LOS ANGELES: County Hospitals Establish New Policy For Trials Of Labor
"In a striking departure from practice, doctors at Los Angeles County public hospitals have been forbidden to allow women who have had prior caesarean deliveries to undergo a trial of labor unless they sign a consent form," the Los Angeles Times reports. The new policy forbids attempts at vaginal deliveries in women "whose previous caesareans involved a particular type of incision into the abdomen, a history of uterine problems or uterine surgery, or those who are carrying triplets." The Times also reports that women carrying breach babies, "as well as women with vertical incisions in previous C-sections, will be discouraged from attempting labor."
Sign Here, Ma'am
"If they intend for you to do vaginal delivery, you're going to have to sign the vaginal delivery form. If you don't, then they can't do that and they have to do the caesarean," explained Dr. Donald Thomas, the county health department's director of clinical and medical affairs. The Times reports that the new policy was urged by the Board of Supervisors in response to the $24 million the county has paid out to settle lawsuits over death and injuries resulting from the county's previous policy of strongly discouraging C-sections. Miguel Santana, spokesperson for county supervisor Gloria Molina, said that "requiring consent is one way to make sure doctors understand their responsibilities to the patient."
The Times reports the new policy is "part of an overall effort to increase accountability among county doctors and avoid malpractice" and "comes at a time when some of the nation's leading experts on vaginal birth are moving away from strongly encouraging natural deliveries for women who have had surgical births." Women who have had "two or more caesareans have a threefold increase in the risk of uterine rupture if they deliver vaginally, compared to women who have had one surgery," according to a recent study. Partly because of "medical philosophy" and partly because of "finances," doctors in the past decade have "pushed [women] to deliver vaginally" before undergoing a C-section. According to Mark Finucane, county health director, C-sections cost twice as much as vaginal deliveries and "require the presence of several physicians, nurses and technicians, as well as the use of an operating room."
The county "was at the head of a nationwide movement to reduce the number of caesarean births ... and made headlines for their success in reducing the numbers of surgical births to 10%" from 40%. However, despite the "accolades," doctors could not ignore the unfavorable results: in one five-year period, "the county settled 49 claims involving 53 women and children who were injured or killed as a result of failure or delay in performing a caesarean" (Bernstein, 4/4).