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Secretly I just wanted to write the phrase 'No choice but the vaginal route'

I serve a tiny slice of Gladwellism in today's Post column about breech births. Of course I'm referring to the old, good Gladwell, before he got into the whole corporate-entertainment business.


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Comments (10)


Out of curiosity, how does midwifery fit into all of this?

I suspect, though I haven't heard anyone say so, that midwives had better technique for vaginal deliveries than obstetricians until quite late in the day. I don't know how they fit into the current picture, except insofar as obstetrics is now returning to a "We don't cut unless we have to" norm.

George Skinner:

Midwifery works great until you have a problem. Then you need somebody with the 10 years of training that produces an obstetrician. Where it gets tricky is that midwives often don't know when they're running into trouble. Let's face it - childbirth is a relatively straightforward process, performed with a relatively high success rate for thousands of years without professionals. However, you need the professionals to get the success rate from 90% to something approaching unity.

George Skinner:

Strike that "often" remark - "sometimes" would be more appropriate.

A fair comment, as long as one keeps in mind that obstetricians with their yonks of training were lowering the "success rate", and killing women that midwives wouldn't have, throughout most of the history of Western medicine.

Steve C:

Is there any evidence that obstetricians were lowering the "success rate", and killing women that midwives wouldn't have?

That was no "John Rock's Error."

Your question is approximately like asking "Is there any evidence Babe Ruth hit a lot of home runs?" Also, "John Rock's Error" is seven thousand words long and the author was paid what I make in a year to write it.

George Skinner:

Of course, to be fair, physicians and surgeons were probably responsible for killing lots of people with lots of different medical conditions for most of human history. Malpractice wasn't unique to obstetrics. But they're doing MUCH better now...

Steve C:

I thought the point of the column was to commend evidence-based medicine. There is no evidence that obstetricians were lowering the "success rate", and killing women that midwives wouldn't have.

"John Rock's Error" is the "Citizen Kane" of general interest OB/GYN writing. I wondered if the Gladwell comment was a "Stardust Memories" reference. Upon further reflection, it's probably not.


Write it? Bro, I took the vaginal route. But I was much younger then.


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