The impression she gives of nature as a perfect midwife is cruelly misguided. In "traditional culture", where the practice of observant neglect may be followed, complications of birth occur which in this country are rarely seen outside a textbook. The prevalence of permanent urinary incontinence following prolonged obstructed labour in such cultures (Ethiopia being a much published example) is high and should concern anyone dealing with the birth process.
She also continues to paint younger obstetricians (amongst whom I count myself) as a "deskilled" body, unable to turn a breech. I, and many of my colleagues of a similiar age, have been turning breech babies around for years. Breech presentation is uncommon, however, and for her to suggest that we could halve the Caesarean rate by practising it universally is wrong.
I think what she means is that we could halve the Caesarean section rate amongst women with a breech, which is not the same at all. There have, furthermore, been no suitably randomised trials that have proven the case for or against Caesarean section for breech beyond reasonable doubt, although there has been a great deal written on the subject.
Mr L J ROBERTS MRCGP MRCOG
Consultant Obstetrician and Gynaecologist