Response to "Natural childbirth ideology is endangering women and babies'

Abstract

A feature of this debate about ‘natural childbirth ideology’ is that caesarean section rate (CSR) should not be used as a clinical indicator.1 The thesis propagated is that by counting caesareans we are likely to do harm. This is an error of interpretation of the utility of clinical indicators. They are not rules to be slavishly followed, but clinical tools, the information from which can guide practice. If an indicator shows a service is an outlier then the action is to understand why, and adjust for factors that might be increasing or decreasing the CSR. It is also important to use a suite of indicators that inform about process as well as outcomes, which need to be both acute and long‐term. Such an approach, used by the benchmarking and jurisdictional bodies that analyse perinatal statistics, gives an overall picture that is required to get the best view. Understanding the journey of birth is as important as the outcome, because with every intervention there are risks and benefits.