> My wife is a doula and apparently the injury and mortality rates for mother and child are much higher than through natural childbirth.

That is of course true, because C sections are primarily used in high-risk pregnancies and in emergencies. But what you actually care about is the counter-factual: if a given set of deliveries were "natural" rather than a C section, would mortality go up or down? It's hard to develop studies to answer that counter-factual. But there is good evidence that C-section rates are negatively correlated with mortality (i.e. they lower deaths) up to about 20% of deliveries, and have no positive or negative effect beyond that: http://www.skepticalob.com/2017/10/more-wailing-and-gnashing....

Indeed, there is new evidence that "natural" births are in the long term bad for mothers, dramatically increasing the risk of things like incontinence later in life: http://www.skepticalob.com/2018/03/what-if-c-sections-are-be.... As a practical matter, these negative effects will impact far more women than differences (if any) in morality rates.

A nit: is it really true that C sections are primarily for high-risk pregnancies? C sections are at an all-time high. Both my kids were delivered by C section after attempts to induce labor, but those inductions were based simply on calendar due dates assigned early in the pregnancy. People schedule C sections in advance.

More importantly: anyone who has had a C section before is likely to deliver all future children via C section; it's not a requirement, but a normal birth after C section is a special arrangement.

Finally: C section itself is a traumatic surgery with long-lasting health effects for the mother. It's routine, but still a big deal.

> A nit: is it really true that C sections are primarily for high-risk pregnancies?

C-sections are very disproportionately used for those, though perhaps not primarily; in relation to the risk statistics upthread, is the same basic impact. You cant just compare adverse outcome rates for C-section and vaginal birth without taking into account factors associated with adverse outcomes which also make C-section a more likely event.

I don't think this is unknowable; just a couple minutes of Googling turned up a bunch of studies. Consumer Reports posted an analysis from journal articles indicating that maternal mortality from C sections is strongly correlated with specific hospitals; since the predicates for an emergency C section generally aren't correlated, that strongly suggests it's the procedure and not the circumstances that are to blame. The major causes of mortality due to C section include sepsis and anaesthesia errors (this happened to my wife during the birth of our first kid), which are also intrinsic to the surgery and not to the circumstances of the pregnancy.

This source seems anti-natural from birth to breastfeeding.

Medicine can certainly help improve things but if you've been through the birth process multiple times it's clear that doctors try to steer you towards C-section.

Several of them have confided to us that it's primarily because of insurance. The hospital procedures want women in C-section for a few reasons:

1. The procedure is expensive (surgeon, anesthesiologist, etc.)

2. The procedure is fast (30-45min) and can be scheduled allowing the hospital to deliver more babies with less staff

3. The recovery period is longer (2-3 day recovery period as opposed to 8-24 hours for natural birth) generating revenue for longer while only being care from relatively inexpensive nurses.

Sure, there are many times when C-section is appropriate and has saved lives, but it's currently being over prescribed because of hospital guidelines that doctor's need to follow or risk malpractice liability.

> This source seems anti-natural from birth to breastfeeding.

Well yes, because the author is a doctor. The maternal death rate from "natural" child birth is 1,000-1,500 per 100,000 births. In the U.S., it is just 26.4.

> Sure, there are many times when C-section is appropriate and has saved lives, but it's currently being over prescribed because of hospital guidelines that doctor's need to follow or risk malpractice liability.

The data in fact shows no evidence that it is being "over-prescribed." If it were, you would expect to see worse maternal outcomes in countries with higher rates of C sections, and you do not.

I think that if you were to plot "c-section deliveries as a percentage of all pregnancies" through the years before and after Edwards' string of winning court cases, you would see that c-sections did increase.

But are the injury and mortality rates higher because C-sections are riskier, or because high risk childbirth are done through C-section? You need to control for the prior, otherwise the statistic is not very useful.

From what I understand C-sections are much riskier for the mother than we might think. It's significant surgery which can always lead to complications or infection.

The other factor is delivering a child naturally that gets stuck and didn't get enough oxygen but lives is probably the most expensive outcome for doctors because that child can live with severe physical or mental handicaps and need support the rest of their lives.

The problem is not that C-sections are riskier than "we" might think, and certainly not that I might think because I'm extraordinarily unlikely to be in a situation to decide whether to do one or not. The important question is whether they are riskier than the alternative (natural child delivery) in the specific instances where a C-section is practiced.

It's entirely plausible that C-sections are done too casually and doing them less often would result in better outcomes. It's also plausible that they are not. The cynical in me finds very plausible that the answer to that question varies widely doctor to doctor.

C-sections are done when something isn't going right, or when there is some medical issue against natural childbirth. You can't compare the risks with natural childbirth because you're looking at two different populations.

Your argument is like saying doctors make people sick because someone in a doctor's office is more likely to be sick than someone on the street.

Its not money and efficiency, its the law! Money and efficiency goals would satisfy your criteria by lowering death and extracting more money from the payer.

Its precisely a law trying to change money and efficiency that produces this result!