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Friday, August 29, 2008

C-section & malpractice suits - some evidence for a link

Researcher studies rates of cesarean sections, malpractice suits
by Kristina Goodnough - September 2, 2008

There may be a relationship between cesarean delivery rates and medical malpractice rates, according to research by Dr. Jeffrey Spencer, a fellow in maternal fetal medicine at the Health Center.

As the state’s medical malpractice premiums increased, the number of cesarean deliveries also rose, according to Spencer, who reviewed the deliveries at Hartford Hospital from 1991 to 2005.

During that time, there were 64,767 deliveries, of which 15,021 (23 percent) were cesarean deliveries. Of the 15,021 cesarean deliveries, 8,045 (59.5 percent) were primary or first-time cesarean deliveries, while 6,076 (40.5 percent) were repeat cesarean deliveries.

During the same time period, medical malpractice rates increased substantially. Spencer obtained mean malpractice premiums for obstetricians from the hospital’s major medical malpractice provider and adjusted them for inflation.

The mean premiums for medical malpractice insurance for obstetricians increased from less than $80,000 for an individual physician to more than $120,000.

“When I compared the malpractice rates to cesarean delivery rates prior to 1999, both were declining at a similar rate,” says Spencer. From 1999 to 2005, however, both were increasing. “I can’t say one led to the other or visa versa,” he says, but he speculates that rising medical malpractice rates are driving up cesarean delivery rates.

Normal vaginal delivery is considered safer than a cesarean delivery for both mother and baby if the birth is uncomplicated. Cesarean deliveries are recommended for complications, such as slow or long labor or indications of fetal distress during labor.

Maternal fetal medicine specialist Dr. Jeffrey Spencer of the UConn Health Center performs an ultrasound.
Maternal fetal medicine specialist Dr. Jeffrey Spencer of the UConn Health Center performs an ultrasound.
Photo by Lanny Nagler

“Most of the large malpractice cases result from a poor fetal outcome, that is, an expected ‘normal’ baby is born with health problems or has a bad outcome for whatever reason,” says Spencer. “The MDs get sued because they didn’t do all that was possible for the baby – meaning perform a cesarean.”

“Malpractice premiums are a huge expense for physicians,” says Spencer. “It’s difficult for them not to practice defensive medicine. But although cesarean deliveries are less risky for the baby, they are more risky for the mom, with longer recovery times, generally, than vaginal deliveries. It’s important to consider whether every cesarean delivery is truly necessary.”

It’s possible that there are other factors that may also account for the association,” says Spencer, who presented his research at the American College of Obstetricians and Gynecologists annual meeting last spring. “With our data, we cannot prove a causation but only suggest an association.”

Nationwide, cesarean deliveries accounted for 30.2 percent of all deliveries in 2005, compared to 20.7 percent of deliveries in 1996. The rising rate of cesarean deliveries has triggered a debate over whether the increase can be attributed to medical necessity.


discussion with a coworker

I know, it never goes well, but a coworker shared his birth "horror" stories with me yesterday. First was induced at 38 weeks due to bag breaking. All went "well" (it didn't end in c-section,, anyway). Second one she was on bedrest at 32 weeks due to preterm labor, delivered at 37 weeks. He said to me, "if we could have a guarantee of a drama-free labor next time we would have another." I said there are no guarantees but get a midwife and have a homebirth and you will probably be OK. Of course he thought I was kidding and laughed a laugh that sounded like an animal in the throws of death.

I walked away with a big adrenaline rush thinking about how for so many women who don't end in c-section--well, it is pure luck. I was the "unlucky one." I couldn't do the induction, nor could baby Earl. But what if I had? That would have been my view of birth--just like my coworker. I am so thankful I found ICAN. I am so thankful for midwives. I am so thankful that birth CAN and SHOULD be wonderful, not a disaster waiting to happen. The beautiful, wonderful, powerful, intense and amazing thing that labor and birth is--well, this is more in line and makes sense for how wondrous life is. It never made sense to me that it should be so awful when it began with something so wonderful (hopefully) and then produces something so wonderful! Think about it! It is all about love and sharing. The disconnect between making a baby and having the baby in arms by the obstetrical model should have everyone suspicious. It just doesn't make sense. The Orgasmic Birth possibility seems less crazy all the time.....

