Monday, July 16, 2012

Ask an OB: "Birth isn't a disease, it's a normal bodily function"

"Ask an OB" is a weekly series with Dr. Maude "Molly" Gurein, MC, FACOG.  If you have a question you'd like to ask her, please share it with us here

Can you address the NCB claim that, "Birth isn't a disease process, and therefore doesn't need medical intervention"?   ~ Michigan mom

This is an interesting statement because it contains an assumption that I don't believe to be correct.  The assumption is that we decide to medically intervene base on whether or not something is a "disease process".  This is actually not true - we decide to intervene if we believe we can reduce pain, suffering, death, or disability.  

Tripping in the forest and breaking your leg isn't a "disease process" - it's a side effect of living life.  Lack of sanitary sewers is not a disease process, but it kills a lot of people.  Getting cancer because you are old and your immune system is weak is also a natural process.  Is obesity a disease process?  How about smoking?  We use "medical intervention" in all these conditions because we believe we can reduce pain, suffering, disability, or death.

Pregnancy related morbidity and mortality were staggering before the modern era, and continue to be a source of concern today. 
"In 1915, the maternal mortality rate was 607.9 deaths per 100,000 live births for the birth registration area.  In 2003, the maternal mortality rate was 12.1 deaths per 100,000 live births in the United States.  Despite the tremendous overall improvement, maternal mortality continues to be a significant public health issue and commands an enormous amount of attention."  [CDC, Maternal Mortality and Related Concepts, 2007]

Based on the facts, I believe pregnancy qualifies as a condition that can cause pain, suffering, disability, or death, and therefore qualifies as a condition that benefits from "medical intervention".  Check out these graphs to see if "medical intervention" has been a good thing for maternal mortality in the US since 1915 or for a perinatal mortality in the state of MI since 1970:

Going back to the 1950's, after antibiotics and general anesthesia, but before risk-based prenatal  care and intervention, fetal monitoring, and timely cesareans,  and you will find a maternal mortality rate 7 times higher than today & a perinatal mortality rate 8 times higher than today.  Yes, your cesarean rate is also 8 times higher.  You pick...


  1. THANK YOU so much for addressing this claim head on. Your examples and illustrations are very pertinent and helpful. The ludicrous claim that birth in the US today is "overmedicalized" is foolish when you look at the not-so-distant past.Great post!

  2. Great post! You make this very easy to understand.