Do we have to give up natural childbirth to save infants?

My friend Aaron Pressman recently asked me what Sarah and I
thought about the October 9th New Yorker article on the rise of the
Caesarian section (C-section) as a child birthing method.  (Sarah hasn’t seen it yet)  If you’ve read the story of the birth of our
first child, you know this isn’t an abstract discussion for either of us. 

The New Yorker article goes into the history of the use of
C-section and it’s prevalence in modern childbirth. The C-section is not the most pleasant, least
intrusive, or most effective technique of mitigating problems in childbirth. It is a medical equivalent of the concept,
“every tool is a hammer”.  Easy to learn and used roughly the very same way every time.

The problem with infant mortality that created the demand
for C-sections isn’t a medical one. Problem births have many non-surgical techniques, all of them doable in
the hands of trained professionals. Medical
researchers discovered that they require a great deal of both talent and
training to apply them correctly. And
when they failed, infants and mothers suffer. Hence, the C-section.

The C-section is relatively easy procedure to perform and
master. It is considered low-risk and carries
a much lower chance of complication than the other methods of mitigating
childbirth problems. It is a perfect
medical option in every way except one: it’s takes an emotional and physical
toll on the mother that is considered unacceptable by many of its patients. 

The goal of medical outcome researchers is to optimize performance
of a system, in this case the system of childbirth. They have done that, using the Apgar score as
a metric for the health of the baby. The
Apgar score, which measures the health of a birthed baby, does not contain a
score for the physical or emotional health of the mother. The author rightly suggests that perhaps it

The unpleasant patient experience is probably the
predominant reason that medical outcome researchers haven’t called for
mandatory C-sections. The problem
identified by the article is that many of the basic techniques for natural
childbirth are being lost as younger doctors learn that birth involves either
catching a perfectly delivered child as it comes out of the birth canal or
scheduling a C-section. If this trend
continues, the cycle of skill entropy will simply perpetuate the predominance
of C-sections.  Do we truly have to give up natural childbirth
in order to mitigate childbirth mortality?

We as a civilization can’t afford to lose these other
child-birthing skills. Not every woman
can or wants to deliver her child in an operating theater. Those that can’t make it to the OR will not be served well by their
caregivers, who will have a hole in their child-birthing knowledge because
nobody remember any of those quaint ‘natural childbirth’ techniques.