Facts you should know about a scary scenario that leads to many C-sections
Tricia Tazuk had been pushing for 30 minutes with her husband at her side in the Seattle hospital, cheering her on. Two midwives had coached Tazuk in shifts throughout 50 hours of intense labor, and everything appeared to be progressing well. Then, as the baby girl began to emerge, one midwife abruptly left the room.
“Suddenly, a whole team of doctors appeared,” Tazuk recalls. “They tried vacuum first [to get the baby out], but the suction head came off. Then they used forceps. As soon as the baby was out, a nurse tucked her under her arm like a football and ran off to the neonatal intensive-care unit with her. It was all extremely upsetting.”
Tazuk later learned that baby Remy’s heart rate had dropped dramatically during labor. She had also inhaled meconium, fecal matter that is expelled into the amniotic fluid when a baby is in distress. Because Tazuk had begun pushing and the baby’s head had crowned, an emergency Cesarean section—the fastest and safest method of delivering a baby who is obviously in trouble—wasn’t an option.
This was a clear-cut case of fetal distress. Many other similarly diagnosed delivery situations are not so black-and- white, however, and this fact has led some critics of our country’s high C-section rate to wonder if fetal distress isn’t overdiagnosed. In 2001, 24.4 percent of births—or 978,411—were via C-section, and according to the Centers for Disease Control and Prevention (CDC), 83,526 of them were performed at least partly in response to fetal distress. But because there is no universally agreed-upon medical definition for the condition, some of these C-sections may have been unnecessary.
Fortunately, no matter how they are delivered, the majority of babies who appear to suffer from fetal distress recover fully and quickly. Remy, for example, is now a healthy 4-year-old. So why, then, are so many C-sections performed in the name of fetal distress?
When and why doctors disagree> In 1999, Jeffrey P. Phelan, M.D., J.D., an obstetrician in Pasadena, Calif., and former editor in chief of OBG Management, wrote an article for which he had asked other OBs to define fetal distress. The 22 physicians he interviewed all gave different definitions. A year earlier, the American College of Obstetricians and Gynecologists (ACOG) had tried to do away with the term, asking OBs to use “non-reassuring fetal status” instead, since most cases result in the births of healthy babies. The attempt met with little success.
In essence, fetal distress is often whatever an individual doctor says it is. “Obstetricians create ‘shortcuts’ [to determine fetal distress] because they are very busy taking care of a lot of patients,” says Gerard Nahum, M.D., an associate clinical professor of obstetrics and gynecology at Duke University School of Medicine in Durham, N.C. However, many physicians do agree on some criteria, primarily a slowing of the fetal heart rate during labor at times when it shouldn’t. Another is a deep slowing of the heart rate for more than several minutes or for longer periods than most doctors are comfortable with. Where obstetricians disagree is how slow a heart rate has to be, at what times and for how long, before intervention is needed.
Who is at risk?> A woman who has been diagnosed with certain pregnancy complications has a greater likelihood of delivering a baby who suffers from fetal distress. “[The babies of] women who are post-term or who have high blood pressure, diabetes, preeclampsia or toxemia of pregnancy are at higher risk,” says Patrick Urban, M.D., an obstetrician in Albuquerque, N.M. Use of the induction drug Pitocin can also cause the baby’s heart rate to slow, especially if the mother is given a large dose, according to ACOG, but careful monitoring during labor can help prevent serious problems. In many cases of fetal distress, doctors have plenty of time to discuss the situation and the options. However, fetal distress sometimes occurs abruptly—when the placenta is tearing away from the uterine wall or the uterus is rupturing, for example. In these scenarios, there is no time for discussion: Doctors have only minutes to get the baby out to avoid fetal brain damage or even death. Fortunately, such emergencies are rare, but when there’s any possibility of something going seriously wrong, doctors wisely tend to err on the side of caution. Because so much subjectivity is involved in defining fetal distress, a pregnant woman should ask her physician exactly how he diagnoses it and determines when to intervene by performing a Cesarean. Says Urban: “I encourage women to talk to their doctor as they near their due date about the chance that their baby will suffer from distress and how the situation will be handled.”