Are Medical Professionals Cavalier about C-Sections?

Posted on December 4, 2008 by David Austin

Posted by Cerebral Palsy Lawyer, David Austin

Birth by cesarean section (C-section) is increasingly common in our society, but the procedure is not always performed for the right reasons. Some experts believe the trend has gone too far, with doctors and women scheduling C-sections sometimes weeks before the recommended gestation period.

Alarming Statistics


The American College of Obstetricians and Gynecologists recommends that delivery occur at 39 weeks or after. However, some doctors are scheduling C-sections for as early as 37 weeks for reasons that include scheduling convenience and fear of lawsuits.

According to the Centers for Disease Control and Prevention, the number of babies delivered prior to 37 weeks gestation increased over 20 percent in a 16-year period. Preterm births are sometimes due to maternal smoking, lack of adequate healthcare and multiple births. But the March of Dimes reports that 90 percent of non-multiple preterm births are due to an increase in C-sections.

"I think unfortunately what we are seeing is ... people becoming more and more cavalier of the outcomes," said Dr. Aaron Caughey, an associate professor at University of California San Francisco.

Preterm Birth: Risk Factor for CP


Nearly one third of fetal brain development occurs in the final five weeks of gestation, and babies born preterm are more likely to suffer developmental delays, cerebral palsy, breathing or feeding problems, and even death.

 

Tweet this
Tags: , , , , ,

C-Sections All The Rage

Posted on June 2, 2008 by David Austin

Ten years ago about 1 in 5 pregnant women had a C-section; in 2006 that number was nearly 1 in 3.  C-section supporters point to eliminating rare but frightening complications of vaginal delivery.  Others point to the increased recuperation time, risks of uterine rupture and other problems during subsequent surgeries.

Another possible explanation for the increase in  surgeries is the cost of malpractice insurance.  In some states that cost may be upward of $100,000 and it could jump drastically if anything goes wrong during labor and delivery.  So doctors can avoid lawsuits by avoiding labor.  It also means that doctors and patients can organize their days much better by scheduling surgeries.

Many women seem to prefer surgical delivery.  Some do so because they either don't have time for childbirth classes or they want to schedule early enough before due date to avoid stretch marks and saggy skin.  Others may simply want to avoid the pain of labor.

So, why not C-sections?  Experts say that C-sections mean a longer hospital stay and recuperation.  Gene Declercq of the Boston University School of Public Health, in a survey of 1600 new mothers, found that more than 75 percent of them complained of pain over the next  two months and 1 in 5 was still having discomfort after 6 months..

More worrisome is the higher likelihood during future pregnancies of having placenta previa, in which the placenta blocks the cervix and detaches during labor (potentially cutting off the baby's oxygen supply), or a ruptured uterus, increasing the possibility of hysterectomy and fetal death in utero. The surgery also carries a slightly elevated risk of death for the mother because of complications from anesthesia, infections and blood clots. And scar tissue that forms at the incision site can lead to bowel obstructions years or decades later.

Another major concern is for the health of the baby.  Researchers reported in the British Medical Journal that, compared to babies delivered vaginally or by emergency c-section, babies delivered electively 3 weeks before due date had four times the risk of breathing complications and five times the risk of lung problems because of immature lung development.

There's no question that some women need C-sections, such as those with placenta previa. But the World Health Organization recommends a cap of 15 percent of deliveries -- the U.S. rate in 1978 -- based on evidence showing that higher levels don't benefit either mother or baby. Though the drama-free planned C-section certainly has its appeal, Declercq stresses that women and doctors need to "stop seeing it as just another surgery."

 

Tweet this
Tags: , , , , , , , , , ,

Elective Caesarean versus VBAC

Posted on April 5, 2008 by David Austin
Now here is an interesting article that weighs the risk assumed by mothers as compared to letting them have a vaginal birth after C-Section (VBAC).

Great little synopsis from the blog where I found it.  The True Face of Birth

I recently came across an article titled Cost-Effectiveness of Elective Cesarean Delivery After One Prior Low Transverse Cesarean. The title isn't that interesting, but the article certainly is. The authors calculated the hypothetical overall cost and relative risks of a policy of ERCS (elective repeat cesarean section) versus VBAC (vaginal birth after cesarean). Some of the findings:

  • In order to prevent one major adverse neonatal outcome (death or cerebral palsy) due to a VBAC, doctors would need to perform 1,591 cesarean sections and incur a cost of $2.4 million.
  • For every five babies' lives saved due to ERCS, one mother will die and many others will be injured.
  • "Elective repeat cesarean delivery in 100,000 women whose first birth was a cesarean through a low transverse incision will prevent 37 cases of cerebral palsy and 37 neonatal deaths. To achieve this health benefit requires an excess of 117,748 cesarean deliveries, seven maternal deaths, and 5500 maternal morbid events."
Hundreds of hospitals have banned VBACs since 1999, when ACOG revised its recommendations on VBAC and stated that it “should be attempted in institutions equipped to respond to emergencies with physicians immediately available to provide emergency care.”[1] In practice, this translated into 24-hour in-house anesthesia and OB coverage, a requirement that often only large, tertiary hospitals could guarantee. Despite the fact that ACOG’s 1999 recommendation was not evidence-based [2], obstetricians and hospital administrators are under heavy pressure to comply with the recommendations. (The American Academy of Family Physicians has developed VBAC guidelines that are evidence-based; they recommend that VBAC "should not be restricted only to facilities with available surgical teams present throughout labor since there is no evidence that these additional resources result in improved outcomes.") As a result of ACOG’s new position on VBAC, hundreds of smaller hospitals have instituted a no-VBAC policy, requiring women to have mandatory repeat cesareans or to travel elsewhere—sometimes very long distances--to give birth. Some states also do not allow home birth midwives to attend VBACs, which further limits women's options.

This article's findings show that a policy of ERCS comes with a weighty set of costs and risks. VBAC bans force women to assume those risks, rather than allowing each woman to decide for herself whether to have a VBAC or schedule a repeat cesarean. A no-VBAC policy is paternalism at its worst; it takes away women's right to bodily integrity and to informed decision-making.

~~~

[1] ACOG Practice Bulletin No. 5, July 1999, “Vaginal Birth After Previous Cesarean Section.” According to the International Cesarean Awareness Network (ICAN), over 300 hospitals have banned VBACs since 1999. ICAN is currently compiling a comprehensive list of the status of VBAC in every U.S. hospital. See ICAN's VBAC Policy Database.

[2] McMahon, M. (1996). Comparison of a trial of labor with an elective second cesarean section. New Eng J Med 335 (10): 689-695.
Tweet this
Tags: , , ,