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Sunday, September 21, 2008

Mankato malpractice case: A dangerous verdict

This week, a jury in Mankato, MN brought back a verdict in a malpractice case that may very well fuel the already skyrocketing cesarean rate. The Mankato Free Press summarizes the verdict saying, "Jurors finished deliberating Friday afternoon and determined the clinic and obstetrician Carla Goerish were negligent by not recognizing the fetus was so large it should have been delivered by Caesarean section."

The situation is a sad one. No parent could help but sympathize with the couple who sued Dr. Goerish. Their beautiful baby daughter suffered nerve damage in the course of her birth. Who wouldn't want someone to be held responsible? We all do when something goes wrong, especially with our children.

However, this verdict sets a very dangerous precedent for birthing women everywhere. We just recently posted here about a recent study demonstrating a link between malpractice lawsuits and the rising cesarean rate. This case will no doubt contribute to more unnecessary cesareans being performed on the basis of a suspected macrosomic (large) fetus.

The plaintiff's lawyer argued that a radiologic report that "suggested a macrosomic fetus," combined with "
accepted, published medical standards (that) suggest a C-section be done with macrosomic fetuses" meant that the OB was negligent in this case. Apparently, the jury believed this evidence. Unfortunately, while some studies and standards my "suggest" a cesarean in such cases, there is far from a solid consensus in the medical literature regarding the use of cesarean for suspected large babies. The truth is, radiologic measurements are notoriously unreliable. Estimated weights can be off by more than a pound in either direction. As Dr. Goerish's lawyer argued, there is simply no way to know if a baby it "too large" based on such evidence. See Kmom's excellent discussion of the medical evidence here.

Not to mention that women's pelvises are made to flex and expand to allow babies to move through during birth; a process that is hindered by standard hospital practice of birthing while lying in bed (usually with an epidural). Babies heads are also made to mold, if given time and opportunity to do so, to fit through the pelvis. See ICAN's White Paper on Cephalopelvic Distortion (CPD) for more information. Gloria LeMay's Pelvises I Have Known and Loved is also instructive.

In reality, things can happen in birth. The temptation to say that a surgical procedure may have prevented a poor outcome is alway strong in hindsight. Perhaps it would have in this case. It seems we expect our doctors to be nearly omniscient when it comes to this. It's no wonder many OBs practice "defensive medicine" out of fear of being sued.

But performing cesareans for suspected large babies is NOT the answer, as this video from ICAN Voices illustrates so well. Women of all sizes CAN birth babies of all sizes. No technology to date can accurately predict this, as much as we might like it to.




1 comment:

Jessie said...

Thanks for starting the blog ladies - I think it's a great way to get info out there! I'm also really excited about the topic nights coming up at the VBAC support meetings. Keep up the good work!