Wednesday, July 04, 2007

John Edwards & the Rise in C-Sections

Was talking to a friend the other day who was curious about the rise in C-sections in Northern Virginia. I told him he just ought to thank John Edwards. This issue got a fair amount of attention a few years ago, and this isn't a bad time to bring it up:

Medical malpractice was his specialty, and he reportedly tried more than 60 such cases, winning more than $1 million in over half of those. Most involved Ob/gyns. Indeed, he was so feared, according to the Center for Public Integrity, "that doctors would settle cases for millions of dollars rather than face him at trial."

Edwards' specialty was cerebral palsy, a set of permanent conditions affecting control of movement and posture that usually appear at toddler stage. There is no cure, although stem cell studies in both humans (umbilical cord cells) and rats (neural cells) have produced promising results. More than 10,000 U.S. children are diagnosed with it yearly. Edwards claimed the disease developed because negligent doctors ignored fetal heart monitors indicating the child might not be getting enough air during birth and thus failed to deliver it immediately through cesarean surgery.

The rise in C-sections isn't limited to my region (around Washington D.C.) ABC news recently reported that it's up 40 percent nationwide:

The World Health Organization has said the ideal rate for c-sections would be about 15 percent of all births. But in this country, final figures for 2004 — the last year for which data is available — show the national rate is nearly 30 percent of all births.

American women have more c-sections than women in the United Kingdom, Canada and many European countries.

So what gives? Why are so many women having c-sections instead of delivering their babies the old fashioned way? It turns out the answer is very complicated. There is no one single reason behind the rising numbers.

No one single reason, but litigation is right up there:

And, for doctors, the threat of lawsuits also comes into play. Obstetricians are among the most vulnerable to litigation if something goes wrong in the delivery room. Choosing to perform a c-section, in some cases, can help reduce the possibility of being sued.

"They're never faulted for doing a c-section," said Faith Frieden, chief of obstetrics and gynecology at Englewood Hospital and Medical Center in New Jersey. "It's never the wrong decision to do a c-section. No one's ever going to say to them, 'why were you so quick to do the cesarean section?'

"Usually what happens is, if anything goes wrong, then they're questioned later on, 'wouldn't it have been better if you did the cesarean section a little sooner?' 'Why didn't you do the c-section?' 'Wouldn't that have been the easiest way to deliver this baby — the less traumatic way to deliver this baby?'" Frieden explained.

Well, so long as the procedure is elected to reduce the risks to mother and child, right? Wrong:

...And while the number of women and infants who die during childbirth is very small, studies have found that mothers and babies are more likely to die during or after a cesarean delivery. That may be, in part, due to the condition in which the mother enters the operating room, but it is a sobering statistic, nonetheless.

"I think we're engaged in a great big uncontrolled experiment as to what happens when cesarean section rates rise," said Plante.

As a public health issue, many doctors worry that it is costing the health care system — and, therefore, all of us — more money to have so many women delivering by c-section and staying in the hospital for longer recoveries. Some say it is an unnecessary drain on resources.

The article excerpted above -- by Michael Fumento -- goes further than ABC is willing to:

Now here's the horrible kicker: A Swedish report released in December found that emergency cesarean delivery increased the odds of cerebral palsy by a statistically significant 80 percent. It's bad for the mother, too. Another 2006 study, in the journal Obstetrics & Gynecology, found that moms with cesareans had more than three-and-a-half times the chance of dying shortly after childbirth than those who had vaginal delivery.

"Some of the increased risks for the mother include possible infection of the uterus and nearby pelvic organs; increased bleeding; blood clots in the legs, pelvic organs and sometimes the lungs, says the March of Dimes. Further, cesarean birth "is more painful, is more expensive, and takes longer to recover from than a vaginal birth," says the group.

It's reprehensible that John Edwards made a fortune encouraging a procedure that seems to be overused, and likely to increase risks. He could at least show some shame.

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