Cesareans: Risky for Babies and Moms

Over the past two weeks, media reports have highlighted the risks of cesarean sections for babies and moms. Yesterday, Market Watch reported on survey results from United Health Care showing that many women are not aware of the risks of early elective inductions and cesareans.

A recent survey by UnitedHealthcare of first-time mothers found more than half the respondents believe it is safe to deliver their baby before 37 weeks’ gestation even if not required because of a medical complication. However, the American College of Obstetricians and Gynecologists (ACOG) recommends that scheduled deliveries occur after 39 weeks’ gestation. Rates of early births (between 34 and 36 weeks’ gestation) are on the rise, despite ACOG’s recommendations and studies showing that babies born between 34 and 36 weeks are more likely to die than full-term infants and, if they survive, are more likely to develop cerebral palsy and have developmental delays than babies born full term.

The survey was created to gauge women’s understanding of the benefits of full-term pregnancy and the gestational age at which it is safe to deliver a healthy baby. The national survey interviewed 650 insured, first-time mothers from varied geographic, ethnic and socioeconomic backgrounds.

Survey results reveal that many women believe a full-term pregnancy is reached before 37 weeks and that an elective delivery does not require waiting until 39 weeks’ gestation. More than half the respondents believe it is safe to deliver before 37 weeks’ gestation, while more than 92 percent indicate safe delivery before 39 weeks. Further, 24 percent believe full term is reached before 37 weeks’ gestation, and a majority of respondents — 73 percent — believe it is safe to deliver before 38 weeks.

The article  cites a study published last year on risks to babies from elective cesareans before term.

A nationwide study published in the January 2009 edition of the New England Journal of Medicine found that from 1999 to 2002, more than 35 percent of elective C-section deliveries were performed before 39 weeks’ gestation. This research revealed that babies born at 37 weeks’ gestation were twice as likely to have health problems, usually respiratory in nature, than babies born at 39 weeks or later. Neonatal intensive care unit (NICU) admissions were 5.9 percent at 39 weeks’ gestation, and rose to 8.1 percent at 38 weeks and 12.8 percent at 37 weeks.

Other recent media reports have highlighted the risks to mothers from cesareans as well, including the risk of death from surgical complications. Good Morning America and the Associated Press featured the story of Linda Coale last week.From AP:

Eleven days after her son Benjamin’s birth by C-section, Linda Coale awoke in the middle of the night in pain, one leg badly swollen. Just as her doctor returned her phone call asking what to do, she dropped dead from a blood clot.

Pregnancy-related deaths like Coale’s appear to have risen nationwide over the past decade, nearly tripling in the state with the most careful count — California. And while they’re very rare — about 550 a year out of 4 million births nationally — they’re nowhere near as rare as they should be. The maternal mortality rate is four times higher than a goal the federal government set for this year.

ABC News also covered the growth in maternal deaths, due at least in part to the rise in cesareans, two weeks ago. The story included profiles of women who died as a result of cesarean complications. This week, Amnesty International published a report titled, “Deadly Delivery“, which details the causes of rising maternal deaths in the U.S. with a focus on racial and economic disparities in access to health care services and insurance. The report includes a story of one women who died of a post-surgical hemorrhage.

Taken together, these reports demonstrate that many mothers (and their partners) are ill-informed about the risks of cesarean and that the stakes in the overuse of induction and surgical birth are incredibly high for both mothers and babies.