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Comment and Controversy

Is “rational” cesarean a misnomer?

September 2006 · Vol. 18, No. 9
This week's quiz:
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“Is patient-choice primary cesarean rational?” by Geeta Sharma, MD (May)

Let me get this concept of “rational” straight. A woman can choose a surgical procedure to terminate the life of her fetus, and this is considered rational by ACOG, the Supreme Court, and many Americans. When another woman chooses a surgical procedure to lessen the risk of mortality to her fetus during delivery, we need a national conference to decide if her decision is rational.

When a Jehovah’s Witness goes through pregnancy and refuses transfusion, the mother’s risk of death is 1 in 170.1 This risk is similar to the maternal mortality rate in developing countries with no prenatal care.2 Many physicians gladly take care of such patients and respect their choices. These physicians allow that such nonscientific beliefs are rational.

Let us differentiate between science and morals, science and marketing, science and religion. Science is rational and, at its best, not subject to cultural relativism. These other components of our everyday practice are suffused with value judgments, financial incentives, and beliefs not based on scientific merit. Patient-choice cesarean section, like the concept of the ideal cesarean-section rate,3 is not a dilemma that will be solved by the tools of science.

Joseph A. Walsh, MD
Farmington, Conn

Dr. Barbieri responds:

Many factors influence the cesarean decision

I thank Dr. Walsh for his concise critique of cesarean delivery on maternal request. His conceptual framework is very practical.

As he notes, medical decisions are heavily influenced by both scientific findings and “nonscientific” factors such as cultural context, subjective value judgments and non-conscious cognitive processes.


1. Singla AK, Lapinski RH, Berkowitz RL, et al. Are women who are Jehovah’s Witnesses at risk of maternal death? Am J Obstet Gynecol. 2001;185:893-895.

2. World Health Organization. World Health Report 2005. Make every mother and child count. Geneva: WHO; 2005.

3. Cyr RM. Myth of the ideal cesarean section rate: commentary and historic perspective. Am J Obstet Gynecol. 2006;194:932-936.

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