My dream for the candidates

So last night, as I was watching Obama give his speech, babe in arm trying to fall asleep (he kept clapping with the crowd!), this is what I heard him say:

•Eliminate capital gains taxes for small businesses!
•Cut taxes for 95 percent of !working families!
•End dependence on oil from the Middle East in 10 years!!

Ok, I was dreaming. But man, it was so sweet. Maybe McCain will say it?

Alright, back to work. Back to reality. Back to the fight against unnecessary c-sections.

Wednesday, August 27, 2008

A better way

I was talking with a woman the other day who had her cesarean two months ago. Although her first birth had been normal, vaginal, this one ended in a cesarean. As we talked, I could hear in her voice and see in her eyes that she was trying to be ok with it. The baby was malpositioned. You do what you have to do. In the end, you have a healthy baby.

I saw myself five years ago.

Now, this woman may end up feeling ok about her cesarean in the long run. Everyone has their own journey and process. It wasn't until two years after my cesarean that I realized I wasn't "getting over it" the way I was supposed to be. It wasn't until even later that I came to believe that I'd been bamboozled by a medical system that, despite its best intentions, tends to cause more problems in normal, healthy births than it solves. I came to feel that it wasn't me that was to blame, or my gigantic baby boy (10 lbs, 14 oz), or even the doctor who performed my surgery. Rather, it was a culture surrounding birth combined with my own ignorance about it, that landed me on that operating table.

That's why I'm excited about Orgasmic Birth, a new documentary film about what birth can really be, if women are allowed to give birth the way our bodies intend us to do. The tagline for the film is, "What if women were taught to enjoy birth rather than to endure it?" Yeah, what if?!?

ICAN Twin Cities is teaming up with several other wonderful birth organizations in the area to bring Orgasmic Birth to the Riverview Theater on September 25th. The producer, Debra Pascali-Bonaro, will also be in town to introduce the film, answer questions, and speak at two other events. You can find out more information here.

I'm glad I found ICAN three years ago. The first time I shared my cesarean story there was the beginning of my healing process - to have other women see it in my eyes and hear it in my voice that I wasn't ok with it and didn't have to be. There is a better way.

Tuesday, August 26, 2008

Hello from Heather--how I became a VBACTIVIST

Welcome! I am so excited to be part of a blog—my first one! I personally will use this to share with anyone who reads it things I have learned about VBAC and all the surrounding issues and controversies, and other interesting things.

My journey to VBAC has changed the course of my life. Because of my VBAC, I now believe in myself like I never had before. This is not because my VBAC was successful, per se, but because I was able to trust in myself, and do the work necessary (read, exercise, read, read, surround myself with support, eat well etc) to avoid another c-section. I did not do these things perfectly, and some worse than others, but I tried, and by the end I was almost unafraid and I did believe. That it did end in a successful VBAC was incredible and cemented my journey as being the right one for me. Had it ended in c-section, I am confident that I would have felt I did everything right and was one of the 5-15% who should end in c-section. I tell myself that anyway—easy to say on my side of the fence….

I hope that anyone who has even the slightest concerns over their first c-section and think maybe they don’t want to do that again, to come on the journey! It leads to amazing women, children, midwives, doctors, doulas and all sorts of birth activists! I forgot spouses/partners—they are a big part of the journey as well…..

I will post my c-section/VBAC photos when I find them.

In the meantime, I started the whole process when I was pregnant again by immediately dumping my OB who wanted to schedule another section, the one who said to not use an epidural is “silly,” went to see a midwife, and signed up for Bradley classes. My new husband and I had no idea how our lives were about to change!

Sunday, August 24, 2008

A tale of two births: In pictures

By way of introduction, here's the story of my two birth experiences using pictures. The first, a cesarean, the second, a VBAC at home. It seems pretty obvious which experience is preferable, doesn't it?

first moments of life after his c-section:

Can you even find the baby in the sea of gloved hands?

Micah's first moments with mommy (two hours after birth):

first moments of life AND his first moments with mommy:

meets daddy:

meets daddy:

The new fam #1:

The new fam #2:

Saturday, August 23, 2008


Thanks for visiting the official blog of the Twin Cities' chapter of the International Cesarean Awareness Network!

More to come...