As we discussed on this blog in March, there has been some controversy over whether too many American moms are choosing to have cesarean-sections mainly for convenience instead of medical reasons. While many mothers may be doing so, a study by the American Congress of Obstetricians and Gynecologists had mixed results.
The group found some evidence that the overall risks and benefits to the birthing mother weighed strongly in favor of vaginal birth. However, the group found that C-sections offered a higher risk of some complications but lower risks for others — but there was less overall risk of fetal mortality with C-sections.
In some situations, however, there are medical reasons for C-sections. In the case of breech-position births, where the baby’s body cannot be turned to the head-down position, the standard of reasonable medical care has traditionally been to perform a C-section. That tradition has been challenged recently by several studies, however, and some obstetricians have been urging a return to vaginal delivery in breech births, perhaps in response to concerns over the increasing C-section rate in the U.S.
Obstetricians are not necessarily violating the ordinary standard of care by handling breech births vaginally, but parents must be given all the information necessary to make an informed choice. And, such cases must be carefully chosen and monitored.
Last year, a woman in that situation was persuaded to try vaginal birth by an Oregon hospital’s advertising that it had special expertise in vaginal births of breech babies. She and her husband did consult with doctors at the hospital, and she was assured the doctors would switch to a C-section if necessary, the parents say.
They did not. Even after complications arose and their son’s heartbeat was abnormal for 20 minutes, the doctors and staff allegedly persisted in the vaginal delivery. Moreover, they failed to resuscitate him soon enough, the parents say. Immediately after birth, the boy began having seizures, due to a lack of oxygen during birth. He has now been diagnosed with cerebral palsy and catastrophic, irreversible brain damage.
The family has sued the hospital for $25.6 million in damages.
Parents have the right to choose what method of birth they prefer in cases where medical opinion is divided. That choice must be based on a full understanding of the potential risks — and ultimately parents must trust that their doctors will follow through with their promises.
- The Oregonian, “OHSU faces $25.6 million malpractice lawsuit over vaginal delivery of breech baby,” Helen Jung, Sept. 24, 2013
- Science-Based Medicine, “Is breech vaginal delivery safe?” Amy Tuteur, MD, Jan. 14, 2010