An ancient principle of the practice of medicine is "Primum non nocere" which means "First, do no harm. It is helpful to look at the context in which the phrase appears. Hippocrates admonishes the physician "to help, or at least to do no harm." For obstetricians, "harm" means one thing above all else: death, of the baby or the mother. The secondary meaning of "harm" is permanent disability such as brain damage of the baby or an obstetric fistula of the mother. Everything that is done in modern obstetrics is done for the express purpose of reducing harm.
Obstetrics has been spectacularly successful in reducing harm. Neonatal and maternal mortality rates have fallen to levels so low that the average person may never meet someone who has lost a term baby due to labor complications, and will never even hear about a woman who has died in normal labor. Every one of the supposedly "unnecessary" medical procedures that homebirth advocates complain about has been instrumental in achieving these successes.
Obstetrics has been transformed from primarily disaster management, to disaster prevention. Moving from management to prevention has meant the application of technology to women who, in retrospect, may not have needed it. Doing "no harm" in obstetrics, as in the rest of medicine, now means preventing known harms from occuring at all, not waiting until they occur and treating them.
Childbirth in nature is inherently dangerous. That's not surprising. Pregnancy has a very high failure rate, too. Approximately 20% of all established pregnancies end in miscarriage and that is a normal part of human reproduction. Approximately 1% of all mothers and 7% of babies will die in childbirth or immediately thereafter, and that is a normal part of human reproduction, too. Modern obsetrics now prevents approximately 99% of maternal deaths and 90% of neonatal deaths. The most common reasons for maternal death used to be pre-eclampsia and eclampsia, hemorrhage, and obstructed labor among others. Those are still the most common causes of maternal death in countries that don't have access to modern obstetrics. The most common causes of neonatal mortality used to be prematurity, congenital anomalies, and obstructed labor, among others. Those are still the most common causes of neonatal death in countries that don't have access to modern obstetrics.
Homebirth advocates look at the current low rates of neonatal and maternal mortality and think that interventions, monitoring and testing aren't routinely necessary. They don't realize that the current low rates of neonatal and maternal mortality are the RESULT of interventions, monitoring and testing.
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An ancient principle of the practice of medicine is "Primum non nocere" which means "First, do no harm. It is helpful to look at the context in which the phrase appears. Hippocrates admonishes the physician "to help, or at least to do no harm." For obstetricians, "harm" means one thing above all else: death, of the baby or the mother. The secondary meaning of "harm" is permanent disability such as brain damage of the baby or an obstetric fistula of the mother. Everything that is done in modern obstetrics is done for the express purpose of reducing harm.
Obstetrics has been spectacularly successful in reducing harm. Neonatal and maternal mortality rates have fallen to levels so low that the average person may never meet someone who has lost a term baby due to labor complications, and will never even hear about a woman who has died in normal labor. Every one of the supposedly "unnecessary" medical procedures that homebirth advocates complain about has been instrumental in achieving these successes.
Obstetrics has been transformed from primarily disaster management, to disaster prevention. Moving from management to prevention has meant the application of technology to women who, in retrospect, may not have needed it. Doing "no harm" in obstetrics, as in the rest of medicine, now means preventing known harms from occuring at all, not waiting until they occur and treating them.
Childbirth in nature is inherently dangerous. That's not surprising. Pregnancy has a very high failure rate, too. Approximately 20% of all established pregnancies end in miscarriage and that is a normal part of human reproduction. Approximately 1% of all mothers and 7% of babies will die in childbirth or immediately thereafter, and that is a normal part of human reproduction, too. Modern obsetrics now prevents approximately 99% of maternal deaths and 90% of neonatal deaths. The most common reasons for maternal death used to be pre-eclampsia and eclampsia, hemorrhage, and obstructed labor among others. Those are still the most common causes of maternal death in countries that don't have access to modern obstetrics. The most common causes of neonatal mortality used to be prematurity, congenital anomalies, and obstructed labor, among others. Those are still the most common causes of neonatal death in countries that don't have access to modern obstetrics.
Homebirth advocates look at the current low rates of neonatal and maternal mortality and think that interventions, monitoring and testing aren't routinely necessary. They don't realize that the current low rates of neonatal and maternal mortality are the RESULT of interventions, monitoring and testing.
July 17, 2008 - 5:46pmThis Comment
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