Saturday, October 24, 2009

More on caesareans and delayed childbirth - commentary by Judy Cohain

Smith GCS, Cordeaux Y, White IR et al (2008). The effect of delaying childbirth on primary cesarean section rates. PLoS Med 5(7): e144. doi:10.1371/journal.pmed.0050144.

Smith et al goes so far as to use dystocia, undefined by American College of Obstetrics and Gynecology (ACOG) or anyone else except as delayed labor, to make women feel guilty for delaying first childbirth. The authors found that at age 16, women have an average labour of 9.1 hours which rises slowly peaking at 10.4 hours from age 33 and above. The authors sampled myometrial strips obtained from 62 women and claim to have found a reduced degree of spontaneous contraction in older women. They used this supposed difference to define older women as having ‘impaired’ uterine function. This ‘impaired uterine function’ is then theorised to explain why women over 16 have labours that on average last up to 1.3 hours longer, explaining their increased rate of caesarean surgery. The authors did not analyse the reasons women in this study underwent caesarean surgery although as previously stated, the vast majority of caesareans are known to be due to ‘dystocia’. No one knows what would have been the outcomes if women were allowed to labour longer. Instead of the authors defining the arbitrary definition of dystocia as the problem, they blame the extra 1.3 hours that older women take to give birth and define the older uterus as dysfunctional rather than slower. Without evidence that a 1.3 hour longer average labour results in poorer outcomes, the term they use to describe older women as having a ‘dysfunctional’ uterus is, in polite terms, inaccurate. This surely is action bias in its most ageist/sexist form.


Is Action bias one of the Numerous Causes of UnneCesareans? by JS Cohain, in press, MIDIRS Midwifery Digest Dec 2009

N.B. why would women who are in normal shape and state of mind, volunteer to let 'scientists' take strips of muscle from their uterus? Would you?

[Judy Cohain is a midwife in Israel]

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