Dr A. Krisman’s letter in the November issue of the BCMJ [2003;45(9):431] criticizing the cesarean section rate of the province will be appreciated by other retired old fogey obstetricians such as myself. One wonders how a respected institution such as the Rotunda Hospital in Dublin can keep its section rate in single figures whilst here we accept a rate three times as high.
Many years ago my father visited the United States with the Gynaecological Visiting Society of Great Britain. He questioned a New York obstetrician about the section rate in that city, which seemed to be much higher than in the UK, and was told that the three commonest indications for this surgical interference were indolence, ignorance, and avarice. This may still be part of the problem, but I suspect that today the main reason is fear of litigation. If the result of any pregnancy is not a perfect infant with no suffering on the part of the mother, the first question the lawyer asks is “Why was a cesarean section not done, or done sooner?” even if it has no bearing on the case. The legal profession has done a disservice both to our patients and to us. I believe that the three quoted indications of the old New Yorker might well be applied to them.
—H. Martin Gough, MD
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