Doctors Throw Blows in Delivery Room, Endanger Baby

The fight over cesareans has gone international...and violent.  Two Italian doctors are being blamed for the botched delivery of a newborn that have led to complications for both the mother and son, after the doctors got into a fistfight in the delivery room.  Medical mistakes UFC-style.

According to reports, the mother Laura Salpietro, 30, had to have her uterus removed and her son, Antonio, suffered heart problems and possible brain damage following his birth last Thursday in a Messina, Sicily public hospital.  The two doctors, one a state hospital employee, the other a private doctor hired by Salpietro as a gynecologist, disagreed on whether the patient should have a C-section.  The disagreement turned to blows.

Sapietro's husband, Matteo Molonia, said the fight delayed the C-section by over an hour leading to the complications.  This has become a big story in the country, forcing the Italian health minister to traveled to Sicily on Monday to apologize to the woman.

The fiasco is only one of a number of errors plaguing the southern Italian region infamous for its high rate of medical mistakes.  Not lost on me is one significant detail of the Italian health system.  Yep, you guessed it--universal health care.

As a result of the entitlement-based system is an explosion of private doctors available to people that can afford them.  I have predicted the same to happen here in the U.S. if nationalization of our system continues to grow.  People that can afford it will hire private doctors to get around the inadequacies of government-run hospitals.  Just a conclusion of deductive reasoning, that's all.

What has made this particular situation tragic is that the patient decided to have her birth in a public hospital with a private doctor present.  Duh!  I guess she learned the hard way that doctors can be territorial, literally and figuratively, and if she has followed common practice she would have given birth at a private clinic instead. 

This story also highlights the dramatically high C-section rates in Italy in general, and Sicily specifically.  According to reports, approximately 38% of all births in Italy are done by C-section, more than twice the 15% recommended by the World Health Organization. In Sicily rates reach 52%.  In other parts of Italy, Campania--the southern mainland region that includes Naples-- for instance, C-section rates have reached 60%.

I have said in several posts, this is a major issue.  C-section are way over-prescribed, and experts believe the trend will continue.  Although many reasons for recommending C-section exist, most thinkers agree it is too high.

So keep your wits about you, America.  Don't ignore the inevitable problems associated with universal health care.  It ain't the panacea it's being sold as.  If you can't see the flip side from our friends in Europe, then you've let your blinders fall too far.  My condolences to the Molonia/Salpietra family--I hope it turns out okay.

VBAC: A Woman's Choice

Bravo to OBGYN!  They're taking their heads out of their keesters and changing the guidelines to repeated C-sections.  "Once a cesarean, always a cesarean" is going the way of bloodletting.  According to a recent report, the American College of Obstetrics (ACOG) is easing restrictions on which women will be allowed to have a vaginal childbirth following a previous cesarean.

It has been the policy of the ACOG to deny women the choice of a vaginal childbirth in order to prevent uterine rupture at the scar from the previous surgery.  However, the chance of this actually happening is less than 1%.

Despite the low risk, most obstetricians and hospitals insist on performing the riskier surgery.  In fact, the number of women going through "vaginal birth after cesarean," or VBAC, has gone from 3 in 10 fifteen years ago to less than 1 in 10 today.

"Why?" you might ask.  Because the rare uterine rupture could lead to emergency C-sections, and many smaller, rural hospitals are not equipped to perform them.  Emergency C-sections are much riskier than planned ones, and in ill-equipped small hospitals, it could be life-threatening.  Add to this a few high-dollar lawsuits and no surprises that the choice of VBAC has been denied to many women.

The numbers don't lie though, and c-sections are expensive, so the National Institute of Health (NIH) strongly urged steps to reverse that trend that saw one third of hospitals and half of doctors banning VBAC.  Talk about no choice.

Dr. William Grobman of Northwestern University and co-author of the guidelines said women's choice is "what we want to come through loud and clear....there are few times where there is an absolute wrong or an absolute right, but there is the importance of shared decision-making."  Indeed, good doctor.

Nearly one third of all births is by cesarean, and even the most medical-worshiping patrons must admit...this number is very high.  Although C-sections can be lifesavers in some cases, they do, in fact, increase the possibility of complications in the next pregnancy, some life-threatening, like placental abnormalities or hemorrhage.

The ACOG in its wisdom states that C-section scars are now located on the lower part of the uterus, further diminishing chance of rupture during VBAC.  And of those who attempt VBAC, say the ACOG, between 60-80% will deliver vaginally.  Of the 20-40% that do not...well, they'll get a C-section.  No harm, no foul.

I realize what a touchy subject this is among doctors and women.  I am reminded of a previous post where a reader lambasted me for not understanding the discomforts of pregnancy and labor because, had I, I would not be so glib in badmouthing C-sections.  Sheesh...I didn't realize how some people just want a quick knife and be done with it.  I get it now.

But here's the beauty of it for you women who despise the natural way of furthering the species: You can still have your choice of a planned cesarean.  Can't fathom the push and contract?  No problem.  C-sections are available.  But for the women that actually would like to connect with nature, the restrictions were BS, and now they can try without some doctor denying them their rights.  So you get yours, they get theirs, and we're all one big happy family.

ACOG did right.  Bravo to them.