Baltimore Sun: Many Cesarean Section Deliveries May Be Unnecessary And Increase Malpractice Risks

The Lancet, a leading medical journal, has stated the rise in the number of cesarean section (C-section) baby deliveries is a “global epidemic.” Roughly 30% of deliveries in the U.S. are currently via C-section. In the 1970’s the ratio was only 1 in 20 births and rose to 1 in 4 in the 1980s. The standards of medical practice had traditionally considered a rate of 10 to 15% to be an optimal number. World Health Organization data show this trend is also occurring in other developed nations. One concern is cesarean section surgery may increase the rate of complication (problems) for mothers and babies and lead to more cases of medical malpractice.

About the Procedure

A C-section procedure involves making a cut into the uterus and stomach area to deliver the baby. Often a C-section is deemed medically necessary due to other complications that are a danger to the mother or baby. Some decisions to undergo a C-section are made for non-medical reasons. Many experts are particularly concerned with the trend because of safety and the higher medical costs incurred.

Electronic Fetal Monitoring

Prior to 1970, the majority of monitoring on a fetus was conducted using a stethoscope. In the years since, the electronic fetal monitor has been the standard for all hospital training programs of physicians in residency. Usage of the electronic monitor contributed to the belief that vaginal birth is dangerous under certain conditions and that C-sections were sometimes a safer alternative. Decisions regarding C-sections and mistakes during the process itself are both commonly cited reasons for many cases of medical malpractice brought against obstetricians.

Factors Causing This Trend

• Generally, C-sections are chosen due to medical conditions of the mother or infant or “late childbearing”
• Other studies show that the choice is largely the result of the physician practicing defensive medicine     
• Many public programs that assist parents encourage considering a C-section
• One contributing factor appears to be that more women today are older when they have their first child

Reasons for Emergency C-sections

Often a C-section is ordered because the umbilical cord has entered the birth canal prior to the baby. Many times the baby is awkwardly positioned, such as sideways. Sometimes the surgery is required due to a baby’s unhealthy heart rate or oxygen level. Complications involving the placenta and situations where the labor process has stalled are other driving factors.

Risks of C-section

C-sections may increase the likelihood for infections compared to conventional birth. Sometimes complications will arise involving scarring in the uterus from a previous C-section. This can lead to a placenta accrete, which is a dangerous concern that is likely to require that a hysterectomy be performed.

Medical Malpractice Involving Birth Injuries

Some cases of medical malpractice arise due to a physician’s delay in performing a C-section or when an error occurs during the procedure. Many instances of birth injuries have severe or even fatal results. Cases of malpractice involving birth injuries are usually complex and are likely to require more testimony from medical experts. These cases are often among the mostly costly to litigate.