Should I have had a cesarean section? Was my baby injured because I did not have a cesarean section? Did my doctors wait too long to perform my cesarean section?
As birth injury lawyers we regularly hear these questions asked by mothers concerned about the wellbeing of their newborn. So let’s discuss what a cesarean section (c-section) is, when it should be performed and what can happen to your baby if a c-section is not timely performed when indicated.
What is a C-Section?
Even though c-sections are invasive surgical procedures, they currently comprise nearly 33 percent of births in the U.S., according to UpToDate. C-section rates have skyrocketed in wealthy countries because they provide a time-tested solution to certain pathologies that present in vaginal births.
Modern medicine has given doctors the gift and the curse of having to decide on a method of delivery in childbirth. Today, cesarean section births are carefully orchestrated procedures where a physician delivers a baby surgically via incisions in a mother’s abdomen and uterus. But for most of human history, the decision to opt for a c-section over a vaginal birth was a necessary last-ditch effort to prevent the death of a mother in labor. Before antiseptics, antibiotics, anesthesia, and midwifery became common in American hospitals, the risks of complications from c-section surgery far outweighed the benefits in all but the most urgent cases.
When Should a C-Section be Performed?
Today, because of dramatically lower risks associated with this surgery, c-section is more frequently than ever before the safer option for mother and baby. While there remain opposing considerations for and against c-section births, doctors are obligated to weigh the medical and ethical pros and cons of both kinds of deliveries, for both the mother and the fetus. You have a right to be informed about these considerations so you can understand the medical decision-making process and voice your own desire whether to have your baby born via c-section.
Approximately 55 percent of c-section cases are due to one of three medical indications — 1) failure to progress during labor, 2) nonreassuring fetal status, 3) or fetal malpresentation. Collectively, these are the most common medical causes to recommend an abdominal birth, although there are several other, less-frequent causes such as abnormal placentation, maternal infection, and particularly heavy babies, to name a few.
After all is said and done, the mother has a great deal of say on which delivery method to move forward with. However, in a situation as time sensitive as assisting a mother in labor, physicians are obligated to make timely diagnostic decisions before the window closes to ensure a healthy delivery.
As a birthing mother, family member or a patient advocate, it is necessary to familiarize yourself with the medical protocols that provide a safety net from medical negligence and avoidable birth injuries. Because maternal preference usually swings in favor of vaginal deliveries, doctors cannot defer to c-section births in the face of any and all abnormal presentations. In order to deliver the most diligent medical care, medical staff must ensure timely intervention of c-sections in order to preserve the health and future of newborns’ lives.
According to UpToDate, there is a general consensus that planned c-sections should be scheduled for either the 39th or 40th week of pregnancy, unless preterm delivery is a medical necessity. Since fetal lungs are some of the last tissues to mature in utero, performing a c-section delivery prior to the 39th or 40th week is associated with higher instances of respiratory problems. However, timely c-section deliveries can save the fetus from a myriad of complications associated with vaginal births.
If and when a c-section is decided on as the method of delivery, it is protocol to A) administer antibiotic prophylaxis, B) test baseline hemoglobin and hematocrit levels to estimate if blood and oxygen supplies will be adequate for both the mother and the baby during surgery, and to C) have an anesthesiologist consult with the mother prior to delivery. For at-risk women, thromboprophylaxis, or, the administration of medication to prevent blood clotting, should be administered.
In a perfect world, vaginal childbirth would be the preferred mode of delivery, but in many cases c-section births may be the safest option because of emergency complications stemming from labor.
What can happen if a C-Section is improperly delayed?
As a medical malpractice law firm that regularly prosecutes birth injury lawsuits, it is our job to discover when medical staff have failed to perform due diligence at the cost of their patients. Specifically, when a doctor fails to order a c-section birth until after either the fetus or the mother has been medically harmed, the damage is typically permanent. There are numerous jury verdicts which serve as examples of what can happen when doctors fail to timely or properly deliver via cesarean section.
For example, in 1996 a Wisconsin Supreme Court verdict ruled in favor of a patient whose baby suffered spastic quadriplegia after doctors insisted on a trial of labor over a timely c-section delivery. Prior to the delivery, the patient agreed to a vaginal birth after cesarean (VBAC, after previous 2 c-section births) although a 3rd c-section remained a viable option throughout the labor. This case is illustrative of a trend dating back to the early 80s of doctors attempting to curb c-section rates in favor of vaginal births. Maternal preference for vaginal deliveries and/or VBAC tend to be higher than for elective c-sections, which further complicates matters for doctors who are obligated to respect maternal wishes while balancing risks of malpractice suits which more often materialize following trials of labor.
In a more recent suit in 2019, medical staff from Presence St. Joseph’s hospital in Illinois was put on the hook for $23.5 million to a mother whose newborn suffered severe brain damage after medical staff deferred a c-section delivery despite indications of fetal distress.
Finally, in another birth injury medical negligence lawsuit, a mother’s newborn baby suffered brain damage and was subsequently diagnosed with cerebral palsy after doctors allegedly decided not to pursue a c-section delivery when that was still a viable option. Medical staff reportedly deemed that the fetus was nonviable and that termination of the pregnancy was an option when in fact, the baby was viable and should have been promptly delivered by c-section. The mother and her legal team proved to a jury that earlier delivery c-section would have avoided some or all of the baby’s catastrophic injuries.
Although physicians are frequently under pressure from opposing influences (common maternal preference for vaginal births versus fears of malpractice suits) it is incumbent upon them to distinguish points in time during deliveries when it is necessary to intervene to spare serious medical harm to the fetus, and to the mother. As medicine has evolved, OBGYN practitioners have needed to adapt more and more to the needs of 2 patients simultaneously – mother and baby. Any and all treatment decisions need to be viewed through this lens, with the mother adequately informed of what the doctor believes is the safest delivery option. Failing to consider and recommend the safest delivery option, be it vaginal birth or c-section, can result in life-altering injuries to the newborn that warrant a medical malpractice lawsuit.
The Pittsburgh lawyers of Lupetin and Unatin have helped many children and families forced to endure avoidable injuries during childbirth, including lives forever altered from delays in performing a c-section. If your child was harmed during their mother’s labor or immediately after birth, and you have questions you need answered, contact our office. We will investigate with no charge to you unless a lawsuit is filed and we earn you a recovery.
Barry S. Schifrin, Wayne R. Cohen, The effect of malpractice claims on the use of caesarean section, Best Practice & Research Clinical Obstetrics & Gynaecology, Volume 27, Issue 2, 2013, Pages 269-283,ISSN 1521-6934
Berghella, V. (2021, January 7). Cesarean delivery: Preoperative planning and patient preparation [PDF]. UpToDate.
FIEGER LAW WINS $23.5 MILLION MEDICAL MALPRACTICE VERDICT [PDF]. (2021, January 7). Southfield, MI: Fieger Law.
Yu, E. (2019, September 26). ‘Largest Medical Malpractice Verdict In U.S. History’ Awarded To Maryland Woman [PDF]. Washington D.C.: WAMU.