C-section not the best choice for small preterm babies

Kathleen Blanchard's picture
Preterm delivery b C-section risky for small babies, finds study.
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Small preterm babies delivered by C-section may be at higher risk for breathing and other health problems, according to a new study.

The research, presented at the 32nd Annual Society for Maternal-Fetal Medicine Meeting, "The Pregnancy Meeting", shows vaginal delivery is better for some babies delivered before 34-weeks of gestation. Babies delivered early whose birth weight was low were found in the study to have a 30 percent higher chance of developing respiratory distress syndrome, compared to infants delivered vaginally.

The study challenges the widely held belief by obstetricians that scheduling a Caesarean section to deliver small babies who are not growing at the expected rate in the womb is the best choice.

"These findings overturn conventional wisdom that C-sections have few or no risks for the baby and are consistent with the March of Dimes effort to end medically unnecessary deliveries before 39 weeks of pregnancy," said Diane Ashton, MD, MPH, March of Dimes deputy medical director. "Although in many instances, a C-section is medically necessary for the health of the baby or the mother, this research shows that in some cases the surgery may not be beneficial for some infants."

Erika F. Werner, MD, MS, assistant professor of Maternal Fetal Medicine at the Johns Hopkins School of Medicine and Heather S. Lipkind, MD, MS, assistant professor of Maternal Fetal Medicine at Yale School of Medicine looked at the birth certificates and discharge information of 2,560 small for babies delivered preterm who were small for gestational age.

The March of Dimes suggests women should wait until labor starts naturally if there are no pregnancy complications that make C-section medically necessary for the health of the mother or infant, or wait at least until 39-weeks of pregnancy.

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Between 1996 and 2004, a March of Dimes study found C-section accounted for almost all of the increases in preterm deliveries in the United States. Babies delivered before 37-weeks of pregnancy are at risk for lifelong health problems that include cerebral palsy and learning disabilities in addition to respiratory problems if they survive. One million infant deaths occur worldwide annually as a result of early birth.

C-section is considered a major surgery. According to the Mayo Clinic, slow fetal heart rate, abnormal position of the baby in the uterus (breech), twins, triplets or other multiples, previous C-section and having a baby whose head circumference is too large to fit through the birth canal may be indications for the surgery.

Other reasons include maternal health problems such as high blood pressure or heart disease or active genital herpes infection that could be passed to the baby during birthing.

Caesarean section risks for mothers include infection, hemorrhage, longer time for healing and less time bonding with baby, scarring internally that can cause long-term pain from adhesion and damage to internal organs that can occur during surgery.

The March of Dimes is working with hospital to reduce the number of unnecessary C-sections and induced labor before 39 weeks of pregnancy, based on the findings that C-sections can contribute to infant respiratory distress syndrome and other health problems.

Sources:
March of Dimes Foundation
“New Research Shows C-Section Not Always Best For Babies”
Elizabeth Lynch, Todd Dezen, Vicki Bendure, SMFM
February 9, 2012

MayoClinic.com
C-Section: Why it’s done
Mayo Clinic Staff

Image credit: Wikimedia commons

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