Hospital May Be Cleared in Suicide of Woman in Labor
The hospital at the center of a controversy after a woman who was in labor committed suicide might be cleared of major wrongdoing, according to initial results from an ongoing government investigation.
The First Hospital of Yulin in northwestern China’s Shaanxi province had followed the proper protocol required in maternity care by advising Ma Rongrong to have a cesarean section to avoid risks during delivery, the city’s health authority said Thursday, citing findings from three preliminary investigations.
The recommendation was based on an ultrasound scan that showed the fetus’s head was big, making vaginal birth difficult. But Ma’s family had signed a paper opting for natural birth on Aug. 31, hospital records showed.
The hospital had issued a statement on Sunday that said unbearable labor pain had caused Ma’s “mental condition to go out of control,” and that finally led her to jump from a hospital window to her death. The fetus also died.
Closed-circuit television footage of the 26-year-old woman kneeling in front of her family in a hospital hallway triggered speculation that Ma’s husband and other relatives may have overruled her request for a C-section, but the cause of her death is still under investigation, the city government said.
“The incident exposed a lack of preparedness among hospital staff when handling medical emergencies and the absence of a proper system for patient supervision,” it said in a statement.
Ma, who was 41 weeks pregnant, was admitted to the Yulin hospital on Aug. 30. On the following day, she jumped to her death through the window of an operating room opposite the fifth-floor labor room at about 8 p.m., according to investigators.
Ma’s family denies the hospital’s claim that they had ignored medical advice, and said the doctors had said there was no need for an operation. Since the video footage had no audio, it is difficult to establish whether the woman was kneeling because she was in pain or for another reason.
While Ma’s family and the hospital continue to trade blame, the tragic incident has also triggered a heated debate among Chinese doctors on how to reduce the overreliance on C-sections.
Experts say the operation should be seen as a last resort when dealing with complications that crop up during childbirth, such as when the umbilical cord is wrapped around the fetus’s neck.
Natural birth should be the first choice because it is in the best interest of the mother and fetus, said Duan Tao, chief gynecologist at Shanghai First Maternity and Infant Hospital.
C-sections are usually reserved for cases in which the pregnant woman has other health complications such as uterine fibroids, hypertension or heart disease, according to Duan. It can also help when natural birth is difficult given the position of the fetus.
Less than 10% of women in labor develop complications that demand an 11th-hour C-section, he said.
“C-sections carried a slightly higher risk compared to natural birth due to the use of partial sedation and other medical procedures,” he said.
Doctors in China have the right to deny requests for C-sections by pregnant women who don’t qualify for one due to medical reasons under the “2014 Expert’s Consensus on C-Sections,” issued by the National Health and Family Planning Commission.
But in practice, doctors often bow to pressure from patients or their families instead of exercising their ability to veto such requests, according to several doctors interviewed by Caixin.
According to a 2014 article in the British Journal of Obstetrics and Gynecology, some doctors were also pushing for patients to have C-section to make extra money or because scheduled operations made it easier to manage a high volume of births with limited resources.
China’s C-section rate from 2007 to 2014 was about 27%, 10 percentage points higher than the international average, according to the World Health Organization.
Amid international pressure, the National Health and Family Planning Commission has called on doctors to recommend the procedure only when essential, but oversight at hospitals in smaller cities remain lax, several doctors told Caixin.
Zhang Jianping, chief gynecologist at the maternity unit of Sun Yat-sen Memorial Hospital in Guangzhou, said that another bone of contention remains on the wide-ranging debate on whether doctors should take into account the level of pain that patients go through when deciding on a C-section, even if there are no other medical complications.
“It often comes down to the judgment of individual obstetricians on whether a C-section is necessary because pain can’t be quantified,” she said.
But to prevent similar tragedies like that involving Ma’s death in Shaanxi, gynecologists have urged the health authority to make a technique of painless delivery that uses Epidural administration available in more hospitals.
This procedure, which offers relief from severe pain by injecting a drug into the epidural space of the spinal cord, is adopted by up to 80% of women in labor in developed countries, according to Duan.
But most Chinese hospitals don’t offer this service due to a lack of awareness, a shortage of trained anesthetists, and the inability to charge extra fees for promoting such a procedure, he said. As a result, only 1 in 10 women in labor in China had their babies delivered this way each year, Duan estimated.
Excruciating pain during labor could lead to depression among some women, which left doctors with no other choice but to offer a C-section, according to one doctor who asked not to be named.
The doctor said one patient kneeled and begged for a C-section, and another patient in labor simply put on her pants and tried to walk away barefoot before the obstetrician agreed to a C-section, the doctor said.
Contact reporter Li Rongde (firstname.lastname@example.org)
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