I responded to this post last night, but I thought of a better response today. I deleted the old one, and here is the new one:

The thing is no one disputes that the appropriate use of obstetric intervention has saved lives, but what also cannot be disputed if you look at the research record is that the inappropriate use of obstetric intervention is taking them. In particular, we have solid evidence that there is an excess of deaths in mothers and babies associated directly with cesarean surgery, as opposed to the indications for the surgery, both in the current and subsequent pregnancies, and we have equally solid evidence that the cesarean surgery rate could safely be somewhere between one half and one third of its current rate in the U.S. Moreover, obstetric intervention has had no effect on either of the two major sources of perinatal mortality: preterm birth and congenital anomalies nor has it had an effect on a major source of maternal death: pregnancy-induced hypertensive diseases (preeclampsia, eclampsia, HELLP syndrome). Meanwhile, cesarean surgery and the overuse of interventions such as induction of labor that increase the use of cesarean surgery increase the likelihood of two of the other major maternal killers: hemorrhage and infection.

It is also true that improvements that have little or nothing to do with obstetric intervention have had far greater impact on reducing mortality rates. These include antibiotics, transfusions, better nutrition (rickets deforms the pelvis, for example), and the ability to control family size and spacing between children.

In addition, the exclusive focus on tests, procedures, and drugs diverts resources and attention from nonobstetric interventions that would have much greater impact on reducing deaths. These interventions would be effective, and, unlike obstetric interventions, would not introduce risk. To cite some examples, the most common cause of maternal death in the postpartum period is suicide, the only intervention that has ever been shown to reduce preterm birth is a specialized type of group prenatal care called Centering Pregnancy, and breastfeeding reduces infant deaths even in developed countries. Yet how much effort are we making to identify and treat women at high risk for suicide? On the contrary, conventional obstetric management increases the risk of experiencing trauma in birth and post traumatic distress syndrome would contribute to risk of suicide. Where is the commitment to promoting breastfeeding? Last time I looked, only 52 U.S. hospitals were Baby Friendly according to WHO-UNICEF guidelines. Moreover, having a cesarean decreases the likelihood of breastfeeding. And as for the group prenatal care model, the randomized controlled trial that confirmed its efficacy and which was published in a major U.S. obstetric journal, was published without fanfare and vanished into the void thereafter.  

--Henci