New Criteria to Evaluate the Practices of Midwifery and Obstetrics

ABSTRACT: A position on the necessity of evaluating both obstretrics and midwifery is offered to utilize what strengths each discipline brings birthing mothers. But beyond this, the effects of birth on subsequent events, for example breastfeeding in the short term, and the potential for sweeping effects in the long term for the culture are included. To summarize, the accumulation of research in a number of areas points to the conclusion that interfering with pre- or perinatal development can have future effects currently not envisioned. Studies that demonstrate this conclusion are offered, from animal studies (ewes given epidural anaesthesia procedure at birth having the effect that they do not take care of their babies) to humans (c-sections). Comparisons are drawn to similar procedures that may be at the root of some existential changes occuring in our own civilization. KEY WORDS: Evaluation, obstetrics, midwifery, genetics, environmental, civilization INTRODUCTION Many factors will influence the future of midwifery and obstetrics. The main one, after thousands of years of culturally controlled childbirth, will probably be our capacity to take advantage of the fast development of physiology to rediscover the basic needs of labouring women and newborn babies. I have had many opportunities to look at this factor and to anticipate that it will take decades to accept that the best environment for an easy birth is when there is nobody around, but an experienced, low profile and silent mother-figure behind the scenes (Odent, 2001a). New Criteria to Evaluate How Babies are Born My immediate objective is to focus on factors that are not usually taken into account when studying the evolution of midwifery and obstetrics. Their importance is probably underestimated. These are the criteria we use to evaluate how babies are born. Until now we have not enlarged a short list of old criteria established during the 20th century: they include perinatal mortality and morbidity rates, maternal mortality and morbidity rates and cost effectiveness Today conventional medical circles and natural childbirth movements still share the same way of thinking. We might add the same battlefield. For example certain obstetrical circles constantly tend to exaggerate the risks of home birth in the same way as the natural childbirth movements tend to exaggerate the risks associated with caesarean sections. It is commonplace to claim that the risks of death are multiplied by three or four after a caesarean birth, without underlining that the caesarean is rarely the direct cause of mortality, and without underlining that the population of women who had caesareans include a comparatively greater number of maternal pathological conditions. Today we can overcome these difficulties. Since in most hospitals all over the world the doctrine is to perform an elective caesarean at 39 weeks in the case of breech presentations, we have at our disposal a new generation of huge homogenous statistics that make it easier to evaluate the degree of safety of the modern caesarean in wellorganized departments of obstetrics. If we combine the results of a large Danish study that included 7,503 planned c-sections for breech presentation at term (Krebs & Langhoff-Roos, 2003), of a Canadian study that included 46,766 c-sections for the same reasons (Liu, Liston, Joseph, et al., (2007), and of the famous randomized multicentre Lancet trial (941 cases) (Hannah, Hannah, et al., 2000), we obtain an homogenous series of 55,210 caesareans without one maternal death. Because the natural childbirth movements do not recognize the modern caesarean as an easy, fast and safe operation, it is difficult to go a step further. The necessary analysis of new criteria to evaluate the practices of midwifery and obstetrics is postponed. In medical circles that do not dispute the safety of the modern caesarean, the increasing rates are acceptable, even welcome. …

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