One in three American mothers deliver their first child through Cesarean section and 90% of those women who then have a second child will deliver through C-section again. It has not always been this way: in the 1970s, only 5% of all births were C-sections. The birth injury attorneys at Pintas & Mullins would like to take a step back and examine this phenomenon, why it came to be, and how it is harming American mothers.
Many people believe that Cesareans reduce the risk of serious complications for both mother and child, however, a report recently issued by the American College of Obstetricians and Gynecologists (ACOG) does not confirm this. Their report actually states that the rapid increase in C-sections has not led to an equivalent decline in complications associated with delivery. In fact, the ACOG expresses deep concern that the procedure is overused in the U.S., and urges doctors to more carefully consider whether a Cesarean is necessary.
Unnecessary C-sections cost more than $5 billion per year, and, more importantly, physically harm patients, sometime fatally. The United States is one of the only places on Earth where maternal mortality (death of the mother during childbirth) is actually rising. The risk of death from C-sections compared to natural delivery is actually three times higher, and is often caused by hemorrhaging, systemic infections, and injury to major organs.
Too many mothers, particularly first-time mothers, are unaware of this. They trust their doctors, and rightfully so, but are not making informed decisions for their own care. Among the consequences of C-sections is the likelihood that all children women have in the future will also be delivered by C-section.
Dr. Chileshe Price, a cardiologist at the University of Pennsylvania, is the exception to this. She is the mother of two children; the oldest was born through a C-section, her second through natural birth. This is referred to as a VBAC, or vaginal birth after Cesarean. Delivering her first child was extremely traumatic: she was in recovery for six weeks, and the pain made it difficult to rehabilitate and care for her newborn son.
Dr. Price did not want to undergo major surgery and be forced into post-op for her second child. She found it very difficult, however, to even find a doctor who would facilitate a VBAC. Most doctors are concerned about the possibility of a uterine rupture during VBAC, although the actual statistical risk of rupture is less than 1%. To see an outstanding short film on Dr. Price's journey, click this link, which will take you to the New Yorker's piece titled Unnecessary Cut.
Uterine rupture is an emergency situation that can constitute medical malpractice if the physician does not properly anticipate it. Choosing to deliver a child naturally after having a C-section needs to be the right thing from a medical perspective, and it is important to measure the risks and benefits. Of course, if we reduced the amount of first-birth C-sections, second-time mothers would not have to worry about the VBAC in the first place.
Some hospitals in California have an 83% rate of primary C-sections in first-time moms. That is a major problem. It is impossible to believe that more than three-quarters of human beings need major surgery to have a child, when just forty years ago, less than 5% required the procedure. What makes this even more difficult to understand is how much we know about the dangers: the first papers expressing concern about the rising C-section rates were published in 1976, so it is far from a new issue.
The truth of the matter is, C-sections decrease doctors' workloads. Many new moms are in labor for up to 20 hours; C-sections take 30 minutes to complete. As Dr. Neel Shah, an obstetrician at Harvard Medical School put it, medical textbooks teach doctors to treat the patient in front of them; but the labor floor does not work like that. Obstetricians in the real world have to treat the patient in front of them while their pager is going off, while three other patients are in active labor, all at once.
Obstetricians have extremely heavy workloads, and C-sections significantly expedite the labor process. This is not being done out of laziness - many of them are ordering the procedure in good faith. The American College of Obstetricians and Gynecologists used to recommend that a normal birth for first time mothers who receive an epidural would be about three hours of pushing. Beyond three hours, and the delivery becomes abnormal.
Doctors throughout the country interpreted this recommendation by ordering C-sections
for most moms who push longer than three hours. The ACOG recognized that this was unintentionally encouraging C-sections, and recently released new guidelines that allow more time for the delivery process. With hope, the new criteria will help drive down the rates.