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Posted 2-9-98

Revised guidelines for delivering babies and a quality-of-care monitoring system are in place at Los Angeles County public hospitals in the wake of reports that the county endangered patients with a policy of avoiding cesareans.

According to a Los Angeles Times investigative report, from the mid-1980s to 1995, physicians at county hospitals required pregnant women, most of whom were on Medi-Cal, to attempt to deliver babies vaginally, even if they had had a prior cesarean. A prior cesarean increases chances that a woman’s uterus will rupture. Vaginal deliveries generally cost half as much as cesareans.

Since 1992, the Los Angeles Times reported, the county has paid $24 million to settle 49 claims involving women or children who were killed or injured by a failure to perform or a delay in performing cesareans.

The Board of Supervisors, which oversees the county’s six public hospitals, has been investigating the cesarean birth policy since the report was published. The board is now satisfied that the county has revised its guidelines to guarantee a patient’s right to informed consent and to give a woman more say in how she will give birth, said Kathryn Barger, health deputy for Supervisor Mike Antonovich, who called for the investigation.

A monitoring system also is in place to assure such situations don’t recur, she said. "The minute anything goes wrong at one of our facilities, we are going to look at it and implement protocol and changes immediately," she said. "We don’t want to wait for a lawsuit to be filed."

One reason for the avoidance of cesareans in the past was the high volume of births and relatively low number of physicians, Barger said. "When you have 30 women ready to deliver and five doctors available, you have to remember a c-section is major surgery. Given their volume, they had to make some choices," she said. Some physicians have argued that cesarians have been over-used and that many women benefit from vaginal deliveries.