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Several decades ago my wife and I had our first daughter at home. As part of the preparation, we took 80 hours of emergency childbirth training.

One of the instructors had been a midwife waaayy back in the boonies of South America for several years about 30 years earlier. She showed us her medical bag and tools.

One of the tools was very oddly shaped. When I asked about it, she explained that it was used to decapitate one baby of a set of twins when necessary.

I was of course appalled. She explained that twins are not uncommonly oriented so that one is breech and the other normally oriented. Their heads can interlock so that neither can be born.

As a midwife, she wasn’t allowed to do a C-section. There was no way to get a doctor to do one where she was.

If she did nothing, both babies and the mother would all die, after immense suffering.

So the answer was to cut the head off one baby so the mother and the other child could be saved.

Sometimes terrible things are necessary.

While she had been trained in how to use this equipment, she was eternally grateful that she hadn’t had to actually do it.

The moral equation is really very simple. It’s better to lose one life than three. We are so coddled we have forgotten that decisions of this type have been common throughout human history. We just refuse to accept it.

Sherman, the decapitation case is different, as I think you will see upon closer examination. Decapitating somebody involves intending their death, either as means or as an end. In this case,it would be as a means, and it does not allow for even the slightest chance of even attempting to save the decapitated child. This is not medically ethical because it involves a directly lethal act against a patient. It would be as wrong a cutting off the mother's head, and then doing a fast-and-dirty C-section to save the two babies.

There are three patients at risk here: two babies and a mother. The midwife's ethical role is to try to save as many as possible, even if the death of one was probable; and in any case, to CARE for all of them, even the dying.

She would be justified under the circumstances to attempt a C-section (whether she was "allowed" to do so or "licensed" to do so or not.) A midwife ---- especially an experienced one with modern training --- would have a bette practical grasp of how to do the surgery than eventhe ebst OB/GYN of 100 years ago. A midwife would have a good idea of how to do the incision, how to control pain and bleeding, how to keep things sterile and antiseptic. If she tried it and she lost one of the babies, it would not be because of beheading the baby, it would be a totally unintended outcome of a legitimate procedure.

The first successful modern C-sections were done in around the 1880's by doctors who were far less trained and equipped to do them correctly, than a midwife would be today.