BIG study....voluntary c-section nearly triples rate of BABY death - Page 2

[wannabe]

Some quotes from the full text

For the purposes of this analysis, women with no indicated risk were defined as those with singleton, term (37–41 weeks' gestation), infants in vertex presentation who were not reported to have any medical risk factors, and for whom no complications of labor or delivery were reported on the birth certificate (17). Medical risk factors that were excluded from the study were anemia, cardiac disease, acute or chronic lung disease, diabetes, genital herpes, hydramnios/oligohydramnios, hemoglobinopathy, chronic hypertension, pregnancy-associated hypertension, eclampsia, incompetent cervix, previous infant 4000+ g, previous preterm or small-for-gestational-age infant, renal disease, Rh sensitization, uterine bleeding, and other.

Complications of labor and delivery that were excluded were febrile, meconium moderate/heavy, premature rupture of membrane, abruptio placentae, placenta previa, other excessive bleeding, seizures during labor, precipitous labor, prolonged labor, dysfunctional labor, breech/malpresentation, cephalopelvic disproportion, cord prolapse, anesthetic complication, fetal distress, and other.

The study was further restricted to women who had never had a previous cesarean, because having had a previous cesarean could strongly influence the choice of method of delivery in the current pregnancy. Slightly more than one-fourth of mothers in the United States met these criteria in the years studied.

This is what was EXCLUDED. So if you had a c-section because your last baby was nine pounds, or your waters had been broken for longer than your OB wanted to be away from his golf game, you weren't included as low-risk. Which makes this an extraordinarily conservative study.

Among this group of low-risk women, the leading cause of neonatal mortality was congenital malformations, deformations, and chromosomal abnormalities (congenital malformations), which accounted for over one-half (54%) of all neonatal deaths. This cause was followed by sudden infant death syndrome (SIDS), accounting for 5 percent of deaths. The relatively small percentage of neonatal SIDS is not surprising, since most SIDS events occur during the postneonatal period (20). The third and fourth leading causes were intrauterine hypoxia and birth asphyxia and diseases of the circulatory system, each with 4 percent of deaths. Bacterial sepsis of newborn was fifth, with 3 percent of deaths. Taken together, the five leading causes of deaths accounted for 71 percent of all neonatal deaths for this population of low-risk women.

For intrauterine hypoxia and birth asphyxia, the neonatal mortality rate was 14.7 for cesarean deliveries, 6.7 times the rate of 2.2 for vaginal deliveries.

In cases where the cause of death was intrauterine hypoxia and birth asphyxia, the neonatal mortality rate for cesarean deliveries was 6.7 times that for vaginal deliveries. This finding may be due to clinicians performing cesareans to attempt to expedite the delivery of infants with suspected intrauterine hypoxia. In such cases, the intrauterine hypoxia might be both the reason for performing the cesarean and the cause of death. Eliminating births with Apgar scores less than 4 as a proxy for asphyxia resulted in the largest drop in the odds ratio for the risk of neonatal mortality. For the residual category of all other causes of death, the neonatal mortality rate for cesarean delivery was 2.9 times that for vaginal delivery.

Looks like they excluded the low apgars at birth in one analysis to account for any potential lapse in reporting the reason for the caesar.

[captain optimism]

Thank you for posting from the full text, that was really helpful. I like how the study authors kept eliminating factors, in order to be absolutely sure that the issue was the c-section.

Slight OT: It's interesting to me that the "premature rupture of membrane" was excluded, because it means they think it's a legit reason for a c-section. I already felt incredibly lucky that I managed to have a vaginal birth when I didn't go into labor after my waters broke. The doctor at the hospital persuaded my midwife that everything would be okay, even though labor was not starting after several days. She was bold to go against the tide of usual medical opinion. (Note that it was the OB, who was not MY OB, who persuaded the midwife! Should i ever be blessed with a pregnancy again, i might go to that OB instead!)