What’s Evolution Got To Do With C-sections?

Childbirth is like pushing an SUV through a keyhole. And that’s the real reason so many women are opting for caesarean deliveries.

WrittenBy:Madhu Trehan
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How can a journalist argue with a scientist? He’s the expert with depth of knowledge, an analytic brain and spends his life examining and creating theories. All these theories are presented with proof along with reasons why a certain conclusion was drawn. My question, then, is: how is it that some scientific theories are disputed with other scientific theories that argue the opposite? How many established long-believed scientific facts have been proven wrong at a later date? There’s a long list.


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One simple and recent example is the theory of ulcers. For decades doctors linked peptic ulcers to the stress of modern life. Doctors advised patients to take antacids and modify their lifestyle. In the 1980s, Australian clinical researcher Barry Marshal discovered that the bacterium H. pylori caused the peptic ulcer disease. Marshal won the Nobel Prize in 2005 for this.

Diet advice on how to keep your cholesterol low has changed so much and so often over the years that you wonder why listen to them at all? First ghee was bad, switch to Safola oil, then switch to Canola oil, then switch to olive oil and now we are back to where we were in the first place: they tell us pure ghee is good for you. CNN has, in fact, done a story on how medical advice has changed over the years.

My father ate austerely following all the earlier advice. Oil-free food, steamed vegetables, no starch, no meat, no alcohol. After he passed away, all the stuff they had told him to stay away from became acceptable to eat. He would have laughed.

Should we accept all scientific papers blindly? One cannot. Of course I’m not saying all scientific papers are wrong. But, what I am saying is, they could be wrong. That possibility exists. All the theories that have been subsequently debunked were at one time believed on the basis of research and analysis.

So, I do take exception to Anand Ranganathan’s article on how caesarean-section deliveries are changing the way our bodies and brains are evolving. Particularly the paragraph below:

“Fifty years ago, roughly 30 babies in 1,000 found it physically impossible to emerge from the birth canal. Today, that figure stands at 36. Five per cent of all deliveries in the United States of America in 1970 were Caesarean. Today that figure is 33 per cent, three times of what the World Health Organisation considers the ideal rate. The world over, C-section is taking the form of an epidemic. Eighty-two per cent of all deliveries in private Brazilian hospitals are now Caesarean. India is no different. The Caesarean rate was 2.5 per cent 25 years ago, well below the WHO recommended 10 per cent. Today it is 15.4 per cent and snowballing rapidly. In the same time as India’s C-section rate jumped to 15.4 per cent, the global average rate did, too – from 6.7 to 19.1 per cent.”

In this, the numbers of caesarean babies who found it physically impossible to emerge is being blurred with the statistics of how many caesareans are done electively. The huge increase in caesareans is not because of medical necessity alone.

Doctors around the world have raised the alarm on the epidemic of caesareans done for the convenience of doctors who do not, then, have to answer calls in the middle of the night. Caesareans mean the hospitals make more money since the duration the patient stays is extended. Huge numbers of young women are opting for caesareans to avoid the excruciating pain of childbirth.

For those who haven’t gone through natural childbirth, it is like trying to push an SUV through a keyhole. There was an Omertà amongst generations of women about the level of pain of childbirth. We were never told about it and we never told our daughters. Many of us have been asked by our daughters, “Why didn’t you tell me?” Well, I cannot see myself sitting down with my daughters about to become mothers and tell them, “Be prepared for the worst pain of your life. And, it’s not for a few minutes. It lasts for hours”.

The truth is you forget the pain forever the second you hold your baby in your arms. I can remember the pain during my recovery from other surgeries, but I cannot, as much as I try, channel my pain when I gave birth. All I can remember is that it was kind of tough and the chaos and mismanagement by doctors around me. This includes my husband who forgot to play husband and could not get out of doctor mode. One of the nurses ticked him off on this.
In the ’70s and ’80s, there was no question of choosing to have a caesarean unless it was a medical necessity. Medical ethics were strong and upheld. No doctor would advise a caesarean because it was more convenient and comfortable for his timings. No doctor would think of a caesarean to help the hospital make more money. Women were not given a choice to have it electively to avoid the pain.

Today, I know more young mothers who have had caesarean deliveries than those who have gone through natural childbirth. Some because doctors are trigger-happy and others who simply wanted to avoid the pain. Of course, there are a few dingbats who have chosen the date and time given by an astrologer.

So, Anand’s article that connects the increased number of caesareans to the newly-minted scientific paper that says that larger heads will make caesareans more common, neglects the fact that bigger brains or not, caesareans are being done for other reasons. Presenting the increasing rates of caesareans and connecting it to the bigger heads theory does not work. As evolutionary theories go, we have no idea how women’s bodies would possibly adjust by developing a wider pelvis.

As this caesarean epidemic rages on, unfortunately, the risks, complications, side-effects and long-term medical problems that arise from it much later in life are not being talked about. How many doctors inform their patients about the risk and complications of a caesarean procedure before they do it?

There are always elements of risks in surgery. You are cutting a body open. You are being put under anaesthesia. Yes, through medical improvements the risks have gone down but they have not disappeared. There is a huge amount of ignorance amongst young women about the down side of a caesarean procedure. When medical decisions such as caesareans and early inducement of labour are conducted for financial gain and convenience, patients are placed in a dangerous zone. Of course, it goes without saying, caesareans must be carried out when the baby and mother are at risk going through natural childbirth.

Performing a surgery when it is not medically necessary is the most violent deviation from medical ethics. Most good doctors will treat a patient for as long as possible through medicines. Surgery is the last resort. My husband is a surgeon. He often says: “If it ain’t broke, why fix it?”

The author can be contacted on Twitter @madhutrehan

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