February 13, 2012

Challenging Conventional Wisdom on C-Sections

By: Demetria “Dee” Hobbs, Ivanhoe Health Correspondent

(Ivanhoe Newswire) — The widely-held assumption that a cesarean or C-section delivery has no health risks for the baby is being questioned by new research that found the procedure did not help some preterm babies who were small for gestational age, and may even have contributed to their breathing problems.

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, with their colleagues reviewed the birth certificates and hospital discharge information for 2,560 small for gestational age babies who were delivered preterm.  Dr. Werner and her team found that small for gestational age babies delivered by a C-section before 34 weeks of pregnancy had a 30 percent higher chance of developing respiratory distress syndrome than babies born vaginally at a similar gestational age. Their study, the "Method of Delivery and Neonatal Outcomes in Preterm, Small For Gestational Age Infants," is the ninth study by the Society for Maternal-Fetal Medicine (SMFM) members to be honored by March of Dimes for innovative research focused on preventing premature birth and its complications.

"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."

For more than two years, March of Dimes has been working with hospitals and health policy experts to implement a tool kit it developed with its partners that promotes policies and practices to reduce the number of medically unnecessary C-sections and inductions scheduled before 39 weeks of pregnancy. In Baltimore, Maryland, at the Mercy Medical Center, they have implemented a similar program that educates women of the dangers of having medically unnecessary C-Sections and inductions.

“Since its implementation, about three years ago, we have had a steady decline in induced labors and elective C-Sections,” Dr. Robert Atlas, MD, Chairman of the Department of Obstetrics and Gynecology, Maternal Fetal Medicine at the Mercy Medical Center in Baltimore, Maryland,  told Ivanhoe. “ Induced labors have gone from 10 percent to three percent and elective C-Sections were once at six percent, now they are at less than one. Most people are waiting the 39 weeks. We are educating the women.”

The March of Dimes says that if a pregnancy is healthy and there are no complications that require an early delivery, women should wait until labor begins on its own, or until at least 39 weeks of pregnancy. Many of the baby's important organs, including the brain and lungs, are not completely developed until then.

SOURCE: March of Dimes Foundation, and Interview with Dr. Robert Atlas, Mercy Medical Center, Baltimore, Maryland, February 9, 2012