Monday, June 02, 2008

Elective C-sections are better for babies

This is a very bad week for homebirth advocacy and "natural" childbirth advocacy. Many central (and unsubstantiated) claims are being systematically demolished by newly published scientific studies and data.

In the past week alone, I have written about the fact that obstetricians want C-sections for themselves, that many women want a C-section after having a vaginal birth, and that birth centers and homebirth don't save very much money. In addition, late prematurity is rising because of deliberate early C-section delivery for pregnancy complications, and the perinatal mortality rate has fallen at the same time. Most importantly, newly released data from the National Center for Health Statistics shows that homebirth with a direct entry midwife is the most dangerous way to have a baby in the US (short of no medical attendant at all).

Now comes new evidence that elective (maternal request) C-sections are better for babies than waiting for labor to begin spontaneously. Homebirth and "natural" childbirth advocates have pointed to the increased risk of self-limited respiratory morbidity as a reason to avoid C-section. However, when all outcome data are assembled, it seems that the trade-off for increased risk of self-limited respiratory problems is a large decline in perinatal mortality.

The article Neonatal Morbidity and Mortality After Elective Cesarean Delivery by Signore and Klebanoff appears in the June special issue of Clinics in Perinatology focussing on the epidemiology and neonatal effects of C-section. The authors conducted a decision analysis
modeling the probability of perinatal death among a hypothetical cohort of 2,000,000 women who had uncomplicated pregnancies at 39 weeks, half of whom underwent ECD and half managed expectantly. After taking multiple chance probabilities into account, the model estimated that although neonatal deaths were increased among women delivered by elective cesarean, overall perinatal mortality was increased among women managed expectantly, because of the ongoing risk for fetal death in pregnancies that continue beyond 39 weeks.

The authors found:
Elective cesarean
at 39 weeks
Expectant management
Perinatal deaths8041496
Stillbirths01118
Neonatal deaths804378
Respiratory morbidity11,0002524
Intracranial hemorrhage4901007
Brachial plexus injury410787
PPH37001488
Suspected sepsis20,00033,211
Confirmed sepsis02635
Laceration80002464


In other words, if 1 million women underwent C-section at 39 weeks instead of waiting for onset of labor and attempting vaginal delivery, 692 more babies would be saved, 517 cases of intracranial hemorrhage and 377 brachial plexus injuries would be prevented. In exchange, there would be 8476 additional cases of short term respiratory problems, 5536 neonatal lacerations, and 2212 additional cases of postpartum hemorrhage.

The authors conclude:
... Elective repeat CD rates have been increasing steadily since the late 1990s, and there may be a growing trend in CDs on maternal request... [E]xisting data suggest that ECD is associated with greater risk for neonatal respiratory morbidity and fetal laceration and potentially decreased risk for brachial plexus injury, neonatal sepsis, intracranial hemorrhage, intrapartum asphyxia, and neonatal encephalopathy. Although neonatal deaths may be increased among infants delivered via elective cesarean, overall perinatal mortality may be reduced because of prevention of antepartum stillbirths. To minimize potential neonatal risks in ECDs, these deliveries should not be undertaken before 39 weeks’ gestation. Patients considering ECD should be made aware of available data on potential risks and benefits to fetus and neonate. Further research is needed to inform these discussions.
We already know that C-section is lifesaving for babies and mothers experiencing complications. It now appears that elective C-section also saves lives.

Labels:

18 Old Comments:

We are a gaggle of volunteers and starting a branԁ neω ѕcheme in our сοmmunity.
Your webѕite ргоvidеd us wіth hеlpful info to wοrk on.
Υou hаve performed a formidablе
pгocess and our entire group сan bе thanκful
tο you.

Fеel free tο surf to my web page; cialis en ligne

By Anonymous Anonymous, at 4:38 PM  

I am regular reader, how are you everybody? This article posted at this web page is really nice.



my web page: tiny Costa Mesa acupunturist in pictures

By Anonymous Anonymous, at 1:39 PM  

Great web site. Lots of helpful information here. I'm sending it to some buddies ans also sharing in delicious. And naturally, thank you for your sweat!

Look at my blog post - our favorite San Diego video firm

By Anonymous Anonymous, at 7:06 PM  

Hi! Do you use Twitter? I'd like to follow you if that would be okay. I'm absolutely enjoying
your blog and look forward to new updates.

my blog post: San Diego life insurance

By Anonymous Anonymous, at 5:33 AM  

Hi there, its fastidious paragraph concerning media print, we all be familiar with media is a wonderful source of information.


Feel free to surf to my web page; nice Newport Beach massage today

By Anonymous Anonymous, at 5:56 AM  

I wanted to thank you for this excellent read!! I absolutely enjoyed every bit of it.
I have you saved as a favorite to check out new stuff you post…

My website :: life insurance quotes San Diego

By Anonymous Anonymous, at 8:37 AM  

I'm amazed, I have to admit. Seldom do I encounter a blog that's equally
educative and engaging, and without a doubt, you have hit the nail on
the head. The issue is something too few people are speaking intelligently about.
Now i'm very happy I found this in my search for something relating to this.

Here is my weblog video marketing tips

By Anonymous Anonymous, at 3:13 PM  

hi!,I really like your writing so a lot! proportion we keep in
touch more approximately your post on AOL? I need a specialist in this space to solve
my problem. Maybe that's you! Having a look ahead to see you.

Feel free to surf to my web blog; Makerting Video

By Anonymous Anonymous, at 10:29 PM  

Saved as a favorite, I like your web site!

Look at my page: avoiding probate

By Anonymous Anonymous, at 4:20 AM  

We understand that since we are in Orange County|an Orange County realty.


Also visit my homepage :: friendly realtor in OC explains secrets

By Anonymous Anonymous, at 8:35 AM  

Thank you for the auspicious writeup. It in fact was a amusement account it.
Look advanced to far added agreeable from you!
However, how can we communicate?

Also visit my homepage - video marketing robot

By Anonymous Anonymous, at 2:22 PM  

First of all I would like to say fantastic blog! I had a quick question in which I'd like to ask if you do not mind. I was curious to know how you center yourself and clear your head before writing. I have had a difficult time clearing my thoughts in getting my ideas out. I truly do enjoy writing but it just seems like the first 10 to 15 minutes are usually wasted just trying to figure out how to begin. Any suggestions or tips? Many thanks!

My homepage :: visit the following internet page

By Anonymous Anonymous, at 10:53 AM  

Excellent way of explaining, and nice paragraph to get information about my presentation focus, which i am going to convey in academy.


Check out my web-site: visit the next web site

By Anonymous Anonymous, at 11:39 AM  

Thanks for every other informative website. The place
else may just I get that kind of info written in
such an ideal method? I've a challenge that I'm just
now operating on, and I have been at the look out for such information.


Take a look at my blog: http://articleneon.info

By Anonymous Anonymous, at 5:36 PM  

Quality articles or reviews is the important to invite the people to pay a quick visit the web page, that's what this web page is providing.

my homepage :: corporate video

By Anonymous Anonymous, at 7:16 AM  

Hi there, just wanted to mention, I loved this post.

It was practical. Keep on posting!

my page :: gogowebapp.com

By Anonymous Anonymous, at 10:06 AM  

It's nearly impossible to find educated people on this topic, but you sound like you know what you're
talking about! Thanks

Here is my blog post :: nude man

By Anonymous Anonymous, at 12:35 PM  

Thanks designed for sharing such a good thought,
paragraph is pleasant, thats why i have read it entirely

Also visit my web-site: Beautifull Butt

By Anonymous Anonymous, at 1:40 AM