Mother awarded $11 million after she was denied a requested C-section and suffered incontinence

Woman wearing incontinence diaper

Many juries have awarded large judgments for babies harmed by failure to perform a necessary C-section. This is the first case I’ve heard about where the large judgment was awarded for failure to perform a requested C-section and the mother suffered the injury.

According to The Intelligencer:

Women have the right have to control their own bodies by opting for a C-section instead of a vaginal birth.

A Bucks County jury has awarded a mother $11 million for ongoing health issues following the birth of her second child.

A Bucks County jury has awarded $11 million to a mother who suffered disfiguring and ongoing injuries during the birth of her second child. The lawsuit states that she had requested a cesarean delivery because of a difficult first birth.

She had suffered a shoulder dystocia and a third degree vaginal tear during her first birth:

The suit, first filed in August 2013, states that in Giberson’s first delivery, which occurred in 2008, her baby was born with shoulder dystocia which occurred when a baby’s shoulder gets wedged under the pelvic bone in the birth canal. Giberson suffered a third-degree laceration with the delivery. Those complications were detailed and known or should have been known by Stoneridge Obstetrics & Gynecology physicians, the suit states.

What is a third degree laceration?

All vaginal tears are not alike. The decision on whether they should be repaired, how they should be repaired and the consequences of not repairing them depend completely on the type of tear. Most tears occur downward into the area between the vagina and rectum known as the perineum. It is more accurate, therefore, to refer to them as perineal tears. The Mayo Clinic website has an excellent series of slides detailing the normal anatomy of the perineum and the 4 degrees of perineal tears. First degree tears are the least serious and 4th degree tears the most.

Here is an illustration of a third degree tear.

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The perineal muscles identified in the illustration are the superficial perineal muscles. The anal sphincter is the ring of muscle that holds the anus closed. It is directly responsible for preventing bowel incontinence. If it will is torn completely apart and not properly repaired, the woman will be incontinent.

Her history put this mother at high risk for a second shoulder dystocia with possible injury to her baby, herself or both. Then she developed another risk factor for shoulder dystocia — gestational diabetes.

She communicated to the practice that a C-section “was requested and necessary” since her first child had been born at 9.9 pounds with shoulder dystocia.

On the day of birth she once again requested a C-section:

On July 21, 2011, the day she gave birth, she again requested a C-section because of the difficult first birth and the fear that something would happen to her or her baby. But, according to the suit, Hancock and the other defendants opted for a vaginal delivery.

The complaint states that ”(the baby) was stuck in the birth canal and not coming out.” The baby weighed 9 pounds, 8 ounces and was not breathing when delivered, the suit states. The baby recovered.

According to the suit, Hancock caused a laceration to Giberson but didn’t inform the plaintiff of the degree. The mother was discharged “in excruciating pain” and was incontinent…

We don’t know if the mother sustained another third degree tear or possibly a fourth degree tear.

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A fourth degree tear extends into the rectum. The result is that the vaginal and rectum form one continuous space. The repair of a fourth degree tear starts with the repair of the rectum itself. Depending on the how far the tear extends up into the rectum, the repair can be technically challenging and can take an hour or more. Once the rectum is repaired, the rest of the tear is repaired like any other third degree tear. However, because the rectum itself has been torn, the possibility exists that the tear may heal improperly and leave a hole (fistula) between the vagina and rectum with continual leaking of feces from the vagina.

The article does not specify the type of tear that the mother sustained, whether it was properly identified and whether it was properly repaired. Something went wrong, however, to render the mother incontinent and surgery was recommended. According to a report in a legal publication, the mother will require additional future surgery.

The verdict sends an important message. A healthy baby is not enough. A woman’s wishes about her own body also count and the desire for a C-section is a woman’s reasonable attempt to prevent damage to her vagina and surrounding tissues as well as future incontinence.

It’s about time that we acknowledge the important right that women have to control their own bodies by opting for a C-section instead of a vaginal birth.

  • Russell Jones

    Nice, and Pennsylvania is one of the few states that doesn’t cap recovery of compensatory damages in personal injury/professional negligence cases like this one. Here’s hoping the verdict survives the post-trial motion and appeals processes.

  • lady-of-shallots

    I hate that things like this happen. I am currently pregnant (14 wks) and for a number of reasons, I would prefer a C-section. I haven’t talked to my OB about delivery stuff yet, but I am really worried about whether she will think my reasons are good enough to convince her. I wish it felt like personal preferences mattered more than I fear they actually do…

    • Griffin

      You have to read up and get your arguments straight. The most convincing argument is that it is definitely safer for baby. The next most convincing is that doctors cannot tell which pregnancy will end up in an emergency CS. Third, if you add long-term problems like incontinence, attempted* vaginal birth comes out equal to or worse than elective CS in terms of maternal morbidity (but read up on this, that’s based on my lit search from 2000).

      Be assertive. Be your own advocate. If, after discussion about the pros and cons of elective cesarean and attempted* vaginal birth, your current obgyn does not agree to perform an elective cesarean, then you should ask her to refer you to one who will. If she doesn’t, ask around and keep pushing.

      Meanwhile, make sure you get your pregnancy dated by ultrasound as soon as possible.

      Here’s my story, to give you heart: 19 years ago, I was 11 weeks pregnant with my first in the Netherlands, which was at that time completely in the woo about midwife-led home birth (they now realize that it’s not as safe as they once thought and the percentage of women going for it has plumetted like a stone). The Dutch obgyn I spoke to was aggressive – he said “You’ll NEVER find anyone here who will give you an elective cesearean”. He refused to answer my questions and rudely ushered me out.

