Open Letter

Open Letter to Good Morning America on ABC-TV USA Regarding the “Cesarean Debate” televised June 18, 2000

Dear producers,

First, thank you for airing a brief but important piece on the huge controversy of Cesarean surgery in this country: it’s benefits, hazards (both immediate and longterm). And thank you, Diane Sawyer, for managing to insert an accurate fact about one of the risks of cesarean surgery for the baby.

As a consumer advocate (with no professional ties to nursing, medicine or midwifery) who’s read the research and studied birth and maternal-infant health practices in this country and worldwide for 25 years, and who has authored and illustrated 7 published books in the field (one of which was named a “Best Book” of the year by the NY Times), may I offer a few words of feedback and a suggestion for a future piece?

  • Give it a few more minutes of time, as the subject greatly deserves it
  • Recognize that birth is a 50 BILLION dollar a year industry (we spend on just birth 1/3 of what this country spends on all of education from nursery school through college) and more than 50% of all hospitalizations in the US are for birth – which is not, by nature’s process, a medical event at all – making birth big profit-making business
  • Understand that this is not a debate between 2 different ways of reading the literature. Those who believe cesarean is equal to or better than vaginal birth have no good science to back their claims. There has been for a decade serious international analysis of research in this field – coming first from Oxford University Department of Epidemiomology and more recently the Cochrane Data Base, separating out “well-done” studies from poor studies.

The debate in terms of science is over and the results are in: as Dr. Wagner said, there is no evidence that a cesarean rate higher than 10% (actually 7%) yields any benefit to mothers or babies. There is ample data that cesarean surgery, especially done electively (without benefit of any labor) hinders the development of mother and baby and places each of them at immediate and long-term risk of numerous problems. What you ended up airing looked to the American public as if it were just a matter of 2 equal arguments, each based in good science, the type that leads people to say “Science can prove anything!” and to be cynical about all research.

  • Go deeper, as our nation’s mothers and babies deserve. There’s enormous profit and ego motives, along with ignorance and denial, compelling many obstetricians to do unnecessary cesareans and to be blind to the longterm negative implications of them (whether or not done for good cause)
  • Understand it’s a women’s issue but that American women are today so frightened of labor and mistrustful of their bodies and the natural process that they have handed birth over to doctors and are no longer thinking deeply about the issues
  • Be aware that it’s also an issue of what is best developmentally for babies ~ and for our entire species ~ as to whether they need and benefit from spontaneous labor and natural birth or not. Scientific evidence abounds that they, in fact, do.

I get discouraged when I see something handled so poorly as this segment. Dr Marsden Wagner and the head of ACOG were not able to give any real sense of their point of view. And the interview was hindered by being so rushed that I could literally feel Dr Wagner’s inability to put a cogent argument into brief enough sentences.

I was interviewed by David Hartman on Good Morning America in the late 70s (or was it the early 80s?), given 7 minutes to have a real debate with the then-head of region 9 of ACOG regarding home birth and “lay midwives.” That debate was genuine and gave the public some real facts and issues to grapple with. And before that, in June of 1975, following the publication of my book Immaculate Deception: A New Look at Women and Birth, Barbara Walters interviewed me for 7 minutes on The Today Show. During that segment huge blowups of 2 black and white photos of mine (one from a US hospital birth and one from a Dutch birth) were displayed behind Ms Walter and me, showing the stunning obvious differences. And that interview was considered so strong that the network chose to continue it for 5 more minutes, after the break, and allow those stations that wanted to, to run the second segment in lieu of local news or weather.

I’d like to have a chance to interest you in the many issues related to birth in this country that are being ignored or short-changed. Please understand that the experiences each mother and baby pair have in birth affect each of them (and their uniquely symbiotic relationship, which is the blueprint for all that child’s future relationships) for many years.

Give me a chance to express in brief to the American public the authentic value of natural, normal birth. I can show very quickly what is wrong with a country that, for 75+ years has routinely drugged and separated mothers and babies and extolled a medical management model for birth, in the face of no good scientific or clinical evidence. Our way of birth continues to be perverted by values that have nothing to do with either good science or humane care. I would be happy to debate anyone on this. However, since the “other side” already controls birth and is the prevailing belief of the culture, it seems more than appropriate that “nature’s” side gets a fair hearing.

Some of the issues that might interest you (and I know would interest the American public) for future Good Morning America segments include:

  • the striking differences between the midwifery model and the medical model in birth
  • pain in labor and why drugs to deal with pain are not worth the cost (in public health, in mother-baby attachment, in money, resources, and women’s empowerment)
  • where feminism has missed the boat in birth by failing to support either natural normal birth or midwifery
  • home birth as a rational choice for healthy women, and why many intelligent women go to huge lengths to avoid hospitalization for birth today (there being, in fact, no good scientific evidence from any country that supports routine hospitalization for birth and much evidence about the negative side of routine US birth practices)
  • what happened to the alternative birth movement, that was burgeoning in the mid 1970s to cause today’s pregnant woman to be such a passive, compliant “patient”?

Finally, it seems perverse that today two men should be debating an issue that is of such intense, private and intimate concern to four million women per year and that no mention is even made about the psychic (emotional and spiritual) as well as physical dimension of the birth process on a human infant.


Suzanne Arms
producer of Giving Birth: Challenges & Choices
Durango, CO

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