WETZSTEIN: Childbirth deaths increase in U.S.

It is refreshing to read an article on the subject of maternal mortality in the U.S. that doesn't simply draw a line between increased cesarean rates and maternal mortality, only to conclude that the surgery itself is at the root of the problem. As you rightly point out, obesity, maternal age and quality of health care are just some of the issues that need examining, and evidently, there are no easy solutions to these: "medical professionals and public health officials will have their hands full trying to talk American women into staying fit and at a normal weight; getting married and bearing children in their 20s and early 30s; getting good prenatal care; and avoiding C-sections, especially "elective" ones." That said, I'm afraid your last remark in the extract above may be factually incorrect in this context, at least it is for women in healthy pregnancies, planning a small family, and giving birth to their babies at 39-40 weeks confirmed gestation. These "elective" or "planned" cesareans are not associated with the same risks as emergency cesareans or cesareans with a medical indication. I would like to draw your attention to some research published in England this year, in which the Birth Trauma Association uncovered data (from the CEMACH report) showing that women giving in birth in 2003-05 were actually "less likely" to die following a planned cesarean delivery than other births. (http://www.telegraph.co.uk/news/uknews/1584671/Women-choosing-caesarean-have-low-death-rate.html) I would add that pregnancy and birth are inherently risky events, and I fully acknowledge that even with a planned cesarean, a woman may die. But I think we need to be very careful when reporting cesarean risks that we don't confuse emergency and elective outcomes or exaggerate risk, and that we don't cultivate an environment in which women who 'want' a cesarean delivery are vilified during an attempt to reduce the number of 'unwanted' and high risk surgeries. It is unfair to them and it doesn't actually address the problem at hand. Pauline McDonagh Hull Editor, http://www.electivecesarean.com Blog, http://www.electivecesarean.blogspot.com