BIG study....voluntary c-section nearly triples rate of BABY death

[Quirky]

From the New York Times Health section today:

http://www.nytimes.com/2006/09/05/he...tml?ref=health

A recent study of nearly six million births has found that the risk of death to newborns delivered by voluntary Caesarean section is much higher than previously believed.

Researchers have found that the neonatal mortality rate for Caesarean delivery among low-risk women is 1.77 deaths per 1,000 live births, while the rate for vaginal delivery is 0.62 deaths per 1,000. Their findings were published in this month’s issue of Birth: Issues in Perinatal Care.

This study, according to the authors, is the first to examine the risk of Caesarean delivery among low-risk mothers who have no known medical reason for the operation.

Congenital malformations were the leading cause of neonatal death regardless of the type of delivery. But the risk in first Caesarean deliveries persisted even when deaths from congenital malformation were excluded from the calculation.

Intrauterine hypoxia — lack of oxygen — can be both a reason for performing a Caesarean section and a cause of death, but even eliminating those deaths left a neonatal mortality rate for Caesarean deliveries in the cases studied at more than twice that for vaginal births.

Link to study

[MsElle07]

Thanks for posting this. Interesting reading!

[Lovinmy2babies+1]

Most c-sections aren't voluntary...

[Full Heart]

I can't access the full text cause I don't have a subscription. But if someone does can you tell me if this was just primary sections? And the article makes it sound like these were sections with no labor, does it say that in the study? Did it break down how many c/s were planned voluntary out of the whole? TIA!

[kerikadi]

Originally Posted by Lovinmy2babies+1

Most c-sections aren't voluntary...

Last I read a higher percentage of cesareans are planned and therefor voluntary.

Keri

[Ruthla]

I wonder if this is because many of these babies weren't ready to be born yet.

[Storm Bride]

Originally Posted by kerikadi

Last I read a higher percentage of cesareans are planned and therefor voluntary.

Keri

That really depends on how you define voluntary, imo. bbbbbbbbbb

[kerikadi]

Originally Posted by Storm Bride

That really depends on how you define voluntary, imo. bbbbbbbbbb

I would imagine voluntary would be qualified as non-emergency.

Keri

[Storm Bride]

Can you tell ds2 contributed to my last post?

Ah. I don't. I've had two scheduled sections, and neither one of them was voluntary. I should have done more to avoid them, and would have if I'd been able to figure out anything to do...but they weren't voluntary, except in the sense that nobody dragged me in and tied me down.

[kerikadi]

I know there are extenuating circumstances with planned cesareans. Sometimes baby is breech and finding a practitioner to deliver is near impossible.
However, my point was that the study would consider a non-emergency cesarean voluntary.

I think that if the cesarean is planned and you agree to show up on a certain date then you voluntarily went into the surgery.

If you are in the hospital with ruptured membranes and a prolapse cord, placental abruption, loss of fetal heart tones, etc. then it is an emergency.

Keri

[MsElle07]

Here's another quote:

Part of the reason for the increased mortality may be that labor, unpleasant as it sometimes is for the mother, is beneficial to the baby in releasing hormones that promote healthy lung function. The physical compression of the baby during labor is also useful in removing fluid from the lungs and helping the baby prepare to breathe air.

The researchers suggest that other risks of Caesarean delivery, like possible cuts to the baby during the operation or delayed establishment of breast-feeding, may also contribute to the increased death rate.

[Ruthla]

I hope this study makes more doctors cautious about schedual c/s before the beginning of labor, and women more catious of accepting them.

For example, say the baby is a footling breech, or transverse, and won't turn, and this is discovered at 38 weeks. A c/s may be necessary- but it doesn't have to take place at 38 weeks- it could be delayed until labor starts on its own and then performed during early labor.

[Storm Bride]

Originally Posted by kerikadi

I know there are extenuating circumstances with planned cesareans. Sometimes baby is breech and finding a practitioner to deliver is near impossible.
However, my point was that the study would consider a non-emergency cesarean voluntary.

Ah - can't argue there.

The study wouldn't have included me, anyway, as it was only looking at primary sections, and my first one was an "emergency".

[natashaccat]

Sorry computer's too slow and I couldn't get to the article...just out of curiosity, did second c-sects (like if you chose not to vbac for whatever reason) fall into the category of "voluntary"?

[Quirky]

Originally Posted by natashaccat

Sorry computer's too slow and I couldn't get to the article...just out of curiosity, did second c-sects (like if you chose not to vbac for whatever reason) fall into the category of "voluntary"?

No, the study is only considering primary c-sections. I.e. first birth.

[Lkg4dmcrc]

Lots of women say that their records actually say voluntary cesarean when they were really told in the moment that it was an emergency (loss of fetal heart tones for example)- they may not have had a crash c-section but nontheless, it was an emergency at the time but never written up that way in the chart. There are also women who claim that their cesareans were planned for breech but then became emergencies when their water broke. I would really like to know what they consider emergency- because a lot of women consent to surgery because they believe that it is an emergency- so does this consent mean voluntary?

[captain optimism]

If you click the link to the study summary, the meaning of "voluntary" is a lot clearer.

Originally Posted by Marian MacDorman, et. al.

risks associated with primary cesarean section compared with vaginal delivery for singleton full-term (37–41 weeks' gestation) women with no indicated medical risks or complications.

See, when you see "voluntary" you are all thinking "moms to blame for choosing to schedule c-sections." The original study authors don't seem to be assigning blame to moms or healthcare practitioners. They just looked at full-term deliveries that did not have medical risks or complications that would have indicated the need for a c-section.

So if you had an emergency c-section because of a genuine medical issue, or it was a planned c-section after a previous c-section--they aren't talking about you. Also, I am not sure that breech births are discussed in this abstract. You have to pay 40 bucks to read the whole article, so maybe in the full text they discuss it.

[Lkg4dmcrc]

Originally Posted by captain optimism

If you click the link to the study summary, the meaning of "voluntary" is a lot clearer.



See, when you see "voluntary" you are all thinking "moms to blame for choosing to schedule c-sections." The original study authors don't seem to be assigning blame to moms or healthcare practitioners. They just looked at full-term deliveries that did not have medical risks or complications that would have indicated the need for a c-section.

So if you had an emergency c-section because of a genuine medical issue, or it was a planned c-section after a previous c-section--they aren't talking about you. Also, I am not sure that breech births are discussed in this abstract. You have to pay 40 bucks to read the whole article, so maybe in the full text they discuss it.

This is where I am still confused- sorry. Some say that if a baby comes out with a good apgar score, then there was no medical need for a cesarean. They also say that fetal distress can only be determined by scalp samples and a low apgar score - so are these the only ones counted?

[Kidzaplenty]

:

[MsElle07]

Originally Posted by Lkg4dmcrc

This is where I am still confused- sorry. Some say that if a baby comes out with a good apgar score, then there was no medical need for a cesarean. They also say that fetal distress can only be determined by scalp samples and a low apgar score - so are these the only ones counted?

No, the study is about no known medical problems BEFORE the birth, which was the criteria for admission to the study. All baby outcomes AFTER the birth were included.