Evakatharina-I don't disagree with anything you said, really. I just wanted to toss in my two cents about IMR variance.
*I'm no expert. Just stating an excuse to use data which are not the most current.
Well I'm not about to pretend to be a statistician! Your criticisms of using IMR to measure safety of birth practices are more than fair!!
FYI- you are totally correct in your guess that poorer regions of the United States have abysmally poor health care for pregnant women, and that it likely drags down the numbers for the entire United States even though birth in wealthy regions of the US is statistically very safe. And it's in some of those wealthy regions that the c-section rate is the highest (for example, in and around NYC the c-section rate astronomical due to the popularity of scheduled sections favored by wealthy women). So I'm definitely not saying that c-section = dangerous.
My real point is that the United States doesn't keep women really any safer than places like Scandinavia or Japan where home birth and midwives are wide spread, and that the system in place actively does harm to women by making birth extremely expensive, systemically limiting their safe options, and having a system that is more focused on doctor convenience (20 min c-sections vs 12 hour labors, birthing on the back, over use of medication) than it is on providing really good care for mother & baby. We would do better financially and in terms of women's overall wellness to focus on making safe midwife care available for the vast majority of normal births in this country, and then let the trained surgeons (the ob's) do what they are good and and likely what excited them in the first place- they handle the difficult cases involving surgery and complications all day every day. There's room for both and IMO both are very important and valid professions. I don't mean to denigrate obgyns in any way- all I'm saying is that it's overkill and there is a potential for a greater number of women to have positive birth experiences with midwives who provide consistent, nurturing care throughout the pregnancy and who allow women the opportunity to choose the type of birth they want without forcing unwanted interventions. If other countries can do birth just as safely as the US and without all the crap that our system forces so many women to go through, then we should be doing that too. It would be a win for everyone.
The reason I feel so passionate about this topic is that I know many women are deprived of having the kind of birth experience they want, and it leaves them feeling traumatized. Conversely, the women I've spoken to who have been lucky enough to have full knowledge of their birth choices and have made their best choice based on all the information (whether they choose a scheduled c-section or a home water birth or anywhere in between) have the opposite experience of feeling empowered and capable to do what they feel is best for themselves and for their babies. Lack of information about (and access to) options and mis-information about the perceived safety of the options is damaging.
Something that hasn't been talked about in this thread is that an unwanted/unneeded c-section deprives the mother and baby of many things, and women might not even be aware of what they are missing out on because the information is not given to women when they are making their decisions about what kind of birth they want. Some advantages women might not even be aware that they and their baby are not getting:
- natural childbirth causes the release of an incredibly powerful and complex combination of chemicals that forms an instant, euphoric love connection between the two and triggers the mothers protective instincts.
- there is no cascade of interventions to create conditions where a csection becomes necessary to "save" a baby that is distressed due to circumstances caused by the drugs. And then everyone saying OMG thank god we were at the hospital or we would have been in trouble!! Pitosin drips cause very strong contractions, and these strong contractions can restrict oxygen flow resulting in neurological damage.
- breast feeding is easier after a natural childbirth- when the mother gets an epidural, those drugs are passed to the baby, and research shows that these babies are less able to use their natural suckling abilities than unmediated babies.
- women who give birth at home or at a birthing center are more supported to move around, eat, drink, etc to feel comfortable and manage their pain which allows birth to proceed more normal resulting in less need to begin medical interventions