"Complication in mother or child", commentary by Prof. Breymman (NZZ readers' letter)

As an obstetrician, I have been attending births for thirty years, both vaginal births and those by caesarean section. The daigram of the Health Department of the Canton of Zurich shows that intervention is necessary in 30 to 50 percent of births in hospitals and birth centers.

The term natural birth says nothing about the actual course of a birth. It can be a naturally beautiful birth, but unfortunately it can also be an inherently problematic or very difficult birth that ends in a caesarean section or a suction bell birth, for example.

It is very difficult to predict the course of a birth, and even though we leave the midwives at our clinic to manage the birth largely independently, I am often called out because of a complication with the mother or the unborn child. A midwife cannot perform a caesarean section in an emergency and cannot control life-threatening situations in the unborn child or the mother. In these cases, action often has to be taken within minutes to avoid worse.

If the child dies during birth, it is a catastrophe, especially if this could have been avoided in a clinic with appropriate care. In Germany, the number of birth centers and home births has fallen massively, as the liability premiums for midwives are extremely high or no insurance covers the risk at all.

In countries without modern obstetric facilities, the maternal and infant complication rate is around a hundred times higher than in Germany. Every fetal and maternal death during childbirth is one too many, especially if it happens due to a lack of professional infrastructure. Every woman and every couple should have a naturally beautiful birth. But in a safe environment, please.

Prof. Dr. Christian Breymann, Zurich