Unethical focus on reducing cesarean rates - another baby dies

This story, published in The Daily Mail on Monday this week, is a harrowing read and absolutely devastating (Why do doctors still use forceps when they killed our baby? by Jane Feinmann).

It sickens me when I hear about women whose legitimate cesarean request is being ignored or refused at antenatal meetings, and the stress and trauma that they have to suffer during their pregnancy, but when I read stories like this - where there was a clear and present danger to the baby, the parents are begging for a cesarean, and medical professionals choose a riskier course of action that results in a precious baby's death - I may have tears in my eyes, but my stomach churns in anger and resolve that something must be done to stop this unethical practice.

Maggie Blott, spokeswoman for the Royal College of Obstetricians and Gynaecologists, is quoted as saying: "If we are going to have normal deliveries, we have to keep on training obstetricians to use forceps."

My view: "I planned a cesarean delivery precisely because I did not want a 'normal' or 'natural' vaginal birth. I didn't trust Mother Nature, I wanted to avoid the unpredictability of a trial of labor, and I took comfort in the growing body of research that demonstrates far safer outcomes for babies with planned cesarean delivery at 39 weeks. I wanted a safe birth - not a normal one - and hospital policy should support this choice."

I would encourage you to read this article in full, but here are some of the main details reported as the investigation continues:

The outcome
- Baby Alexandra, born weighing 9lb 4oz, died when she was just three days old

- She died as a result of severe injury to her spinal cord inflicted during a forceps delivery that went wrong - 10 hours after her parents had repeatedly begged the obstetric team to deliver the baby by cesarean

- Parents Beatrix and Craig Campbell lost the daughter they had conceived through IVF after 5 years of trying (which had involved both parents undergoing surgery)

The birth
- June 2009, at the Royal Infirmary Edinburgh’s Simpson Centre for Reproductive Health

- Beatrix, a slight 5ft 2in, was past her due date with a large baby lying sideways

- 30 hours after induction started, exhausted and barely dilated, Beatrix told the midwife she wanted a cesarean. The hospital later admitted that this would have saved Alexandra, but the request was refused.

- It took 4 doctors 75 minutes to stitch Beatrix and she had to return a month later for surgery on the wound

What the parents say
- ...they believe she was the victim of medical arrogance and a determination to reduce the rising cesarean rate

- ...they are hoping there will be an independent investigation into Alexandra’s death

- They have begun their own investigation into forceps, discovering that deaths or serious injury are far from rare. ‘We were horrified to discover this is a frequent occurrence that no one seems to be monitoring,’ says Beatrix. ‘Craig has found local newspaper reports of ten examples of babies dying or being damaged during forceps delivery, with the coroners’ reports in many cases saying that a Caesarean should have been performed earlier.’

Informing women...?
Feinmann writes: ‘NHS websites talk about “the slight risks associated with forceps delivery”, citing temporary problems such as bruising or scratches,’ says Beatrix, 32, a researcher. In fact, studies since the Eighties have reported high rates of damage to mothers and babies through forceps use. Recent research confirmed this poses a higher risk of birth injury than other interventions, including Caesareans.

Over the past decade, there has been a decline in the use of forceps worldwide - the instrument is consigned to medical history in most U.S. maternity hospitals.

Using forceps safely requires a high level of skill and expertise, which ‘means that the outcome is always uncertain, even for experienced surgeons,’ says leading U.S. surgeon Atul Gawande, head of the World Health Organisation’s Safer Surgery initiative.

‘If you’re seeking the safest possible delivery of every baby, you have to take notice of the steady reports of terrible forceps injuries to babies and mothers, despite the training that clinicians have received,’ he says.

Experts are particularly concerned about a type known as Kielland’s forceps, which were used to deliver Alexandra... Unlike most forceps, which are used to speed up the delivery of a baby that has become distressed or obstructed in the final stages of delivery, Kielland’s forceps are used to rotate an infant stuck in a sideways position, usually higher in the birth passage.

The procedure is so tricky, says Professor Nick Fisk, former consultant obstetrician at Queen Charlotte’s Hospital, London, ‘that even experienced senior consultants would not attempt a Kielland’s forceps delivery’.

Should forecps be used?

Feinmann writes: Phil Steer, Professor of Obstetrics and Gynaecology at Imperial College, London, is among the many who have abandoned forceps - they are a rarity in Chelsea & Westminster, where he is a consultant obstetrician, with Kielland’s forceps all but unknown.

Yet at least 31,500 babies a year are delivered by forceps - that’s one in 20. Some hospitals continue to use Keilland’s forceps; at the Royal Infirmary, where Alexandra was born, there are 170 such deliveries a year.