Despite its spine-chilling title, this is not a book against surgery or doctors. Written by Dr. Herbert Keyser, a practicing gynecologist for 20 years and a faculty member at the University of Texas Health Sciences Center at San Antonio, it concludes that there are far too many operations performed on women. He presents hospital statistics that compare rates at which procedures such as hysterectomies and cesarean sections are performed in different institutions and by different doctors. It's impossible, he says, for some of the high rates to be justified.
Keyser provides a useful, clear and detailed description of each surgical procedure and the conditions for which it is justifiably performed. He urges women to inform themselves, ask questions and seek second opinions from a qualified physician not associated with the doctor proposing surgery when an operation is advised.
There are 1 million D&Cs -- dilation and curettage -- performed annually in the United States. Stretching the opening of the uterus and scraping off the lining is a relatively easy operation for the doctor. It is valuable in helping detect endometrial cancer, clearing up abnormal bleeding, removing polyps and completing miscarriages. But, says Keyser, the D&C is subject to excessive use when a better course of treatment might be hormone therapy, biopsy or nonsurgical management. And the D&C is temptingly profitable for the physician.
Hysterectomy, the surgical removal of the uterus, has an unsavory past in the annals of needless surgery. Keyser says it's still often performed unnecessarily. He describes six basic situations in which the operation is appropriate; but in two of them, prolapsed uterus and fibroid tumors, the condition often is not severe enough to warrant surgery, and should be treated in other ways if at all.
Cesarean section -- the delivery of a baby through a surgical opening in the abdomen -- is a serious and costly operation that Keyser claims is done unnecessarily in many cases and is subject to abuse by unethical doctors. He recommends requiring physician consultations in cases of abnormal labor or fetal distress, which would be reviewed by the department, and monitoring of patterns of C-section frequency to avoid unneeded operations.