LOS ANGELES: To Probe Caesarean Denials In High-Risk Cases
Los Angeles County Supervisor Mike Antonovich yesterday "called for an investigation of a policy under which poor women were forced to deliver babies vaginally, even in high-risk cases," the Los Angeles Times reports. The policy, which "cost the county millions of dollars in legal settlements" and reportedly injured or killed some mothers and children, has been discontinued. However, "Antonovich said he will order an investigation ... into whether other policies at county hospitals mandate a particular course of action instead of taking into account the medical needs and wishes of patients" (Bernstein, 1/26).
Sunday's Times details "the grim cost of the county's leadership in a nationwide movement to reduce the number of costly caesarean sections," reporting that the county paid $24 million to settle "49 claims of mothers and children who died or were injured" when women were forced into vaginal deliveries. In these deliveries, county doctors reportedly "carr[ied] out an official policy that directed a trial of labor -- an attempt at vaginal birth -- for the vast majority of women who came to county hospitals to deliver babies." According to the Times: "[t]wo women suffered uterine rupture"; "[f]ifteen of the children are mentally retarded"; "[f]our ... are expected to die before age 10" and "[t]en of the children suffer from paralysis of the shoulder, arm and hand." According to a physician "who helped formulate the policy," the public hospitals ordered labor in cases where the mothers had prior caesareans, even in a high-risk group of women who had had two or more caesareans. The "trial of labor" policy was developed in the late 1980s, but was only "phased out in 1995" after health administrators decided that it "was not the ideal."
Practice And Consequence
Currently, the Los Angeles County hospital caesarean section rate "hovers around 20% -- nearly twice what it was when the policy was in place." From the mid-1980s to the mid-1990s, the patient volume in California's public county hospitals was so high that "strict rules" were in place for when to perform the procedure, according to Dr. Richard Pual, head of County-USC's OB/GYN program. The Times reports that Los Angeles county followed a national trend "led over the past decade by natural childbirth advocates, [HMOs] and the federal government to reduce the rate of caesarean births." However, a "liberalized Medi-Cal" program began to "lur[e] maternity patients away from county facilities," which allowed county doctors to loosen the caesarean section rules as the patient volume lessened (Bernstein, 1/25). Today's Times reports that county supervisors have implemented "new rules, put into place over the past two years," which require an "experienced staff physician" to be present for decisionmaking when a woman is facing a difficult delivery (Bernstein, 1/26).