Evidence Increases For Risks In Cesarean Surgery As National Rate Continues To Rise, USA

Main Category: Pregnancy / Obstetrics
Article Date: 19 Mar 2009 - 5:00 PDT

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As research continues to mount for the risks of cesarean surgery, the Centers for Disease Control released new, staggering statistics today reporting that 31.8% of women endure birth by cesarean in the United States (2007). This announcement comes after the release of significant findings from the New England Journal of Medicine reinforcing that birth by cesarean surgery before 39 weeks of pregnancy causes increased complications in newborns.

Despite the latest advances in medical technology, health care providers cannot determine a baby's due date with 100% accuracy. Therefore, cesarean surgeries scheduled before a woman's estimated due date could result in a baby born as early as 36 weeks to a few days before the baby is actually due. During the last few weeks of pregnancy, a baby's lungs mature and a protective layer of fat forms, both of which are vital developments for a healthy baby. In addition, babies need time for their lung cells to shift from being fluid producing to fluid absorbing cells. Without time during labor to prepare the baby to breathe, lungs cells may not be ready. Thus, babies born by cesarean surgery, even when they are full-term, need to go to an intensive care unit more frequently than babies who were born vaginally to get help breathing.

Research published in the New England Journal of Medicine (NEJM) supports earlier findings that cesarean surgery performed prior to 39 weeks of pregnancy increases poor outcomes in babies. Of the babies in the NEJM study born before 39 weeks, more than 26% had complications, including the need to be on a ventilator, respiratory distress syndrome, low blood sugar and severe infection (sepsis).

"Overuse of cesarean surgery complicates the otherwise natural process of birth," says Lamaze Institute Chair Debra Bingham, LCCE, MS, RN, DrPH, "Allowing the natural process to occur not only reduces risks for mothers in this and future pregnancies, but also reduces health risks for her baby."

Spontaneous labor is almost always the best indication for a baby's physical readiness for life outside of the womb. As one of the key steps to a healthy birth, Lamaze International recommends that women let labor begin on its own. Allowing labor to begin naturally increases the likelihood that a baby is healthy and ready for birth. When a birth outcome is good, mother and baby can bond and start breastfeeding immediately after birth-both of which provide the best start for a baby's growth and development.

Lamaze International President Pam Spry, PhD, CNM, FACNM, LCCE says, "Maternity care in the United States is at a crossroads. The most commonly used practices don't align with the best evidence for a healthy birth." The Milbank Report's Evidence-Based Maternity Care: What It Is and What It Can Achieve reveals that several routine maternity care practices, including cesarean surgery, contradict best evidence and are overused in the United States.

Cesarean surgery-a major abdominal surgery-also carries risks for women, such as blood loss, clotting, infection and severe pain, and poses future risks, such as infertility and complications during future pregnancies such as stillbirth and placenta problems like percreta and accreta, which can lead to excessive bleeding, bladder injury, hysterectomy and maternal death. The research is clear, however, that when medically necessary, cesarean surgery can be a lifesaving procedure for both mother and baby, and worth the risks involved.

Two of the most important decisions a woman can make are where she gives birth and who she chooses as her care provider. Lamaze International has developed tools to help women with these decisions, including the questions to ask and other reference material. Visit http://magazine.lamaze.org/ to learn more about the Lamaze during pregnancy, birth and beyond.

About Lamaze International

Since its founding in 1960, Lamaze International has worked to promote, support and protect birth through education and advocacy through the dedicated efforts of professional childbirth educators, providers and parents. An international organization with regional, state and area networks, its members and volunteer leaders include childbirth educators, nurses, midwives, doulas, lactation consultants, physicians, students and consumers. For more information about Lamaze International, visit http://www.lamaze.org.

Source
Lamaze International

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