Birth injuries are a common source of medical negligence claims in the U.S. One compelling reason for this is the fact that when a newborn suffers an avoidable neurological complication as a result of obstetrical malpractice, the costs — both human and economic — are catastrophic. C-sections are frequently performed to avoid risks associated with vaginal deliveries in some circumstances, such as macrosomia (big baby) and acute fetal distress. A recent study, however, shows that rates of C-sections vary widely.
The study, published in the journal Health Affairs, reports that rates of caesarean delivery vary from 7% to 70% depending upon the hospital. The authors report that after adjusting the figures to account for varying patient populations and differences in risk factors, the variations in C-section rates are so wide that quality of care is most certainly a factor. In other words, some institutions are performing too few C-sections while others are performing too many.
The decision to perform a C-section often depends upon a balance of factors and clinical developments. While C-sections generally improve outcomes for babies, by avoiding complications like asphyxiation, cerebral palsy, brachial plexus injury (e.g., Erb’s palsy), they increase the risk to the mother of operative complications like infection, bleeding or pulmonary embolism. The decision to perform a C-section, outside the setting of a clear-cut emergency, involves careful weighing of risks and benefits by the caregivers and patient.
Medical negligence cases arise in this setting in a number of ways, such as the following:
- Failure to take into consideration risk factors, such as cephalopelvic disproportion (CVP) that makes vaginal delivery difficult
- Failure to take into account clinical developments, such as signs of fetal distress seen on fetal monitoring strips
- Failure to implement appropriate maneuvers in the face of shoulder dystocia (i.e., where the baby’s shoulder becomes stuck during delivery)
- Failure to obtain proper informed consent when contemplating an operative delivery
- Medication overdose
- Failure to prophylax against deep vein thrombosis (DVT), leading to pulmonary embolism (PE)
- Wrongful death of the mom or baby
- Failure to intervene with prolonged labor
When birth injuries occur, the family’s expectations of a joyful, celebratory event turn to pain and despair. The Health Affairs article points put that there is currently too much variance in OB/GYN practices when it comes to the manner of delivery.