Cesareans, or C-sections, and their proliferation over the past 15 years have become an issue of increasing concern among patient safety advocates and medical professionals. Statistics indicate that the rate has increased by 50% during this period so that a C-section is the second most practiced surgical procedure in the US. According to the New England Journal of Medicine, 30% of all deliveries are now done by C-section.
But the rate at which hospitals perform the surgery vary widely, even among those situated within a few miles of each other.
According to a former chair of the Department of Obstetrics at San Francisco’s California Pacific Medical Center, the data showing the huge increase in C-sections is not supported by professional guidelines or the studies related to birth outcomes. California hospitals show a C-section rate that varies from 11.2% to an astounding 68.8%.
Any surgical procedure presents risks such as infection, respiratory problems from undergoing anesthesia or complications related to the patient’s physical condition. C-sections, though routine, still present such risks among others, many of which are unnecessary because C-sections are often a procedure the particular patient did not require at the time.
The reasons why one hospital should schedule more C-sections than another vary. For instance, hospitals that are not fee-based or who revolving staff on duty have fewer such surgeries so that the doctors are paid regardless of the number performed. Hospital guidelines differ; for example a hospital may dictate that babies of a certain size be considered candidates for C-sections while other do not, or that certain patterns on a fetal monitor alert doctors to perform the operation while others seeing the same pattern have “wait and see” instructions. Some physicians worry that a labor that appears to be taking too long means the fetus is at risk and will perform the procedure even though there are no signs of fetal distress.
There are experts though who say that the overwhelming majority of mothers who have not had a prior C-section, who have their baby properly positioned and are not delivering prematurely should have vaginal deliveries unless there are conditions that make the procedure necessary to save the life of the mother or baby.
When are C-Sections Planned or Unplanned?
There are a number of reasons for a doctor to order a C-section:
- The labor is taking much too long
- Fetus or mother are showing signs of distress
- The umbilical cord is wrapped around the baby’s neck
- The size of the baby
A doctor might plan for the procedure in advance if the following is present:
- The mother had a previous C-section—a vaginal delivery might tear the prior incision
- It is a multiple delivery
- The mother’s weak or precarious condition
- The baby is not properly positioned
What are the Risks of a C-Section?
C-sections can save the lives of both baby and mother but the procedure is not always warranted among women who are pregnant for the first time or whose babies are well-positioned and are otherwise low risk. For these women, the risks may outweigh the benefits in a large number of cases. Among the complications that C-sections present are:
- Post-partum depression
- Continued pain and lingering numbness along area of incision for months
- Heart attack
- Blood clots
- Kidney failure
Compared to women who gave birth vaginally, healthy mothers who were undergoing their first C-section were 3 times more likely to suffer any of these complications. Vaginal deliveries in uncomplicated cases result in babies with fewer respiratory problems, are more likely to be breastfed and may be less prone to later conditions such as asthma, allergies and even obesity.
If a mother has a C-section, the chances that a subsequent birth will be by C-section is 90% and the chances of complications are increased as well. Other collateral consequences are home care expenses and longer recovery periods.
How to Reduce C-Sections
A number of hospitals have taken measures to reduce the number of C-sections performed. Having doctors compare their rate of performing the procedure with others and showing that they are out of step with their colleagues has resulted in fewer procedures taking place.
Implementing stricter guidelines also has reduced the incidence. For example, in some hospitals the physician must indicate if the surgery is elective or medical and it must be approved by a division head or laborist, a doctor who handles deliveries.
New protocol regarding fetal heart rate monitoring patterns have reduced the number somewhat as has discouraging labor inducement until the cervix is at a point where the delivery can be short and successful.
What this Means for Malpractice Claims
What happens when a C-section goes wrong and the mother suffers a heart attack, kidney failure, hemorrhages or dies? There are risks to any surgery as noted, but what if the mother was healthy and the baby was positioned properly though the birth was taking longer than the doctor wanted?
The issue turns on what the standard of care was in this situation and if the doctor deviated from it. If the mother or fetus was not experiencing distress, the physician was on his/her own in making the decision, was being paid for each procedure and had a history of performing a high number of C-sections, then there may be a viable claim and a medical malpractice lawyer should be consulted.
Generally though, a medical malpractice claim hinges on whether the doctor negligently performed the procedure and not whether the mother was exposed to more risk because this was her second or third C-section. The claim may also center on whether the doctor should have performed a C-section due to distress of the baby or mother or if it was performed too late.
A medical malpractice claim related to a C-section will pertain to injuries to either the baby or the mother, or both. Birth injuries may result from:
- Lack of oxygen—leads to cerebral palsy and developmental deficiencies
- Premature birth—if the procedure is done too early, the baby risks having organs that have not yet fully developed
- Erb’s palsy—a condition resulting from the doctor using excessive force in pulling the baby out so that the baby has an injury to the brachial plexus nerves in the shoulder group (usually occurs when a C-section should have been performed)
- Lacerations and permanent scarring—too deep of an incision requiring stitches to the baby and permanent disfigurement
For a mother, injuries include:
- Hemorrhaging—severed artery or a cut to uterus resulting in great loss of blood
- Infections—lack of antibiotics for the mother, unsterile instruments
- Blood clots—failure to use blood thinning medications or having the mother walk around too soon after delivery
- Bladder and bowel lacerations
- Anesthesia errors
Should you or a loved one have suffered a serious injury from a negligently performed C-section or because one should have been performed, then contact Boston attorney Doug Lovenberg. Mr. Lovenberg is a medical malpractice lawyer who has represented the interests of injured patients and their families for two decades and has obtained millions in compensation for his clients. Contact his office today for a free evaluation of your malpractice claim.