An Act of Unpredictability.

Abstract

The authors are to be thanked for their effort to describe and analyze this dramatic paradigm change in obstetrics. And their conclusion is encouraging: Cesarean section is an escape hatch, not an equivalent alternative to spontaneous vaginal delivery (1). The article highlights yet another perspective: It appears that we have succeeded within a few years to reflect the merits and dangers of cesarean section. But we have not succeeded in understanding childbirth at all. Here, it is high time to develop a theory of science, as the lesson to be learned from the history of obstetrics is to be humble. Many developments (forceps delivery, routine episiotomy, cerclage, etc.) have been put back into perspective or even abolished over the years. I think that the increasing popularity of cesarean section is mainly due to changes in how society views childbirth and the related significant increase in fear and anxiety among both obstetricians and expectant families. In times dominated by control and perfection, an act of unpredictability and devotion, such as childbirth, has hardly any chance to survive. What is needed is “contemplation“ and “de-frightening“ right from the start; and a corresponding health aim and new guidelines should be defined. In Germany, about 50% of all cesarean sections are planned procedures (2). I think that this is solely due to organizational and economic reasons; there is no medical rationale for it. Birth without advance warning is an event not provided for. Therefore, my team and I are happy to get up at night whenever the self-determined date and hour of birth should be. I firmly believe that this approach makes sense.