If medicine is a craft, then you focus on teaching obstetricians to acquire a set of artisanal skills—the Woods corkscrew maneuver … , the Lovset maneuver …, the feel of a forceps for a baby whose head is too big. … You accept that things will not always work out in everyone’s hands.
But if medicine is an industry, responsible for the safest possible delivery of some four million babies a year in the United States alone, then a new understanding is required. The focus shifts. You seek reliability.
You begin to wonder whether forty-two thousand obstetricians in the Unites [sic] States could really safely master all those techniques. You notice the steady reports of terrible forceps injuries to babies and mothers, despite all the training that clinicians received.
After Apgar, obstetricians decided they needed a simpler, more predictable way to intervene when a laboring mother ran into trouble. They found it in the Cesarean section.
Atul Gawande, Better: A Surgeon’s Notes on Performance, at 192 (Henry Holt & Co. 2007) (emphasis and extra paragraphing added).