January 7, 2009

Study: Elective C-Sections Increase Risk Of Complications

A new study of over 24,000 full-term births found that the risk of complications increased 20-100% with scheduled [repeat] C-sections, depending on how early they were scheduled [i.e., 37-39 weeks]. The research was conducted by doctors at the University of Alabama Birmingham using data from the National Institute of Child Health and Human Development. It was just published in the New England Journal of Medicine.

I don't doubt the findings, but the different presentations of the study in the media make me want to see the full text of the study before deciding one way or another [not that I'm planning to have a C-section any time soon, obviously]. The Washington Post article emphasized the risks and complications ["Early Repeat C-Sections Increase Risks, Study Finds"], while the AP takes a womb-half-full perspective ["C-sections best for baby when close to due date"].

Meanwhile, the spokeswoman for the NICHHD [?] gets all and interpretive, trying to elaborate on why women schedule C-sections, you'd think they'd interviewed the 24,000 women over coffee instead of reviewing their birthing center records. Possible motivations include the arrival of in-laws, a favorite doctor's vacation plans, convenience, being tired of pregnancy, and "being eager to see their baby." Actually, except for locking in a favorite doctor, I have a hard time believing anyone giving any of those reasons out loud.

Early Repeat C-Sections Increase Risks, Study Finds [washpost]
C-sections best for baby when close to due date [ap/yahoo via dt reader sara]


So these were c-sections that were scheduled simply as repeats and not a second necessary section? I wonder what the difference in risk is when the second section is also necessary.

On the reasons, I expressed the same disbelief to my OB when we were discussing scheduling my third c-section. I said, people really don't ask, do they? And she said yes,yes, they ask for all sorts of odd reasons.

This survey makes me wonder about where I'd fit in--is my type of experience even in this study?. I had 3 c-sections. But I went into labor each time. I had a scheduled c-section date for the last two. The first breech baby started us on this cascade. My first two came at 37w6d and my third at 36w3d (she's only 4 months old, which is why this is fresh in my mind). They all were healthy...no oxygen, no NICU, no special care. Anomolies, I guess? Or the going into labor makes it all OK?

We know a woman who scheduled the C-section for in-law arrival timing. Did it proudly.

I suppose I might consider scheduling around the arrival of my own parents...but not my in-laws! :)

The AP article put these folks last, but the CNN article emphasized a couple willing to go national with their intense desire for a c-section to get a tax deduction: http://www.cnn.com/2009/HEALTH/01/07/c.section/index.html

I found it ironic that one of the researchers was at UNC, because when I scheduled a c-section there at 40 weeks everyone (schedulers, nurses) I talked to at the hospital except my OB tried repeatedly to talk me out of going further than 38 weeks. Even my OB suggested 38 weeks initially until I explained my reasoning, the short version of which is that I was hoping for a VBAC but didn't want to go post-term and didn't want to induce.

So I was surprised by the commentary in the WP article; I don't know where they found all those folks who say "gosh, we have no idea why parents would schedule earlier than 39 weeks." I can tell them why: because they were told to schedule it earlier.

NICHHD - National Center for Child Health and Human Development

It's a division of NIH (National Institutes of Health).

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