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Not so fast: Let your fetus pick its own birthday

Thomas Secrest's picture

There’s no question that 9 months is a long, long time to be pregnant. As I male, I can’t even begin to know what it must be like. I can only imagine that at some point women start asking when is this going to be over. That question, in part, explains the trend in cesarean births in the U.S. over the past two decades.

In 2009 there were 1,300,000 cesarean sections performed. In 1998, 21 out of every 100 births was a cesarean birth. In 2010, 33 of every 100 births were cesareans. That’s a 12% increase in 12 years. In medicine, very few things change by 1% per year.

The trend is important since it tells us what the future will look like. The trend shows that the increase has slowed, but projections suggest that it will continue to increase at a rate of about 1% per year. If unabated, in less than 20 years half the children born will be born by cesarean.

Elective child birth is something that has become more and more popular. For a variety of reasons, often having nothing to do with the health of the fetus, mothers and doctors are agreeing on early delivery dates.

Often doctors don’t mind, since, unlike natural labor, the whole thing is over in less than an hour and it lets them managed, otherwise wildly unpredictable, schedules.

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Some women are afraid of the pain or have heard about other complication of vaginal delivery. However, new guidelines from the American College of Obstetricians and Gynecologists (ACOG), published in the March 21, 2013 issue of Obstetrics & Gynecology found that “rates of postpartum pelvic pain, sexual dysfunction, pelvic organ prolapse, and depression — which some women hope to avoid via surgical delivery — remain unchanged.”

While the risk of hemorrhage is reduced with a cesarean section, there are increased risks of “bladder and bowel injury, longer hospital stays, higher infection rates, and increased neonatal respiratory morbidity.”

Of the women I have talked to about this, all, with the exception of an OB/GYN doctor, had no idea that an early cesarean section posed a risk to the child. They assumed that the child was plucked out, and except for a few stitches in the lower abdomen, everything from that point forward would be fine.
It was this general lack of knowledge that prompted me to write this article. The guidelines mentioned above were in large part “intended to curb the skyrocketing rate of US cesarean deliveries by limiting "maternal-request" surgeries and early deliveries for presumed ‘big babies.’”

The guidelines go on to state that “in the absence of maternal or fetal indications for cesarean delivery, a plan for vaginal delivery is safe and appropriate." “ACOG notes that fear of childbirth pain is not a valid reason for surgery.” This is especially true with modern pain management strategies.

One final observation from the new guidelines is that “those last few weeks (of pregnancy) can be critical: Babies born at 37 and 38 weeks are at 2.3- and 1.4-fold increased risk for neonatal death relative to 39 and 40 weeks. Infant mortality rates are likewise elevated by factors of 1.9 and 1.2, respectively, as surviving neonates find their young lives complicated by respiratory distress, respiratory failure, pneumonia, and other conditions requiring intensive care.”

The overall message is that unless there is an overriding medical reason for an early cesarean birth, it is best to let the fetus pick its own birth-date. For mothers it is important to know that with perseverance you could probably pressure your doctor into performing a cesarean on you. However, your job is to resist the temptation and provide your unborn child with those extra couple of weeks nature intended for them to have.