 Pregnant Women: Just Say 'No' to Early C-Section
Source: US News and World Report by Deborah Kotz Date: 1/13/09
The news today that early elective cesarean sections pose serious risks to newborns should have every pregnant woman on high alert. The study, published in the New England Journal of
Medicine , found that babies delivered via a scheduled C-section before
the 39th week of pregnancy
were more likely to have breathing problems
that required a ventilator, infections,and low blood sugar.
There's
nothing new in that finding. Previous studies have shown the same
thing—which is why the American College of Obstetricians and
Gynecologists recommends against scheduling C-sections more than a week
before a woman's due date. What's highly troubling, though, is that 36
percent of the more than 24,000 elective C-sections studied (in which
the surgery was performed for no good medical reason) were done before
39 weeks—in flagrant disregard of ACOG's sensible guidelines.
Many
of the news reports, like this one in the Wall Street Journal, blame
women for having their C-sections too early. They say that women
schedule delivery early to get the doctor of their choice or because
they can't stand being pregnant once they've reached full term, defined
as 37 weeks.
Yet,
the reporting I've done on this issue suggests otherwise. C-sections
have risen precipitously in recent years from 1 in 5 deliveries a
decade ago to 1 in 3 today. Much of this rise can be attributed to
doctors who like the predictability of C-sections; they're faster,
neater, and generally simpler than vaginal births and less likely to
lead to expensive malpractice suits. And while it's true that an
estimated 3 percent of women actually request to have C-sections over
vaginal deliveries—for the convenience or to avoid the pain of
labor—the rest of us prefer to give birth the natural way, thank you
very much.
As
for scheduling those elective C-sections early, the onus falls on the
obstetrician to follow the best medical practices. Clearly, many
aren't, and they shouldn't be placing the blame on their patients. I
think if women understood the real risks to their babies, they'd be
happy to settle for a different doctor.
On
a separate issue, the researchers also pointed out that babies born via
C-section are—even when delivered on their due dates—at increased risk
of respiratory problems, especially if they're delivered before a woman
goes into labor. (This could be because certain stress hormones
released right before and during labor help with a baby's lung
maturation.) Many doctors are reluctant to allow a woman to go into
labor if they know she's going to have a C-section.
So
what should you do if you're pregnant and facing a C-section? Discuss
the new research with your doctor, and come up with a delivery plan
that's safest for both you and your baby. Doctor choice, timing, and
convenience should be low down on your priority list. And your
doctor's, too.
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