C-Sections in the News Today...

For anyone who didn't see on the news tonight:

http://www.reuters.com/article/healthNews/idUSTRE5067B620090107

Early C-section for full-term babies poses risk
Wed Jan 7, 2009 5:34pm EST

By Gene Emery

BOSTON (Reuters) - More than half of all Cesarean deliveries are done by choice and more than a third are done too early, putting the babies at risk of breathing and other difficulties, U.S. researchers reported Wednesday.

The study of 13,258 births found that the risk of complications doubled if an elective C-section was performed at 37 weeks, when the baby is classified as full term, instead of at 39 weeks when the American College of Obstetricians and Gynecologists (ACOG) regards the operation as safe.

At 38 weeks, the risk of complications was 50 percent higher, the researchers reported in the New England Journal of Medicine.

"Even those deliveries done about three days prior to 39 weeks still have an increase in these adverse outcomes," said Dr. Alan Tita of the University of Alabama at Birmingham, who led the study.

Despite the ACOG guidelines, 36 percent of the babies were delivered early, and the research may have underestimated the risk of complications.

One reason: the study was done at 19 academic hospitals where doctors are usually more attuned to national guidelines. "The assumption is it may be higher if we looked at private physicians in the community," Tita said in a telephone interview.

Another reason is that the researchers had no way of knowing whether a C-section was done after doctors had performed an amniocentisis to confirm that the fetus' lungs had matured. If those cases had been excluded, the risk of early delivery would have been even higher, he predicted.

Why are so many infants being delivered early?

"There is usually this sense that 37 weeks is full term. That's our standard practice," said Tita.

"So women, I believe, when they attain this gestational age, are tired of the pregnancy, they're excited to see the newborn and they start asking to be delivered. So I think part of it is the pressure from the patients who want to be delivered and physicians who want to accommodate their patients."

In a commentary, Dr. Michael Greene of Massachusetts General Hospital said the profile of women who delivered early suggests that they were more likely to be eager to have their own doctor do the delivery.

"To accommodate busy schedules and to minimize the chance that a patient will begin labor and require a nonelective procedure when her doctor might not be available, procedures are frequently scheduled just before 39 weeks of gestation," he said.

The study suggests doctors should not wait too long either. The complication rate rose after 41 weeks, "leaving a relatively narrow two-week window of minimal risk in which elective repeat Cesarean deliveries could optimally be performed," said Greene.

Re: C-Sections in the News Today...

there is so much I could say about this but I'll keep my mouthshut for fear of flaming daggers being thrown at me

Re: C-Sections in the News Today...

good article!!! Thanks for posting!!!
XOXOXO
BOTB

Re: C-Sections in the News Today...

Interesting article - although the article (or perhaps the study) does not seem to tell the whole story. It would be interesting to see if for that 1/3 that are performed too early how many are actual scheduled, elective c-sections (with no medical reason) and how many are more emergent situations.

For instance, I delivered DD at just barely 38 weeks by c-section because of pre-eclampsia. I have 2 friends who had early c-sections (one at 34 weeks and one at 37 weeks) both because the went into pre-term labor with breech babies. I just do not know anyone who just said "hey I am just going to have a c-section at 37 weeks - just for the heck of it".

So it would be interesting to see the entire study.

Re: C-Sections in the News Today...

Re: C-Sections in the News Today...

Re: C-Sections in the News Today...

Very interesting article -- thanks for posting

Re: C-Sections in the News Today...

Re: C-Sections in the News Today...

Well, from seeing this story on two different news broadcasts-- it was a little weird. Since *most* scheduled C's are due to medical necessity-- and some people NEED to have one before 39 weeks, as it would be too dangerous to wait any later.

They also didn't talk at all about women who deliver naturally earlier than 39 weeks either-- we see it on here ALL the time. Why would the babies be at a different risk based on how they deliver?

I think it's mainly that the New England Journal of Medicine is trying to make a stand against c-sections, since I think there is a general impression that the medical community is a little laissez-faire regarding C's today.

I guess the message really is, if you *can* control it, you should wait til you are 39 weeks. But, I mean really-- can you really control childbirth? Isn't that the first rule of acceptance-- don't expect to have a plan, or to control anything?

Re: C-Sections in the News Today...

I don't know why but I had thought many women elected to get c-sections because they didn't want to go through vaginal childbirth. I remember posting about it a few months ago and EVERYONE thought it was a very bad idea because recover/risk was so much worse.

Re: C-Sections in the News Today...

I do not think that this article gave the whole story at all. The article talks about ACOG guidelines and implies that early deliveries are against the guidelines in a lot of cases. Well, I had a C-section at 36 weeks and, for my particular medical issue, this is the ACOG guideline. I have a huge issue with articles like this because so many people who had read things like this have suggested that I just did not want to carry my baby to term. My 36 weeker had some problems at the beginning. The thing to remember is that he is fine now and carrying to term posed a risk of fatality for both of us. I would never elect to have a 36 week baby if I did not have to. I had a very long talk with one of the NICU doctors and she told me what she has seen with people who had my condition and waited to deliver. 6 days in the NICU seemed like hell to me but it was nothing compared to what could have been.

Re: C-Sections in the News Today...

A reputable OB would do an amnio to confirm maturation of the lungs prior to 39weeks.

I had an amnio at 38w, got the go ahead, and had a cesarean at 38w 1d. If the fluid had indicated that DS's lungs were not fully developed, my dr would not have performed the section.

Re: C-Sections in the News Today...

Re: C-Sections in the News Today...