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Are Cesarean Sections Helping Or Hindering The Health Of Mother & Infant?

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As a lawyer, who litigates birth injury cases, I’ve noticed that there is still quite a bit of confusion about c-section deliveries.  I’ve noticed that many doctors fail to adequately explain the procedure to their patients and many times is is done so during a particularly stressful time— like when the woman is in labor!!

Why are they needed? Are there risks to mother or baby?

Below is some information that I have learned over the years as well as some terrific resources regarding this potential confusing medical procedure.

A cesarean delivery (C-section) is a surgical delivery of a baby requiring an abdominal incision and a uterine incision.  C-sections can be elective or medically necessary.

Reasons for a C-section include:

•    Stalled labor (failure to progress)
•    Baby has reduced oxygen supply (changes in baby’s heartbeat)
•    Baby is in breech (feet or buttocks first) or transverse position (side or shoulder first)
•    Carrying multitudes (twins, triplets)
•    Problem with placenta
•    Problem with umbilical cord
•    Baby has a large head
•    Mother has medical condition (heart condition, genital herpes)
•    Baby has a health concern

If your doctor determines that a C-section is medically necessary, a delay in the procedure can cause preventable injury to the mother or the baby.

In other situations, the mother requests a C-section (elective c- section).  There are many reasons that can lead to this decision:

•    Convenience of scheduling
•    Fear of vaginal birth (fear of labor and pain)
•    Fear of sexual dysfunction after birth
•    Avoiding vaginal birth compilations
•    Previous vaginal birth complication

There are risks associated with C-sections because it is a surgical procedure.  Risks to the mother include:

•    Longer recovery time
•    Surgical injury (to nearby organs)
•    Wound infection
•    Endometritis (inflammation and infection of the uterine lining)
•    Increased bleeding
•    Reaction to regional anesthesia
•    Blood clot
•    Increased risk of complications during future pregnancies

Risks to the baby include:

•    Breathing problems (transient tachypnea, respiratory distress syndrome)
•    Fetal injury (nicks or cuts on the baby’s skin)

Besides the medical risks, C-sections also require a longer recovery.  You may require help with childcare or household help in the weeks following your C-section.  This can be difficult for some families, especially because some C-sections are last minute emergency decisions.  Therefore, it is important to prepare for the possibility of a C-section birth even if you plan on vaginal delivery.

It used to be that if you had a C-section, you could not have a vaginal delivery in the future.  But now, a vaginal birth after C-section (VBAC) is possible in many cases.

So, choosing a C-section for your first child does not necessarily preclude you from experiencing a vaginal birth with subsequent children.  In women who choose a VBAC, 60-80% have a successful vaginal delivery.  Factors that improve the chances of a successful VBAC including:

•    Only having one prior low transverse uterine scar (most common uterine incision)
•    Pregnancy is progressing normally and mother and baby are healthy
•    Labor begins naturally on-time or before your due date
•    You have had previous successful vaginal delivery

The C- section procedure can usually be completed in less than an hour.  First, the health care team cleans the abdomen, place a catheter in the bladder, and start an IV line to provide fluid and or medication.  Then, regional anesthesia in delivered, which in most cases is a spinal block.

Next, the doctor makes two cuts, one to the abdominal wall, and another to the uterus.  Finally, the doctor removes the baby, clamps the umbilical cord, removes the placenta, and closes the incisions with sutures.   Following a C-section, the mother and baby usually stays in the hospital about three days, while health care professionals help monitor your pain and help you recover.  (C-section birth video)

It is important that you discuss delivery options with your the health care provider, so an informed, safe, and healthy decision can be made.  If fear is your primary motivator in requesting an elective C-section, it is important to talk to your doctor first about your concerns.

Oftentimes, a frank and open discussion with a medical professional can help you understand what to you can expect.  Why people like to tell birth horror stories to expectant moms is beyond comprehension.  There is nothing wrong with telling these people that they can share their, supposedly well-intentioned, stories after you have your child.

Determining whether a C-section is necessary requires the risks and benefits to be weighed.  The health of the mother, the health of the baby, the mother’s wishes, the mother’s medical history, and any complicating factors must all be considered when deciding whether a C-section or vaginal birth is appropriate.

It is important to remember that although C-sections are a relatively common procedure, it is still abdominal surgery that carries with it the risks and complications of any surgery.  Some people even assert that medical literature is fraught with misinformation because it is written to defend birth trauma lawsuits.  This just further reinforces the importance of finding a health care provider that you trust, so that all decisions are made with you and your baby’s best interest in mind.

Some people believe that many C-sections performed are unnecessary, putting both the mother and the baby at increased risk for complications.  In 2004, 29% of all babies born in the United States were born by C-section.  In a CNN article, one woman (Barbara Stratton) discusses how her obstetrician induced her labor a week early because she was worried that the baby would be too large if they waited.

Ms. Stratton ended up requiring a C-section because her labor would not progress.  Then, the baby ended up weighing only 8 pounds, 7 ounces, which was much smaller than the obstetrician had thought.  Ms. Stratton reported that she suffered from pain every day for a year and a half after she gave birth to her son by cesarean section, which affected the quality of her mothering.  She advocates that women should ask questions about whether induction or a C-section is absolutely necessary.

There are also cases where birth injuries occur as a result of a preventable delay in a C-section procedure.  For example, in the case of a California woman, Aliscia Towles, the mother alleges that her son was stillborn because doctors at Centinela hospital Medical Center failed to immediately deliver her son when it was apparent he was in fetal distress.

Doctors gave Ms. Towles Pitocin to accelerate labor, but this failed to help her labor progress, and instead caused a change in the baby’s heart rate.  Ms. Towles alleges that her doctor purposely delayed the delivery of her baby to increase the chance that the baby would die before delivery because of increased chance of brain injury.

It is important to feel that you have an advocate during your delivery, so that your concerns and wishes are taken into consideration.  If you do not feel like your doctor is taking the time to answer your questions about vaginal births and C-sections, you may want to look for a new doctor or enlist a birth advocate to be present during the delivery.  If the unthinkable happens and you or your baby suffers an injury during a C-section, either because the C-section was unnecessary or the procedure was delayed, you may be entitled to compensation.

Special thanks to Heather Keil for her assistance with this Child Injury Law entry.

Sources:

Opposing Views: The Necesarean – When Is A C-Section Really Necessary?
Mayo Clinic: C-section
Mayo Clinic: Elective C-section – Keep fear out of the decision
Mayo Clinic: VBAC (vaginal birth after C-section)
CNN Health: Five ways to avoid a C-section
Baby Center: Giving birth by cesarean section
ChildBirth.org: The Cesarean Section FAQ
The Women’s Health Activist: Cesarean Section When It’s Not Medically Necessary – Safe Practice or Risky Decision?

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