"...Medical malpractice was his specialty, and he reportedly tried more than 60 such cases, winning more than $1 million in over half of those. Most involved Ob/gyns. Indeed, he was so feared, according to the Center for Public Integrity, "that doctors would settle cases for millions of dollars rather than face him at trial."
Edwards' specialty was cerebral palsy, a set of permanent conditions affecting control of movement and posture that usually appear at toddler stage. There is no cure, although stem cell studies in both humans (umbilical cord cells) and rats (neural cells) have produced promising results. More than 10,000 U.S. children are diagnosed with it yearly. Edwards claimed the disease developed because negligent doctors ignored fetal heart monitors indicating the child might not be getting enough air during birth and thus failed to deliver it immediately through cesarean surgery.
Yet Edwards won his cases not because scientific evidence favored him but because of his smooth-talking "trust-me" demeanor -- and heart-wrenching pleas in which he ghoulishly sometimes pretended to be the voice of the unfortunate child crying out for justice.
It's not considered impossible that asphyxiation during birth could cause cerebral palsy; just darned unlikely. United Cerebral Palsy lists about a dozen ways to help prevent the condition. Not one mentions the birthing procedure.
A 2003 study evaluated almost 1,000 life births to see if cerebral palsy or other problems could by affected by type of birth. Conclusion: "Delivery mode (whether vaginal or cesarean delivery) was not associated with any of the outcomes that were evaluated."
Months earlier, another study observed that cerebral palsy rates have shown "no change over 30 years" despite fetal monitoring and a huge increase in the number of C-sections. Further, "The prevalence of cerebral palsy is the same or lower in underdeveloped countries than in developed nations," even though "emergency cesarean delivery based on electronic monitor data is limited or absent."
Now here's the horrible kicker: A Swedish report released in December found that emergency cesarean delivery increased the odds of cerebral palsy by a statistically significant 80 percent. It's bad for the mother, too. Another 2006 study, in the journal Obstetrics & Gynecology, found that moms with cesareans had more than three-and-a-half times the chance of dying shortly after childbirth than those who had vaginal delivery.
"Some of the increased risks for the mother include possible infection of the uterus and nearby pelvic organs; increased bleeding; blood clots in the legs, pelvic organs and sometimes the lungs, says the March of Dimes. Further, cesarean birth "is more painful, is more expensive, and takes longer to recover from than a vaginal birth," says the group.
But scientific reality is but a minor hurdle to slick plaintiffs lawyers like Edwards. Insurance companies fork over massive payments to plaintiffs and their lawyers, then pass the costs on to doctors in malpractice fees. In one state, annual Ob/gyn malpractice premiums have reached $250,000.
Many doctors are fleeing the practice as fast as they can tie off that last umbilical cord. One in seven of fellows of the American College of Obstetricians and Gynecologists have quit obstetrics and many rural areas now have no such doctors.
Meanwhile health insurance premiums have skyrocketed, in part because doctors don't just absorb higher malpractice fees; they also pass them on.
Further, in what's called "defensive medicine," lawsuit fears increased the number of "When in doubt, cut it out" C-sections. Cesareans in the U.S. had begun dropping in the late 1980s, going as low as 22 percent of deliveries. As Edwards and friends spread fear across the Ob/gyn land, rates began to climb again. The rate is now 30.2 percent, a record high for the nation..."
fumento.com
Preventive Health care, John Edwards style
On the front page of Sunday's Philadelphia Inquirer is a shocking expose on what I think is a corruption of medical practice -- the fact that the once-risky (and distinctly icky if not unnatural) procedure of delivering babies by cesarian section is "now is used in about a third of U.S. births":
"This is mostly about changes in culture," said Eugene Declercq, an expert in maternal and child health at Boston University's School of Public Health. "In all the gray areas of clinical decision-making, obstetricians have moved to cesareans. Mothers are more accepting, too."
Cesarean critics worry that doctors are frightening mothers into the surgery.
"A woman who is given reason to be scared that something bad might happen to her unborn child will do anything to avoid it," said Jose Gorrin Peralta, a University of Puerto Rico obstetrician. "If the doctor says, 'Your baby could die unless I do a cesarean,' what woman is going to say, 'Don't do it'? I call it obstetrical terrorism."
Far be it from me to call it "obstetrical terrorism," but if we must call it that, shouldn't we also be looking for the root cause? Is it that there's a new generation of doctors who just enjoy cutting women open? Or is something motivating them?
Sure, it's easier to perform a c-section than ever before, but the rates are still four times that of a normal delivery. The Inquirer hints at economic factors:
....the specter of lawsuits heavily influences the use of cesarean.
