don't know if this helps
I was looking for stuff on VBAC when I came across this on the aims site
How often do babies get cut during caesarean deliveries?
At the Royal Gwent Hospital in Newport, a mother sued after her baby was cut on the face during an elective section. At the time the hospital believed such injuries were rare - less than 1 in 100, so mothers need not be warned of the risk. The litigation prompted them to do a prospective study for the year 2000. A book was placed next to the resuscitation trolley in which all injuries were to be entered.
There was a 24 per cent caesarean rate (876 women) 1.5 per cent of the babies had skin lacerations (13 babies) - seven of these had emergency sections and six elective sections. Two of the elective sections were done because the baby was breech, two at "maternal request", one because there was a previous section, one for disproportion and one for a transverse lie. Three of the emergency sections were done because of "failure to progress".
A consultant did three of the sections, a registrar did seven (the same registrar did four of them)
"middle grades" did two and a senior house officer supervised by a consultant did one. They say "injury occurred regardless of the grade of operator". However, the fact that four injuries were caused by one doctor "implies a fault in technique" said the authors. One injury was done by scissors, the rest by a scalpel.
Only 7 of the 13 injuries were noted by the surgeon. The authors suggest that is why obstetricians think such injuries are "rare" - the baby is taken away and wrapped, the cut is not seen until later and the obstetrician may not be told.
They suggest that the risk of lacerations to the baby should be something mothers are warned about.
AIMS Comment
This is yet another example of how risks which have always existed, which mothers were never warned of, are suddenly published and made transparent if there is a need to protect doctors from litigation. If obstetricians can produce literature saying that it is a "standard risk" of the procedure, and go on to warn mothers about it, they have already taken steps to begin a future defence. Can you imagine a mother being rushed off for a section, already terrified, being told, "By the way, we might accidentally cut your baby in getting it out"?
However, questions remain. The fact that one registrar was responsible for nearly a third of the injuries in one year, and this was only discovered because they did a prospective study is very worrying. What did they do about that doctor? There is also the question of technique; the article describes procedures that should be used to minimise risk.
Apart from the transverse baby, who was injured on the thigh, they do not tell us where the others were injured, apart from the left or right side.
Unfortunately the authors do not tell us what percentage of caesareans at the hospital were elective and how many were emergency. However it is clear that those who have elective sections are still at risk.
We have had several cases of such injuries reported to us. In one, a baby girl was cut across the face and will be permanently scarred. The mother heard the midwives say to each other "How many more is he going to cut?"
Reference
- Wiener J and Westwood J, Fetal lacerations at caesarean section, J Ob Gyn, 2002; 22: 23-4