Understanding the Risks of C-Sections

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For parents, the birth of a child is usually one of the happiest days of their lives, but that day can also be fraught with worry if something goes wrong.

Millions of babies are delivered each year via Caesarean section -- when doctors cut through a pregnant woman’s abdomen to surgically remove the fetus -- rather than through a normal vaginal birth.  Many C-sections are planned ahead of time due to issues known to both the pregnant woman and her doctor, but many women still experience the need for an urgent C-section when something goes wrong during labor.

With the current state of medical technology, most women who seek prenatal care will know ahead of time whether a health issue such as diabetes or hypertension or other complicating factors of her anatomy (i.e. whether her pelvis is too narrow for her infant to pass through) will necessitate a Caesarean.  However such pre-screening cannot always determine what complications may arise during an otherwise healthy woman’s delivery.

Even pre-planned C-sections are not without risk.  During a normal vaginal birth much of the fluid that resides in an infant’s lungs is usually squeezed out allowing the baby to begin breathing normally after birth, but the squeezing doesn’t happen in a C-section, leaving a lot more of that fluid in the lungs.  This can lead to a respiratory problem called transient tachypnea of the newborn.

The risks from a C-section for a mother can be even greater.  Medical professionals have to be prepared to deal with increased levels of anesthesia in the mother and increased bleeding as compared to a vaginal birth.  A C-section carries an increased risk of infection (both short term and long term), and risks for other abdominal and pelvic organs including the bladder and bowel.  Additionally, in most cases after one C-section doctors are reluctant to allow a woman to attempt vaginal delivery with subsequent pregnancies.

The potential harms compound after multiple C-sections.  For example, if a woman has delivered via C-section several times she runs a greater risk of hemorrhaging, needing a transfusion or a hysterectomy, and possibly even dying in delivery because the placenta can no longer properly separate from the uterine wall.

When the need for an emergency C-section becomes apparent during a normal birth medical professionals don’t have much time to act, so everything from getting the mother into the operating room, to anesthetizing her, to draping her and opening her abdomen is performed with the greatest speed possible because an infant has a window of about 20 minutes in which it can survive in a low-oxygen environment. 

While in labor, it may be difficult for a mother to observe all the action in the delivery room. Fortunately, most hospitals these days have a fairly liberal visitation policy allowing other family members to be present.  In addition to supporting the new mother, family members also have a responsibility to observe and take note of what is happening in the room. If several doctors and nurses suddenly rush into the room and begin working on a number of different things, it is a sign of a problem. The problem could have arisen with the fetus or with the mother.  If the mother is in distress, she may not be able to observe anything happening during the delivery because she may lose consciousness or have to be sedated.

In cases of an emergency C-section, a few specific culprits may emerge. The most common are:  when the umbilical cord emerges from the birth canal before the infant’s head, an abnormally slow infant heartbeat, and uncontrolled bleeding during the delivery process.

While the mother and her family members may not be aware of everything that happens in a delivery room, they can learn to recognize something called the child’s APGAR score, which doctors use to determine if the child is experiencing problems following birth.  The APGAR score rates the infant on a scale of 0-2 on five different aspects – Appearance, Pulse, Grimace, Activity and Respiration – and is calculated at one minute and five minutes post delivery.  An overall score of six or lower at the 5-minute mark is considered low and an indication of a problem.

While the need for a C-section can arise from a number of factors, medical deviations from the standard of care can’t necessarily be ruled out.  There are several reasons your chosen doctor may not be able to appear at your bedside the moment your contractions start.  Obstetrics is a fairly dynamic field, and your doctor may have several other patients with due dates around the same time, so he or she may be delivering another baby, performing a scheduled procedure on another patient, or even on his or her way to the hospital.  Additionally, most women are in labor for a long period of time, and assuming you’ve shown no indications of any looming complications during prenatal care, your obstetrician may not feel it necessary to arrive until the active labor period begins (denoted by 5 or more centimeters of dilation of the uterus).

However, if the nurses in the delivery room are making notes of problems and your doctor is not responding despite being notified, unless extenuating circumstances are preventing your physician from even returning a phone call, mal-practice may be an avenue you should look into. 

Those pursuing legal recourse should choose a law firm that has experience with medical malpractice and is not simply rolling the dice on the case to see where it goes.  Firms that focus significantly on medical malpractice, like Ross Feller Casey, LLP, have even begun hiring medical experts to provide better quality review on the cases they evaluate.  The attorneys of Ross Feller Casey can be contacted at 215-515-4401 by anyone seeking advice about issues surrounding an emergency C-section.

A talented medical expert with over three decades of experience, Dr. Charles Bowers, Jr. is an esteemed member of Ross Feller Casey, LLP's Medical Forensic Evaluations Department.

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