At Lankenau, for example, the cesarean rate rose from 28 percent in 2001 to 36 percent the very next year. The jump was largely triggered by a lawsuit contending that a child was born with cerebral palsy because a cesarean was not performed. The parents won a $24 million verdict.
"You can imagine there is that fear of what can happen," said Nancy Roberts, the chief of obstetrics.
A Pennsylvania State University College of Medicine study of 31 hospitals found that the more physicians perceived they were at risk of being sued, the more cesareans they did.
I know Lankenau Hospital very well, and the implications of the statistical change shocked me.
I think it is a violation of the Hippocratic Oath for a doctor to take into account potential legal liability in deciding to cut a woman open instead of waiting for nature to run its course.
It's not preventive health care on behalf of the patient; it's preventive legal care on behalf of the doctor and the hospital.
Doctors, of course, counter that it isn't their fault, and a number of commentators have pointed the finger at John Edwards:
Edwards specifically has made much of his fortune suing doctors for not performing C-sections, arguing that they help prevent cerebral palsy in children. In 1970, six percent of all births were C-sections; in 2003, that number had climbed all the way up to 28 percent. However, as John Stossel reports, there had not been a decrease in prevalence of cerebral palsy during that time. Hence, although Edwards' lawsuits have not, apparently, prevented anycases of cerebral palsy, they have, at least in part, yielded a great increase in the occurrence of C-sections. Now doctors do C-sections "just to be safe," meaning safe from lawsuits, though the procedure is not so safe for mothers. While C-sections are not overly dangerous, women are four times more likely to die during a C-section than during vaginal birth; this is not an insignificant risk...
classicalvalues.com
The Caesarean Epidemic and John Edwards
The epidemic of unnecessary Caesarean sections continues to take its toll.
UPI, 8/15/06: Cesarean spike drives up Medicaid costs
Newsday, 9/8/06: Cesarean risk high for babies of low-risk mothers
John Edwards - the 2004 Democratic candidate for Vice President and probable presidential candidate in 2008 - and fellow enterprising trial lawyers who sued doctors for millions for not performing Caesareans, allegedly causing cerebral palsey (now scientifically shown to be a false connection) bear a large responsibility for today's epidemic of unnecessary Caesarean sections. It wasn't the only factor. But it was an important one.
New York Times, 1/31/04, Adam Liptak and Michael Moss: In trial work, Edwards left a trademark
"1985, a 31-year-old North Carolina lawyer named John Edwards stood before a jury and channeled the words of an unborn baby girl.
Referring to an hour-by-hour record of a fetal heartbeat monitor, Mr. Edwards told the jury: "She said at 3, 'I'm fine.' She said at 4, 'I'm having a little trouble, but I'm doing O.K.' Five, she said, 'I'm having problems.' At 5:30, she said, 'I need out.' "
But the obstetrician, he argued in an artful blend of science and passion, failed to heed the call. By waiting 90 more minutes to perform a breech delivery, rather than immediately performing a Caesarean section, Mr. Edwards said, the doctor permanently damaged the girl's brain. ...
The jury came back with a $6.5 million verdict in the cerebral palsy case, and Mr. Edwards established his reputation as the state's most feared plaintiff's lawyer.
In the decade that followed, Mr. Edwards filed at least 20 similar lawsuits against doctors and hospitals in deliveries gone wrong, winning verdicts and settlements of more than $60 million, typically keeping about a third. ...
The effect of his work has reached beyond those cases, and beyond his own income. ... And doctors have responded by changing the way they deliver babies, often seeing a relatively minor anomaly on a fetal heart monitor as justification for an immediate Caesarean. ...
Studies have found that the electronic fetal monitors now widely used during delivery often incorrectly signal distress, prompting many needless Caesarean deliveries, which carry the risks of major surgery.
The rise in such deliveries, to about 26 percent today from 6 percent in 1970, has failed to decrease the rate of cerebral palsy, scientists say. Studies indicate that in most cases, the disorder is caused by fetal brain injury long before labor begins."
archontan.blogspot.com
Labor and delivery factors in brain damage, disabling cerebral palsy, and neonatal death in low-birth-weight infants.
Qiu H, Paneth N, Lorenz JM, Collins M.
Department of Epidemiology, College of Human Medicine, Michigan State University, East Lansing, USA.
