Moms decry high N.J.

C-section rate

Two recently died after the procedure

BY CAROL ANN CAMPBELL, (nj.com) May 18, 2007

A small group of women, some nursing babies and others holding signs, stood in front of the Statehouse in Trenton yesterday to draw attention to the recent deaths of two women after they had Cesarean sections -- and to highlight the state's high rate of surgical births.

In New Jersey, more than one out of every three births -- or 37 percent -- were delivered by C-section in 2005, according to state health officials.  The U.S. Centers for Disease Control and Prevention said New Jersey had the nation's highest Cesarean rate in 2004, according to the latest nationwide data available.

"This is a good moment in time to bring attention to the Cesarean crisis in New Jersey," said Jennifer Santos Kraft, a child birth educator from Hopewell.

The rally yesterday was sparked by the deaths of Valerie Scythes, 35, of Woodbury, who died March 28th, and Melissa Farah, 28, of Oaklyn, who died April 12.

The two women were co-workers in the same elementary school, and the school staff threw them a joint baby shower just weeks before both women died.  Both delivered healthy baby girls before dying.

The women went to Underwood-Memorial Hospital in Woodbury, Gloucester County.  A hospital spokesman said both women were transferred to other hospitals before their deaths.  Spokesman Richard Bellamente said he could not comment on individual cases because of confidentiality laws.  Attorneys for the woman have said they are awaiting final autopsy results.

Though rare, each year in New Jersey some women die giving birth.  In 2000, 17 women died in pregnancy-related deaths.  In 2005, the figure was eight, according to state health officials.  The data does not specify whether the births were C-sections.

After the deaths of the two women, Bellamente said Underwood-Memorial conducted an in-depth investigation and "we found that everything in terms of protocol of care is consistent with appropriate treatment."

About a dozen protesters, some from the International Cesarean Awareness Network, first gathered outside Underwood-Memorial and then traveled to the statehouse in Trenton.

Several participants at yesterday's rally acknowledged facts surrounding the women's deaths remain unclear, but they nonetheless said risk of maternal death is higher during C-sections.  They are pushing for laws requiring all health professionals involved in childbirth, such as physicians and midwives, to provide their C-section rates to potential patients.

Tamra Larter, of Westville in Gloucester County, said she delivered her new baby at home, even though her HMO refused to pay the midwifery costs.

"I did not want to deliver a baby at a hospital with a Cesarean rate above 30 percent," the 37-year-old woman said while holding her 4-month-old daughter.

The C-section rate in New Jersey and in the country has risen steadily in recent years.  Several hospitals in the state now give nearly half their pregnant women Cesareans.

Paul Stumpf, immediate past president of the American College of Gynecology and Obstetrics -- New Jersey, said surgical births are slightly more dangerous for the mothers, though less risky for the baby.

"The increase in risk to the mother is very small," he said.

He said C-sections are rising because women are giving birth later in life and have more multiple births.  In addition, doctors say fear of lawsuits prompts early intervention to prevent problems with the baby.

But rally organizers cited studies that said C-sections increase maternal death 3 to 4 times.  They said the World Health Organization says rates should not be higher than 15 percent, and that some C-section babies are delivered too soon because of errors in predicting the due date, jeopardizing the baby's health.

Some hospitals work successfully to keep rates down.  Kimball Medical Center in Lakewood delivers only 17 percent of birth surgically, the state's lowest rate.

"We have incredible teamwork between the nurses, midwives and physicians.  There's mutual respect," said Eric Lehnes, chair of the hospital's ob-gyn department.

Some newer studies have compared vaginal delivery to planned C-sections, which appear to be safer than surgical births that follow unsuccessful labor, physicians have said.

"A Cesarean section after someone has gone through labor is more difficult," said Patrick Culligan, a uro-gynecologist for Atlantic Health in Morristown.

He treats women who experience incontinence, often, he said, caused by labor and vaginal birth.  He believes a physician should comply if a woman who has fully explored her options selects a planned C-section, which he said is as safe as a vaginal birth.

"A woman has the right to make her own medical choices," he said.

Carol Ann Campbell may be reached at (973) 392-4148 or ccampbell@starledger.com.