欧宝娱乐

I really like Gawande's writing style, and for the most part feel like he gives a very rational, nuanced look at medical care in the US. The only exception to this is the essay "The Score." Although his main point in this essay, that a concrete, replicable measurement of baby health led to great improvements in infant mortality in the US, is well-taken, his description of the history of obstetric care and the near inevitability of an increasing c-section rate in the US is shockingly uninformed. Many modern industrialized nations have far better maternal and infant outcomes and far lower c-section rates in the US. The difference is not that in those countries doctors make extensive use of forceps instead of c-sections; the difference is that the system of care for laboring mothers depends heavily on the use of midwives. Obstetricians are only used as the exception, not the rule. (The Netherlands is the best example of this.) To say that the package of numerous unproven technological interventions in the physiological process of birth since 1940 have caused the "dramatic" improvements in the outcome statistics is totally unfounded; correlation is not causation. Gawande concludes that there's "no getting around C-sections":

"We have reached the point that, when there's any question of delivery risk, the Cesarean is what clinicians turn to鈥攊t's simply the most reliable option. If a mother is carrying a baby more than ten pounds in size, if she's had a C-section before, if the baby is lying sideways or in a breech position, if she has twins, if any number of potentially difficult situations for delivery arise, the standard of care requires that a midwife or an obstetrician at least offer a Cesarean section. Clinicians are increasingly reluctant to take a risk, however small, with natural childbirth....Putting so many mothers through surgery is hardly cause for celebration. But our deep-seated desire to limit risk to babies is the biggest force behind its prevalence; it is the price exacted by the reliability we aspire to."

This is simply not true! There is absolutely no positive correlation between increased c-sections and improved birth outcomes for moms and babies; in fact, there's a negative correlation. If Gawande had looked outside North America for information on this issue, he would not come to this absurd and harmful conclusion. It's really disappointing that someone as thoughtful as Gawande has not looked beyond the party line of doctors in this country on this unbelievably important issue.

If you have any interest in this issue, read Jennifer Block's brilliantly researched new book "Pushed."