“It’s payment-based. ”

Incorrect.

The C-section pattern looks entirely different. There is a huge spike first thing in the morning, another bump just before noon and a plateau in the early evening before the drop at night. There are very few C-section births at night. Roughly 10 times as many babies are born per minute during the early morning peak than the middle of the night. Whereas some C-sections are performed due to an emergency during birth, most are scheduled for varied reasons. Therefore, when a C-section takes place is heavily influenced by hospital schedules and the workweek, as is true for any other planned medical procedure.

A naturally-born baby is an emerging health crisis. The negative outcomes stretch all the way to neonatal and maternal death. The timeframe can be a dozen minutes to dozens of hours. Treatment is an unknown and emergent process involving many different specialists whose schedules are effectively locked down for the duration of labor.

A c-section baby is a surgical procedure that you can plug directly into Outlook. It is entirely managed by the medical team with zero input or influence from the patient. It is routine, it is repeatable, it is entirely divorced from the natural complications of birthing an infant naturally and consistently too large for a mother's hips.

A C-section rate of 10% to 15% is “natural”, she said. “Above 15%, you don’t have additional benefits, and you have the risks, and you have the unnecessary health costs.”

This is a really common number that nobody likes to talk about the source of. We like to say that 80% of women are perfectly capable of having an unassisted childbirth without any external help whatsoever - because prior to the advent of modern medicine, the infant mortality rate was around 20%. So - control for "modern medicine" and around one in five women is going to need some sort of medical intervention. That it's gone from around 15% to around 30% has a lot more to do with liability and scheduling than it does with "money."

Fun fact: 90% of private hospitals and 40% of public hospitals deliver by c-section in Brazil.

Interesting stuff, and it's one area where I'm glad there's been some pushback against too much intervention.

When my wife was pregnant, we initially went to an OB that some friends had used. She seemed fine, and was generally supportive with my wife wanting as little intervention as possible (she wanted to do a wholly-natural birth if at all possible). Ultimately we had to change practices, though: after talking to the OB, we realized that we of course couldn't guarantee that she would be the one on call when my wife went into labor, and that other doctors in her practice weren't as willing to go with it. Her privileges were also in a hospital that was much more interventionist.

So for the last couple months, we went with the local nurse-midwife practice. We were fortunate in that my wife was under 30, healthy, and in good physical shape, which also made things easier and had more options. VCU hospital was fantastic, and they're totally cool with low-intervention births.

What was great about this was that it allowed us to gradually increase what was done. My wife's water broke around 1:30am, and by 7am she was like 7cm dilated and ready to go. But after pushing for awhile things just kind of stalled. She tried different positions, tried the tub, but just couldn't make progress. Rather than pushing petosin, they offered an epidural so that she could take a break. She agreed, and the anesthesiologist was good enough that my wife could still walk afterwards. She rested for an hour or so and then got back to it. By around 4:00, though, things were still stalled. Our daughter was positioned funny, and the midwives tried moving her and/or the kid around, to no avail. Finally they brought in the obstetricians on call to discuss further intervention (e.g. forceps). They poked around a little, and said that the baby was too far back for that to be a good option, and recommended a c-section. Part of it was that after 12 hours from the water breaking, infection starts to become a concern. My wife was also exhausted, since she'd been in active labor for a good 8 hours by this point. I talked to the midwife, and she agreed. It turned out that our daughter was asynclitic, meaning that she wasn't in the birth canal crown first (her head was kind of sideways). The c-section went off without a hitch, with the added bonus that it was the birthday of one of the obstetricians who performed it.

I tell all this just to say that the way things went from the medical care standpoint was pretty much perfect. They stepped up the intervention only as much as was necessary to try the next step, but at the same time didn't shy away from needing to do something more aggressive once that started to make sense. This push can be stupid -- see the comeback of anti-vaxxers, of snake oil (read: homeopathics) in places like Whole Foods, etc. As with all things it's a balance, and our experience represents that balance perfectly.