      Everywhere I went, I got the same response. At 16 weeks, I was starting to get worried.

      I then heard from my BIL about an obgyn in a neighboring country. He had readily performed an elective CS for my SIL, who had been in labor for 4 days (baby too big). We spoke to this obgyn and he and the head midwife set it up so that we would pretend to be passing through the country, I would be in pretend obstructed labor at 39 weeks, and they would have to perform a pretend emergency CS.

      It was crap that we had to do this but it worked really well. I had no problems, baby was Apgar 9 (but had the cord wrapped 3 times around her neck!), and everything was just so perfect and gentle.

      So if you really want an elective CS, you may have to fight for it but keep trying.

      *I say attempted because a good proportion of women who intend to have a vaginal birth go on to be emergency CSs – and those mothers have a pretty bad time of it on average

    • MelJor

      I had an elective c section and am happy to talk to you about my experience.

    • allie

      Time is of the essence here: your clock is ticking. You need to discuss this with your OB as soon as possible, so you’ll have time left to explore alternatives if she refuses.

      Prepare a clear, succinct summary of your reasons for preferring a cesarean, and be prepared for her counterarguments. Whether she is likely to agree depends on the strength of your arguments and whether some medical indication can be fabricated from them, but also on the amount of ‘punishment’ your OB is likely to receive from her hospital for doing maternal request cesareans (if she is allowed to do them at all!).

      Your case will drive up the hospital’s cesarean rate, which is to be kept low for publicity reasons, and your OB might be afraid of getting a reputation as a MRCS friendly provider and attracting more cases in the future. If those factors make it impossible for her to do MRCS you will need to go looking for another provider.

      Make sure you sort this out before you get too far along to travel!

      • AnnaPDE

        Depending where you are, and what care arrangement you have, the MRCS rate might not be a problem.
        Here in Australia, the public system is under pressure to lower CS rates. In contrast, some private hospitals are known as “CS central” — because everyone who wants a CS without having to jump through hoops, and has the insurance or money to spare for private care, will go straight there. Being happy to do an MRCS is a selling point for a segment of obstetricians. That’s how I picked mine. 🙂

    • E.C.

      If she says no, look for a male obstetrician over fifty-years-old. The two doctors that I know of who do elective c-sections are both men over fifty. Not sure why but, other than Dr. Tuteur, every woman doctor seems to be a cheerleader for unmedicated vaginal birth.

  • rational thinker

    I should have put up more of a fight with my first, 3 days before I had him I had an ultrasound and it was extremely painful and no it was not an internal it was regular on my stomach and the tech was not pushing hard at all. I was fighting back tears the whole time. To me that was the first sign he was too big.

    On the delivery day the doc and the nurses just thought I was just nervous cause it was my first. They dismissed my feelings and my request for a section like a joke and assured me everyone gets scared the first birth.
    I ended up with 4th degree tears cause he was too big. Now I have to sneeze with my legs crossed even 17 years later.

    • alongpursuit

      I am so sorry. I’m also angry that you weren’t listened to.

      • rational thinker

        I get why they thought it was just the pain talking im sure women yell all kinds of things when having contractions but even they knew he was big and I actually I think I was being prepped for an emergency section right before he finally came out. I think I remember them saying my sons heart rate was dropping then they put an oxygen mask over my face and said “your baby needs air”. Then they put a urine catheter in me after I had already been pushing for two hours (and had not even drank anything in 24 hrs), but he was born 5 min after that.

    • Grey Sweater

      During my labor, my daughter was stuck in the same place for a long time. I was pushed to be induced against my wishes, and my body reacted so quickly that I never felt able to gradually accommodate her. My doctor hardly spoke to me even after my husband and I begged her to tell us what was going on. She muttered to herself about a c section, so we asked if we could talk about that as her heart rate was plummeting and there was no progress. She just told me to push as hard and fast as I could. The tearing was extremely severe and I ended up wheeled off to emergency surgery to try to fix the damage. I didn’t even really get to my baby for a long time after she was born. My recovery was stressful and painful and it was awful to think about “what might have been” had the doctor allowed me a choice.

      I’m sorry that you had similar complications and that no one listened to you either. It disturbs me that things seem to be the same almost two decades later.

      • rational thinker

        I think of it now as a learning experience. I had my daughter two years later and that was a much better birth and it was a different OB and a different hospital. My first birth was a baby friendly hospital my second was not and I got so much better care at the non baby friendly hospital. I was induced and was only in labor for about 3 hours and only pushed a few times and I didn’t tear.
        Now at least I know the warning signs of a baby being too big. Now I use my son’s birth story as a warning for other women so maybe they wont have a severe vaginal injury like I did. I do wish more doctors would listen to women about their concerns about method of delivery, especially first time moms.

  • MaineJen

    OMG OUCH.

    That’s it. That’s all I got.

  • RudyTooty

    It’s not a choice to give birth in a certain way if the choice is never given. Choosing to have a vaginal birth requires the option to NOT have a vaginal birth, too.

    Forced, coerced vaginal birth or denied cesarean is not a choice at all.

  • Cartman36

    I hate that this happened to that mother but I am glad that she filed a lawsuit and I hope she gets the money. This NEVER should have happened.