USA Today Examines Debate Over Safety Of Elective C-Section Delivery In U.S.

Main Category: Pregnancy / Obstetrics
Also Included In: Nursing / Midwifery
Article Date: 09 Jan 2008 - 7:00 PDT

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USA Today on Tuesday examined the debate over the safety of elective caesarean section deliveries in the U.S. CDC's National Center for Health Statistics last month reported that the U.S. c-section rate reached an all-time high of 31.1% in 2006 -- a 50% increase over the previous 10 years. As the c-section rate has increased, so has the rate of pregnancy-associated deaths in 2003 and 2004. Data showed that the rate reached 13 deaths per 100,000 live births in 2003 and 14 deaths per 100,000 in 2004. Before 2003, the rate had not been above 10 deaths per 100,000 live births since 1977.

NCHS researchers say the increase primarily is because of improved reporting of pregnancy-related deaths. Mary D'Alton, Columbia University ob-gyn and chair of a 2006 NIH conference on maternal request c-sections, said, "I don't think there's evidence to say that (a planned c-section) is at the present time riskier than a vaginal delivery," adding, "There are risks and benefits to both. You need to know more about the individual woman to be able to assess the risks."

Some advocates and some doctors say the rise in maternal mortality in part is because of the increase in c-section deliveries, citing studies that found women who chose vaginal delivery over an elective c-section generally had lower rates of pregnancy-related deaths and illness. Elliott Main -- chair at California Pacific Medical Center in San Francisco and head of the California Maternal Quality of Care Collaborative -- said he does not rule out a connection between increased c-sections and maternal illness and death. "Blood clots can lead to sudden deaths," he said, adding, "There can be anesthesia complications, hemorrhage complications." However, Main added that some say the underlying reasons for an elective c-section, not the procedure, cause complications.

D'Alton and Kenneth Leveno, chair of obstetrics and gynecology at the University of Texas Southwestern Medical Center, have proposed a clinical trial in which women would be assigned randomly to deliver their first infants by planned c-section or planned vaginal delivery to determine whether either is safer. D'Alton and Leveno said they would need to enroll 10,000 women and follow them for at least five years because c-sections can affect subsequent pregnancies. The estimated cost of the trial is $75 million, USA Today reports. Leveno said that a study so large and costly would have to be conducted by the Maternal-Fetal Medicine Units Network, which conducts research funded by the National Institute for Child Health and Human Development. Catherine Spong, chief of NICHD's pregnancy and perinatology branch, said the "issues" surrounding such a trial, such as when to "randomize" the participants, "are going to be difficult to really figure out" (Rubin, USA Today, 1/8).

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