Linda Coale had been home from the hospital for a week after giving birth to her son last year when a blood clot traveled to an artery in her heart — and killed her.
She was recovering from a caesarean section — a surgery that increased her risks for childbirth complications that her sister said she wasn’t fully prepared for — and was waiting for her doctor to call back when tragedy struck.
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“She was gone in what seemed like an instant,” said Clare Johnson, Coale’s sister.
Coale’s death could have been prevented, Johnson said, if her sister had gone to the emergency room immediately instead of waiting for her doctor’s call about her leg cramps.
Coale’s doctor had given her a packet of information, but nothing mentioned the risks of a caesarean or the signs of complications — cramping, swollen or irritated legs, or high temperature — said Johnson, a patient liaison at Greater Baltimore Medical Center in Towson.
Now, as the rates of caesarean sections continue to rise, Johnson and other advocates want to raise awareness of the risks of the surgery.
“I have a head full of bad stories with caesareans,” said Barbara Stratton, a birth advocate and volunteer with the Baltimore chapter of ICAN, the International Caesarean Awareness Network, which aims to prevent unnecessary caesareans and support women in their recovery.
“They are not 100 percent” successful, she said.
Nationwide, the rate of babies born by caesarean section was 30.3 percent in 2005, the latest data available, which is 4 percent higher than in 2004, according to the Centers for Disease Control and Prevention.
The rate declined between 1989 and 1996, but has since been on the rise, according to the CDC.
In Maryland, 33.6 percent of babies were delivered by caesarean, up 1 percent from the previous year, according to state health department data. Ten years ago that rate was 20.8 percent.
“It’s been pretty dramatic, particularly over the last 10 or 15 years,” said Dr. Raymond Cox, chair of obstetrics/gynecology at Saint Agnes Hospital in Baltimore and chair of the Maryland Patient Safety Center Perinatal Collaborative.
Some of the rise can be attributed to what Cox called “defensive medicine,” physicians’ hesitation to assume risk of complications to the baby during labor.
Doctors also may feel pressure to accommodate a woman anxious to end her pregnancy, Cox said, prompting a doctor to induce labor, which often leads to a caesarean.
The rates also may be rising due to the increase in high-risk pregnancies because woman are having babies at an older age or have other medical problems such as obesity and hypertension, said Dr. Fred Guckes, an obstetrician-gynecologist at Anne Arundel Medical Center.
There are situations that warrant the surgery, Cox said, such as abnormalities with the baby’s heartbeat, a ruptured placenta or if the baby isn’t in the right position or can’t make it down the birth canal.
But a caesarean section is major surgery and carries risks of bleeding, adverse reactions to anesthesia, and damage to internal organs such as the bladder or bowel, Cox said. The surgery also can pose problems for later pregnancies, because of scar tissue on the uterus.
“People think they are avoiding risk when in fact on the backside they are addressing a completely different set of risks,” he said.
Advocates and physicians agree there should be more education about caesarean sections.
“I think we need to do a better job of educating not only the physicians but also the patients that caesareans are not without risk,” Cox said.
Women should be informed throughout their pregnancy, setting their expectations for the delivery, Guckes said. “It’s not a decision you make on delivery day.”
