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

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#1 of 22 Old 09-05-2006, 02:10 PM - Thread Starter
 
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From the New York Times Health section today:

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

Quote:
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

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#2 of 22 Old 09-05-2006, 02:32 PM
 
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Thanks for posting this. Interesting reading!
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#3 of 22 Old 09-05-2006, 02:35 PM
 
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Most c-sections aren't voluntary...
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#4 of 22 Old 09-05-2006, 03:09 PM
 
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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!

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#5 of 22 Old 09-05-2006, 05:25 PM
 
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Quote:
Originally Posted by Lovinmy2babies+1
Most c-sections aren't voluntary...
Last I read a higher percentage of cesareans are planned and therefor voluntary.

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#6 of 22 Old 09-05-2006, 05:31 PM
 
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I wonder if this is because many of these babies weren't ready to be born yet.

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#7 of 22 Old 09-05-2006, 05:48 PM
 
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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

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#8 of 22 Old 09-05-2006, 05:49 PM
 
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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.

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#9 of 22 Old 09-05-2006, 05:56 PM
 
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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.

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#10 of 22 Old 09-05-2006, 06:02 PM
 
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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.

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#11 of 22 Old 09-05-2006, 06:17 PM
 
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Here's another quote:

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.
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#12 of 22 Old 09-05-2006, 06:32 PM
 
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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.

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#13 of 22 Old 09-05-2006, 06:47 PM
 
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Quote:
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".

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#14 of 22 Old 09-05-2006, 09:52 PM
 
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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"?
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#15 of 22 Old 09-05-2006, 10:03 PM - Thread Starter
 
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Quote:
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.

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#16 of 22 Old 09-05-2006, 10:46 PM
 
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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?
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#17 of 22 Old 09-05-2006, 11:01 PM
 
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If you click the link to the study summary, the meaning of "voluntary" is a lot clearer.

Quote:
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.

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#18 of 22 Old 09-05-2006, 11:32 PM
 
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Quote:
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?
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Any misspellings or grammatical errors in the above statement are intentional;
they are placed there for the amusement of those who like to point them out.
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#20 of 22 Old 09-06-2006, 06:02 AM
 
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Quote:
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.
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#21 of 22 Old 09-07-2006, 01:17 AM
 
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Some quotes from the full text

Quote:
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.

Quote:
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.
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#22 of 22 Old 09-07-2006, 11:07 AM
 
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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!)

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