those deaths could have been prevented. And the number has been rising for more than 25 years.

Infant mortality rates (the proportion of babies who die before their first birthday) are lower in 41 countries than in the United States.

What’s wrong?

The problem lies not with individual doctors but with a system in which stretched-thin doctors have an unjustified monopoly. Women and babies are left to pay the price. Yet there are other ways to give birth when the mother and fetus are healthy.

In every country with a lower maternal (mother) or infant mortality rate than the United States, midwives, not obstetricians, manage normal pregnancies and births. Midwife-attended births are safer than obstetrician-attended births, less expensive, and more likely to facilitate a satisfying experience for the mother and family.

For more information:

World Health Organization report
www.who.int/reproductive-health

Centers for Disease Control and Prevention
www.cdc.gov/nchs/birth

Wagner M. Safe Motherhood: Preventing Pregnancy-Related Illness and Death. Atlanta, GA: Centers for Disease Control and Prevention, 2001.

Links to resources and data on safe motherhood: www.rho.org/html/safe_motherhood.htm

Wagner M. Revealing the real risks: obstetrical interventions and maternal mortality. Mothering. 2003;118 (May/June).
Available at: www.mothering.com/articles/pregnancy_birth/birth_preparation/risks.html

Wagner M. Midwifery in the industrialized world. Journal of the Society of Obstetricians and Gynaecologists of Canada. 1998;20(13):1225-1234.
Available at: http://www.asac.ab.ca/BI_fall99/midwifery.html

What percentage of births are better because of cesarean section? At what point does having a cesarean do more harm than good?

In emergency situations, a cesarean section can save the life of the mother, the baby, or both. As major abdominal surgery, though, it carries heavy potential risks, including the death of the either or both.

A recent study done by the World Health Organization showed that mortality (death) rates increased if the cesarean section rate was below 10% or above 15%.

What should I know about the benefits versus harm of cesarean section to make an informed decision about whether to have one?

Unless there is a compelling and well-supported reason for cesarean section, vaginal birth is the safest way for women to give birth and for their babies to be born.

That was the conclusion of a systematic review of several hundred studies that compared the harm of cesarean versus vaginal birth. The review was conducted by Childbirth Connection out of concern about the rising cesarean rates and reduced access to vaginal birth after cesarean.

To learn more about the myth versus reality of cesarean section:
www.childbirthconnection.org/article.asp?ck=10312