Fear of lawsuits? Judicial reforms would reduce cesarean deliveries

Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448. Link

The reasons for rising C-sections ... are not as mysterious as may appear. Some of these reasons are due to medical science; some of them are societal.

Important strides in the past 40 years or so has led to the often-mistaken belief held by society that medical science ... can deliver perfection. The holy grail of obstetrics is to deliver a "perfect" baby each and every time. Reality, however, reminds us of our humanity.

We can summarize the reasons for performing caesareans by their indications or lack thereof. In no particular order, we can list the so-called abnormal fetal heart rate patterns, other than head-first presenting fetal body part, more than one baby in the womb, failure to deliver or progress by a certain timeline, failed attempts to initiate labor, repeat caesareans, problems of the placenta causing maternal and/or fetal hemorrhage, maternal fever and infection, extreme prematurity, and, what I call, the Nike indication -- "Just do it!"

Because of the above, nationwide, the caesarean rate ... rose from 5 percent in 1970 to more than 30 percent in 2008 ...

... the statistics are not reassuring. Despite 40 years of using Electronic Fetal Monitoring, we have more children born today with cerebral palsy and brain damage as a percentage of live births as we did in 1970. This is explained because we now know that watching an EFM strip cannot give us the information we need to prevent brain damage. EFM has been shown to be virtually useless as a screening tool ... Yet, every hospital birth ... is monitored electronically ... Most babies that have cerebral palsy had normal EFM tracings ...

How many caesareans are done in the name of defensive medicine? ... the climbing caesarean rate is driven by doctors' fears of litigation ...

... Unfortunately, I don't believe that the trend in this state will significantly change without significant structural judicial change, which, can only come about if the people want it ...

Melissa Maimann, Essential Birth Consulting 0400 418 448