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Comment and Controversy

When a high C-section rate is an advantage

July 2005 · Vol. 17, No. 7
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During the 1980s, I took pride in having the lowest C-section rate at my hospital: I delivered more than 220 babies a year with a primary rate of 12%. I delivered twins and breech presentations vaginally and was skilled with Laufe divergent forceps.

Some time during the 1990s, I reconsidered my approach. What if my birth outcomes were not so routinely good? Would I be able to defend the tactics I used to effect delivery? Could I defend myself with any breech birth?

Since my C-section outcomes were excellent, I decided to deliver all breech presentations and twins via cesarean. I have used this strategy for more than 10 years now and have no regrets about my higher C-section rate. Further, if I have any reservations about using forceps, I proceed with a C-section.

In 30 years of practice, I have been sued only once: for a delayed C-section in 2002. The hospital accepted responsibility and settled for $3 million, and I was dismissed from the case. That experience convinced me my strategy of performing C-sections is justified.

Ted E. Manos, MD
Eustis, Fla

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