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Birth-Related Brain Damage in Newborns

Laurence M. Deutsch and Steven E. North

Of every three babies born in the United States each year, one is delivered by cesarean section, according to the U.S. Centers for Disease Control and Prevention. While Cesareans can be life- and health-saving, they are not without risks of their own. Yet recent studies show a significant increase in cesarean sections, the most common surgery performed in the United States, according to a recent article on Medscape.com.

Some of the most serious medical malpractice cases our firm has handled are those in which newborns suffer a lack of oxygen during the labor and delivery process because of negligent management. The resulting cerebral palsy can manifest itself in a variety of ways – neuro-intellectual impairment, severe muscular compromise, varying degrees of cognitive impairment, and significant sensory deprivation among other avoidable impairments.

In the field of maternal-fetal medicine, one of the critical concerns is recognizing if a fetus is in distress and, if so, alleviating that distress by an emergency cesarean section and other necessary steps. Once a fetus exhibits a significant decrease in its heart rate (Brady cardia), the heart does not pump enough blood to the brain to provide the oxygen needed to sustain it. That is why electronic fetal heart monitors are put in place to keep track of monitor the fetal heart rate and the duration of uterine contractions.

Because physicians are so vulnerable to potential lawsuits when cesarean sections are not performed in time to keep a fetus out of trouble, it is possible that cesarean deliveries may occur more frequent than necessary. Doctors may be erring on the side of too much caution as a hedge against potential claims.

At one time, it was standard for physicians to perform C-sections on mothers who had previously delivered that way. The thinking was that once cut, the uterus is more prone to rupture if a fetus is allowed to go to term. That practice was largely abandoned on evidence that women who have had C-sections can successfully deliver vaginally.

There is a vast range in the percentage of Cesarean births compared to vaginal deliveries from region to region and even from hospital to hospital within a city. According to Medscape, the rate of C-sections at one New York hospital is 7%, whereas it is has gone as high as 65% at births in a Florida hospital. This suggests that in addition to the potential of legal action, local or even individual hospital norms may play a role in the decision to deliver by cesarean section rather than the patient’s presenting factors.

The author emphasizes the importance of an expectant mother trying to ascertain the cesarean statistics for the hospital where she expects to deliver, which will help her decide whether the procedure may being used in the absence of a medical reason.
Source: Medscape.com, May 16, 2017 – Cesarean Rates Above Target