#80 - Jacqueline Wolf, PhD: On the Sordid History of C-Section in the U.S.

Jacqueline Wolf, PhD, is a history profess at Miami University. She has probably read more medical literature pertaining to the history and consequences of c-section in the United States. She is the author of an AMAZING book called "Cesarean Section: An American History of Risk, Technology, and Consequence". 30-40% of babies in the U.S. are born by c-section, and the rate doesn't seem to be in decline any time soon due to the universalization of continuous fetal heart monitoring. Litigation against doctors for things out their control in birth makes matters even worse. With the advent of FHR monitoring, we have seen an increase in c-section rate without any benefits to mom or baby. Womp. This episode is (insert fire emoji)!



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[00:07:30]

• OBGYNs need to learn the history of c-section


• In some parts of U.S., >40% of babies are born by c-section


• OBGYNs are being de-skilled


• 70% of our training is in surgery


• C-sections are traumatizing

[00:14:00]

• Gynecology deals with pathology; obstetrics dealing with surveillance of a natural, physiologic process


• Joke: how do you hide something from an OBGYN? (Punchline is too good to include in show notes…)


• C-section used to be rare because it was so dangerous


• WW2 brought blood banking and antibiotics


• Mortality and morbidity initially went up when birth moved to the hospital

[00:30:30]

• The unforeseen downsides to high c-section rates (e.g. placenta accreta)


• A maternal death should be a worse case scenario


• Should there be firm indications for c-sections in the U.S.?

[00:36:00]

• Up until 1940, most births took place at home


• 25% of births in the US are induced


• ContInuous fetal heart monitoring has been the greatest reason for high c-section Rates


• It was initially designed to be used for high risk birth but it has become universal


• “Physicians began dropping the knife with every drop in fetal heart rate “


• Intermittent auscultation > continuous monitoring

[00:59:00]

• Malpractice concerns 


• Skilled birthworkers generally need to do very little at a birth


• Midwives should be attending most uncomplicated  vaginal births


• My c-section rarely goes above 5%

[01:16:00]

• Labor curves should be forgotten


• Preventing the First Cesarean Delivery, by Spong et al

Jacqueline's website (buy her books!)and her podcast



Find me on Instagram @nathanrileyobgyn and my practice at: www.BelovedHolistics.com



Music by: Labrinth and Preservation Hall

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