Consortium for the Evidence-based practice of Obstetrics -- 
C.E.O. is dedicated to bringing science-based 
maternity care to all childbearing women

 Quotes and Excerpts from and 
 other respected sources  of professional information
on safety, complications & practice trends for obstetricians  

Bibliography, Recommended Reading and Scientific Citation from obstetrical sources:

The Connection ~  Cesareans & Electronic Fetal Monitoring

A Scar is Born – every 39 seconds – Cesarean rate in 1995 / advertisement for a silicone sheeting product  to reduce scarring in Cesarean incision; Ob.Gyn.News, April 15, 1998

Why the C-section rate is rising Editorial, Medical Economics, Oct 2000;

Who Speaks for Science in Court? Peter Huber, Geo C. Marshall Institute 2001

C-Section to Prevent Cerebral Palsy: Results May Be a Wash; Ob.Gyn.News; Apr15,2002, Vol 38, No 8

Excerpt ~ “Neonatal Encephalopathy & Cerebral Palsy” by the ACOG Task Force

Documentation Important in CP Deliveries, Ob.Gyn.News July 1, 2002 Vol 37, No 13;  

Why the C-section rate is rising – Editorial by Dr. Steven Drosman, MD, obstetrician-gynecologist in San Diego, CA; Medical Economics, Oct 2000; Dr. Drosman is "otherwise known as MD 23%" for his 23% Cesarean section rate

Probably  the biggest C-section motivator, however is fear of a lawsuit. The rational is simple: At worst, you'll be criticized for performing a C-section but you can be roasted for delaying one!  

When a patient is hooked up to a fetal monitor, it initiates an unholy trinity--the anxious patient, the hovering nurse and the paranoid physician. The tension escalates as monitoring devices are added: the fetal scalp electrode, the fetal pulse oximeter, and intrauterine pressure catheter.  Add some more Pitocin to the mix, and the action begins. 

The labor and delivery nurse watches the monitor and observes decreased variability and persistent late decelerations. The obstetrician is notified, wipes the perspiration from his forehead and pops a handful of antacids. 

The patient and her family are informed of the potential crisis, and the can of worms has been opened. More likely than not this "electronically compromised" fetus will be delivered by emergency C-section, with perfect Apgar scores. 

Excerpt ~ Who Speaks for Science in Court? Peter Huber, attorney, Geo C. Marshall Institute 2001

C-Section to Prevent Cerebral Palsy: Results May Be a Wash; Ob.Gyn.News; Apr15,2002, Vol 38, No 8  

Performing cesarean section for abnormal fetal heart rate patterns in an effort to prevent cerebral palsy is likely to cause as  least  as many bad outcomes as it prevents   …..the false-positive rate for these abnormal fetal heart patterns was 99.8% (N.Engl. J. Med 334[10:613-19, 1996) 

“Extrapolating from this study, Dr. Hankins calculated that a physician would have to perform 500 C-sections for multiple late decelerations or reduced beat-to-beat variability to prevent a single case of cerebral palsy. But since Cesarean section carries a roughly 0.5% risk of future uterine rupture, those 500 C-sections would result on average in 2.5 uterine ruptures. This in turn would cause one case of neonatal death or cerebral palsy….”

“So I’ve prevented one case of cerebral palsy and I’ve caused one.” Concluded Dr. Hankins, professor and vice chair of ob.gyn at the University of Texas, Galveston.  

Moreover, those 500 women who underwent C-section because of an abnormal fetal heart rate pattern face substantial morbidity related to their surgery, including a 5 to 10 fold increase in relative risk of infection, a 5-fold increase in [blood clots] as well as a 10- to 20-fold increase in future risk of placenta previa and acreta, he added. 

[*placenta accreta is when the placenta grows abnormally into the deep structure of the uterus or even grow through the uterus and attaches to the bladder or bowel (known as a ‘percreta’).  Accreta or percreta is a life threatening complication and frequently requires an emergency hysterectomy to stop the bleeding]  

Excerpt ~ Neonatal Encephalopathy & Cerebral Palsy” by the ACOG Task  

[This report was several years in the making and had the endorsements and support of 6 major federal agencies and professional organizations, including the Center for Disease Control & Prevention (CDC), the March of Dimes and the obstetrical professions in Australia, New Zealand and Canada. It is described as the "most extensive peer-reviewed document on the subject published to date".]

"Since the advent of fetal heart rate monitoring, there has been no change in the incidence of cerebral palsy"  

"... the majority of newborn brain injury does not occur during labor and delivery. Instead, most instances of neonatal encephalopathy and cerebral palsy are attributed to events that occur prior to the onset of labor". 

   Documentation Important in CP Deliveries, Ob.Gyn.News September 15, 2003 Vol 38, No 18;  

A growing number of studies suggest that infection and infectious processes play a greater rolesin the development of cerebral palsy than previously thought...

The idea that infection might play an important role in CP development evolved over the years as it became apparent that in most cases the condition cannot be linked with the birth process

"The increasing cesarean delivery rate that occurred in conjunction with fetal monitoring has not been shown to be associated with any reduction in the CP rate..."

In other studies, including one involving more the 155,000 babies, only 9% of CP cases could be linked to birth-related processes.

" ... only 0.19% of all those in the study had a nonreassuring fetal heart rate pattern....  

If used for identifying CP risk, a nonreassuring heart rate pattern would have had a 99.8% false positive rate....".