OBJECTIVE: We assessed the relationships between active labor and neonatal death, neonatal brain damage, and disabling cerebral palsy in low-birth-weight infants. STUDY DESIGN: A population-based cohort of 961 infants with birth weights of 580 to 2000 g and gestational ages >or=26 completed weeks. Neonatal brain damage was assessed by ultrasound scanning in the first weeks of life; disabling cerebral palsy was assessed at 2 years of age (corrected for gestational age). RESULTS: After being controlled for possible confounders, active labor was associated significantly with an increased risk of parenchymal echodensities/lucencies and/or ventricular enlargement (odds ratio, 2.3; 95% CI, 1.2-4.5) but not with germinal matrix/intraventricular hemorrhage (odds ratio, 1.3; 95% CI, 0.8-2.1), neonatal death (odds ratio, 1.8; 95% CI, 0.8-4.0), or disabling cerebral palsy (odds ratio, 1.6; 95% CI, 0.7-3.7). In vertex presentations only, active labor was associated with a nearly 4-fold increase in risk of neonatal death (odds ratio, 3.8; 95% CI, 1.3-10.9). In nonvertex presentations only, active labor was associated strongly with parenchymal echodensities/lucencies and/or ventricular enlargement (odds ratio, 4.3; 95% CI, 1.2-15.6) and disabling cerebral palsy (odds ratio, 8.2; 95% CI, 1.4-49.9). CONCLUSION: The only adverse outcome that was associated consistently with active labor was parenchymal echodensities/lucencies and/or ventricular enlargement. Fetal presentation modified the relationships between active labor and adverse outcomes. Delivery mode (whether vaginal or cesarean delivery) was not associated with any of the outcomes that were evaluated.
ncbi.nlm.nih.gov
Temporal and demographic trends in cerebral palsy--fact and fiction.
Clark SL, Hankins GD.
University of Utah School of Medicine, LDS Hospital, Salt Lake City, USA.
The rate of cerebral palsy has not decreased in developed countries over the past 30 years, despite the widespread use of electronic fetal heart rate monitoring and a 5-fold increase in the cesarean delivery rate over the same period of time. However, neonatal survival has improved during these decades. These observations have lead to the hypothesis that increased survival of premature, neurologically impaired infants may have masked an actual reduction in cerebral palsy among term infants as a result of the use of electronic monitoring and the avoidance of intrapartum asphyxia. A review of the medical literature, as well as a demographic analysis of term and preterm birth rates in the United States, refutes this hypothesis on four grounds. First, cerebral palsy prevalence has been separately analyzed in term infants and shows no change over 30 years. Second, the prevalence of cerebral palsy is the same or lower in underdeveloped countries than in developed nations; in the former, the availability of emergency cesarean delivery based on electronic monitor data is limited or absent. Third, the increase in prevalence of cerebral palsy among low-birth-weight infants and the increase in cesarean sections based on presumed fetal distress were not simultaneous events-the former preceded the latter by a decade. Improved neonatal survival since the 1980s has been associated with a stable or decreasing rate of neurologic impairment and thus could not have obscured improvement from reduced term asphyxia. Finally, compared with the number of infants born by cesarean section for fetal distress, there are simply not enough infants born in the most vulnerable weight groups to make any impact on even a minimal improvement of outcome in the group delivered by cesarean section for presumed fetal distress. Except in rare instances, cerebral palsy is a developmental event that is unpreventable given our current state of technology.
ncbi.nlm.nih.gov
Postpartum maternal mortality and cesarean delivery.
Deneux-Tharaux C, Carmona E, Bouvier-Colle MH, Bréart G.
INSERM, Unite Mixte de Recherche S149, Institut Federatif de Recherche 69, Epidemiological Research Unit on Perinatal and Women's Health, Hopital Tenon, Paris, France. cdeneux.u149@chusa.jussieu.fr
OBJECTIVE: A continuous rise in the rate of cesarean delivery has been reported in many countries during the past decades. This trend has prompted the emergence of a controversial debate on the risks and benefits associated with cesarean delivery. Our objective was to provide a valid estimate of the risk of postpartum maternal death directly associated with cesarean as compared with vaginal delivery. METHODS: A population-based case-control study was designed, with subjects selected from recent nationwide surveys in France. To control for indication bias, maternal deaths due to antenatal morbidities were excluded. For the 5-year study period 1996-2000, 65 cases were included. The control group was selected from the 1998 French National Perinatal Survey and included 10,244 women. Multivariable logistic regression analysis was used to adjust for confounders. RESULTS: After adjustment for potential confounders, the risk of postpartum death was 3.6 times higher after cesarean than after vaginal delivery (odds ratio 3.64 95% confidence interval 2.15-6.19). Both prepartum and intrapartum cesarean delivery were associated with a significantly increased risk. Cesarean delivery was associated with a significantly increased risk of maternal death from complications of anesthesia, puerperal infection, and venous thromboembolism. The risk of death from postpartum hemorrhage did not differ significantly between vaginal and cesarean deliveries. CONCLUSION: Cesarean delivery is associated with an increased risk of postpartum maternal death. Knowledge of the causes of death associated with this excess risk informs contemporary discussion about cesarean delivery on request and should inform preventive strategies.
ncbi.nlm.nih.gov |
