June 21, 2014

Many Pregnant Women Having Early Elective Deliveries

Brett Smith for redOrbit.com – Your Universe Online

A new study showed that many pregnant American women are having labor induced or Cesarean sections between 37 and 39 weeks gestation, which isn’t considered a full-term delivery. These “early elective” deliveries are associated with health issues and additional care for both mothers and their children.

Published in the journal Medical Care, the study is based on birth certificates with hospital data for all births in California, Missouri and Pennsylvania between 1995 and 2009 -- equivalent to about 20 percent of all US births across a wide range of socioeconomic factors and geographic regions.

“Our study showed that early elective deliveries made up more than three percent of US births each year over the past 20 years. This may seem to be a small number, but with four million births a year in the US, each percentage point represents 40,000 babies,” said study author Katy Kozhimannil, an assistant professor of health policy at University of Minnesota School of Public Health. “In addition, we showed that there are important sociodemographic differences in the chances a pregnant woman has an early elective cesarean or an early elective induction of labor.”

The researchers discovered that women who underwent early induced labor tended to be 35 or older, well-educated, white, privately insured and patients at rural or non-teaching hospitals. Women who underwent early Cesareans tended to be less than 20 or older than 35, black, well educated and patients at small-volume hospitals.

“There are misunderstandings about when a baby is ready to be born,” Kozhimannil said. “Since our findings show there are differences in who is having an early elective delivery, the importance of a full-term birth needs to be communicated to all women, not just those who may traditionally be considered high risk for elective procedure or high risk for poor outcomes.”

She noted that American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine consider a pregnancy is full-term only after 39 weeks, not the commonly held belief of 37 weeks.

With respect to the implications of these early births, the study found infants born by early elective cesareans were 60 percent more prone to staying longer in the hospital and over twice as likely to have respiratory problems, as opposed to infants born on or after 39 weeks. Infants born by means of early elective induction were also more prone to stay in the hospital beyond the expected length of time, the researchers said.

“While prior work has shown that early elective delivery policies can be highly effective within particular healthcare systems, there is a need to address this issue at the population level,” said Kozhimannil. “It is our hope that this study will add fuel to the ongoing efforts to educate pregnant women and influence clinical and policy environments to facilitate healthy, full-term deliveries whenever possible.”

An additional risk associated with Caesarian birth could be a higher risk for obesity. A study published in February found the chance of being overweight or obese increases 26 percent for a child when it is born by caesarean section compared to vaginal delivery.