RuralDocAlan is my Twitter handle. Seemed an appropriate way to identify myself and at the same time let readers know I practice medicine in a rural area, rural North Dakota. For those of you who are old enough not to care about my Twitter handle, my name is Dr. Alan Lindemann.
I am pleased to have this opportunity to write about a topic which is in the news almost daily—the maternal death rate in the United States.
Why am I discussing this topic instead of a professor of obstetrics at a well-known medical school? Or a committee member on some board charged with getting to the bottom of this really shameful maternal death rate in the U.S.? While committees meet, I’ve been in the trenches delivering about 6000 babies with no maternal deaths, no mothers with strokes or eclampsia, and no babies with cerebral palsy. I have learned a lot over my years of delivering babies and I want to share what I have learned.
I’ve been delivering babies for a very long time. I began medical school in 1973. Yes, 46 years ago. During my third year student rotation at Regions Hospital in St. Paul, I was offered a residency in OB/GYN. Delivering healthy babies from healthy mothers became my vocation, my avocation, indeed you might say, my obsession.
I was fortunate to have been part of a good residency program where the subtleties of maternal and infant danger in pregnancies were part of everyday practice. So here I’d like to thank my preceptors and the nurses in the clinic and labor and delivery for sharing with me their extensive knowledge of pregnancy, labor, and delivery.
During my residency, my cesarean-section (C-section) rate had been 9.9 percent (today the national c-section rate averages 35 percent). For me, it seemed important to maintain this rate. After graduation I joined my first practice in Crookston, MN. I was shocked to find the C-section rate was 15.6 percent. In order to try to find out why this rate was so high, I reviewed charts from the previous three years. I found three primary reasons given for the C-sections: (1) the delivery of breech babies; (2) failure for labor to progress; and (3) repeat C-sections.
At this time, allowing women to have a Vaginal Birth After C-section (VBAC) was becoming popular. To lessen the number of repeat C-sections, I introduced the notion to the community that you could have a vaginal birth after a C-section. I found most of our patients were ready and willing to have a V-BAC. At that time there were very few rules and regulations restricting choice in pregnancy. By the end of the following year, we had reduced the C-section rate to 10.2 percent, close to what I had had in residency. Today, the C-section rate in this country is 32.3 percent, higher than in many third world countries.* In my course, you will find out some of the many reasons why this country’s C-section rate is so high.
It probably seems unbelievable to most listeners, but the model for pregnancy, labor, and delivery I learned in residency no longer exists except in some home births. In the following course modules I will tell you how, from my perspective, this patient-centered model of labor and delivery has become corrupted by the profit-mongering of corporate medicine. I wrote Modern Medicine: What You’re Dying to Know over 25 years ago to show how the physician-patient relationship was being destroyed by the profit motive of big business medicine. In this course, I show how the corporate takeover of medicine by profiteering has radically changed pregnancy, labor, and delivery for patients today.
I went into OB/GYN before big business took over medical care and arranged health care services to maximize profit. I have observed how the practice of obstetrics has deteriorated under this system. With health care under the thumb of big business profit-mongering, the committee call for “fixing” the problems with the U.S. maternal and infant death rate is about as effective as arranging napkins on the Titanic. It’s the old top-down approach as opposed to the bottom-up perspective. Real, meaningful reform will come only when physicians take back their control of patient care so they may practice in the best interests of their patients.
*McCulloch, Sam. “Highest C-Section Rates by Country.” June 5, 2018. <https://www.bellybelly.com.au/birth/highest-c-section-rates-by-country/>