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Iatrogenic Fetal Injury: How often are babies cut during a c-section?

A new mother recently posted on BabyCenter about the scalpel laceration that her daughter sustained during an emergency cesarean on July 4, 2009. She reported feeling helpless and watched her newborn girl grab at her face in pain, scratching the cut.

From the woman’s point of view, the doctor arrived at 7:00 p.m. on the Fourth of July with blood-shot eyes and performed the surgery so quickly in an effort to return to his holiday celebration that he erred twice—first with the original laceration and then by using some kind of non-dissolving suture that became infected after two weeks.

According to the woman, the doctor never said he was sorry and offered her what she felt were excuses. Disclosure of errors to patients and apologies remain hot topics among physicians who admittedly invest a lot of energy learning ways to avoid litigation. One theory on apologizing to patients is that patients will seek out a lawyer to fill in the gaps and answer their unanswered questions.

The woman is talking to a malpractice attorney and feels that the doctor should be held accountable for “get[ting] her face fixed” when she is older.

James Alexander and colleagues at the University of Texas Southwestern Medical Center looked at 37,110 cesarean deliveries over a two year period (1999 and 2000) in 13 medical centers with a goal of describing both the incidence and type of iatrogenic fetal injury from cesarean delivery. More than one percent of all infants had an identified fetal injury. Skin laceration was the most common at 0.7 percent (272 cases) and other injuries included cephalohematoma (88 cases), clavicular fracture (11 cases), brachial plexus (9 cases), skull fracture (6 cases), and facial nerve palsy (11 cases).

The study also found that fetal injury did not vary in frequency with the type of skin incision, preterm delivery, maternal body mass index, or infant birth weight greater than 4,000 g, but did vary greatly based on the reason for the cesarean surgery as well as with type of uterine incision and length of time from decision to incision.

Nursing Birth posted the verbiage of an actual elective primary cesarean consent form which includes “Injury to the baby” as one of the possible risks and complications of the surgery.

According to the anonymous NICU nurse of Reality Rounds, lacerations from cesarean sections at the hospital at which she works are rare and very seldom serious. She stated via e-mail that she has seen far more neonatal lacerations from forceps and scalp electrodes than from a cesarean and someone from pediatric plastic surgery is always called in for any facial laceration. The worst case she can recall was a baby girl who received a shallow laceration underneath her eye, but the majority of wounds do not require stitches—only Bacitracin and steri-strips.

Forthrightness with the women whose babies were injured is a priority at her hospital. Said the nurse, “We have always been completely honest with the patients, and honestly, none of them were very angry or upset.”

While very uncommon, some doctors believe that the incidence of iatrogenic (doctor-caused) fetal injury is frequent enough to inform women considering a cesarean of the risk. An article entitled, Iatrogenic Fetal Injury that appeared in the Green Journal in November 2005, cites and photographically documents a case of a baby whose finger was amputated during an elective cesarean section. According to the authors of the article, “Clearly, when considering the stressful circumstances of an emergency cesarean delivery, it is not surprising that the probability of complications is greater than in elective cases. The incidence of iatrogenic fetal injury is high enough to warrant inclusion as a specific complication when obtaining consent.”

How often are babies cut during cesarean surgery?

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