Early Planned C-Sections Cause Infant Complications
Caesarean section deliveries have been increasing throughout the decade and one in every 14 births in the United States is now delivered surgically through the abdomen. The New England Journal of Medicine has published a new study that shows a third of scheduled c-sections were performed before 39 weeks of gestation. The study revealed that babies delivered earlier than 39 weeks had a higher rate of complications, including respiratory distress syndrome, hypoglycemia and newborn sepsis. The earlier the babies were delivered, the more complications occurred and at 38 weeks, the complications were 50% higher, according to the study authors.
Dr. Alan Tita of the University of Alabama at Birmingham led the study. The researchers looked at 13,258 births at 19 academic hospitals. Even in these institutions where the faculty is more likely to follow national guidelines, 36% of the babies were delivered earlier than 39 weeks. The American College of Obstetricians and Gynecologists (ACOG) recommends the operation at 39 weeks or later for optimal safety.
Although a baby is considered “term’ at 37 weeks, the normal gestation for pregnancy is 39-40 weeks. Most women are uncomfortable and are ready for the pregnancy to be over when they are experiencing the last month of pregnancy. Elective c-sections are a way for the mother to control the time of delivery and many will schedule it when their doctor is available at 37 weeks or even earlier. The study showed that more women chose early c-sections if they were white, married, had private insurance and had prenatal care.
Obstetricians and their patients have tried to solve the mystery of when “labor will begin” for centuries. When babies are born naturally, the labor begins without medication and the baby may be fully mature at the time of vaginal delivery, even at 37 weeks. In elective c-sections, there is no signal from the baby to the mother that he is ready to be born and this study shows that even a few days earlier can have bad health risks for the baby.
Celebrities who plan their births may fuel the increased incidence for planned c-sections. The tabloids run stories and interviews with actresses like Elizabeth Hurley, Madonna, Kate Hudson, Ex-spice girl Victoria Beckham and Christina Aguilera, who took childbirth into their own hands and had scheduled deliveries. Often called “too posh to push”, many women believe they will recover faster and will avoid wear and tear on their bodies if they forgo vaginal delivery.
The medical community is divided on the issue and with malpractice premiums between $150,000 to $200,000 per year, many doctors can no longer afford to take the risk of a “bad baby’ born vaginally, especially of the mother has asked for a c-section. The woman’s right to choose is honored as long as she is fully informed of the risks and benefits.
The NEJM study should not deter women from undergoing early c-sections when it is deemed necessary for the health of the mother or baby. C-section deliveries are safer than ever and have contributed to a profound decline in maternal and fetal deaths. At the turn of the 20th century, childbirth was the most common cause of death for young women, as it still is in many developing nations. This study dealt with elective, planned c-sections, not emergent cesareans that were medically indicated.
The findings of this study would point to the benefit of women waiting until 39 weeks to plan an elective cesarean for the best health outcome for the baby.