"Good morning and thank you for coming.

Unnecessary cesarean sections threaten the future health of mother and child, and are being performed on more and more women without a clear understanding of the risks of this major surgical procedure.  As specialists in women's health care, midwives are very concerned that decisions to perform surgery are being made based on circumstantial evidence, misinterpretation of evidence and/or on lack of respect for the short and long term risks of this major abdominal surgery. 

In just one week from today, the National Institutes of Health will convene a State of the Science Conference on Cesarean Delivery on Maternal Request.  During that two-and-a-half day event, we can expect to learn more about what the scientific literature says about the risks and benefits of what we believe should be the most infrequent surgical procedure known to women.  Maternal request for cesarean delivery is a surgical indication that is not clearly defined and is probably a result of inadequate information or misrepresentation of the options available, and in some cases, is the result from coercion based on the preferences of the providers and institutions that find spontaneous vaginal delivery a major inconvenience. 

The College and our partners are also extremely concerned that a major element of the cesarean debate - the voices of women experiencing complications from cesarean section - have and will continue to be unheard.  It is for that reason we are gathered here today. 

Let me be clear that we believe that the vast majority of physicians and hospitals are doing the right thing when it comes to maternal request for cesarean section.  Many physicians share our concern that what should be an extremely rare event may become a cultural norm, because it fits into a health system that puts cost savings and convenience above good medical judgment.  It fits into a health care system that does not value prevention and education bur routinely applies technologies that are life-saving for some, but not without complications for others.

Specifically, the motivations may be financial: hospitals can maximize revenue per procedure and perform more procedures each day.  They may be physical: hospitals can exert more control over staffing schedules and workforce needs.  Some hospitals and physicians tell us they are responding to peer pressure as they do not want to lose patients to their competitors.  Finally, there is the fear of litigation-physicians often refer to fear of lawsuits as a motivation for performing a cesarean, even when they do not believe it is necessary. 

This country has a major problem that must be resolved before women can be told the truth about the risks of cesarean section.  There is no national databank that links subsequent complications such as those you will hear described today to the original surgical procedure.  Thus, any conclusions about the risks of cesarean section are mere speculation, and some of those conclusions are potentially life-threatening.

Women must be told the truth about the long and short tem risks of surgical birth.  They only get to make the decision once as scars and adhesions last forever.  A uterus lost to complications of cesarean section cannot be replaced. 

The REDUCE Campaign's purpose is to give voice to the women who have suffered long-term problems resulting from a cesarean birth.  We know there are women who are disabled, who have lost their ability to bear a child, who are permanently scarred because of their cesarean birth.  

When you hear their stories, you too will want to go back to the days when we did not take the decision to do a cesarean section lightly.  As clinicians, we believe that if a woman is harmed or dies from complications related to a cesarean birth, we want her and her family to know that the surgery was necessary. 

I want to take a moment to acknowledge the generous support from our REDUCE Campaign partners - the American Association of Birth Centers, Citizens for Midwifery, the Coalition for Improving Maternity Services, International Cesarean Awareness Network, and Lamaze International."