C-Sections Best For Baby When Close To Due Date

NEW YORK — Babies do better after a scheduled Caesarean section if they're born no sooner than seven days before their due date, a new large study of U.S. births shows. Those delivered earlier had more complications, including breathing problems, even though they were full term, the researchers reported in Thursday's New England Journal of Medicine. Even just a few days made a difference, they said.

The findings offer important guidance to the growing number of women who face planned C-sections. And the study supports recommendations that elective C-sections be scheduled after 39 weeks unless tests show the infant's lungs are fully mature. Due dates are set at 40 weeks gestation and infants are full term at 37 weeks.

"Take your due date and subtract seven and any one of those seven days is fine," said one of the researchers, Dr. John Thorp, of the University of North Carolina at Chapel Hill School of Medicine.

He delivered a healthy baby girl on Tuesday after persuading her mother to wait a few more days for a C-section, even though last week would have been more convenient for both mother and doctor.

"We bit the bullet and did it at the right time," said Thorp.

The rate of Caesarean sections in the United States is at an all-time high, accounting for about 31 percent of births. There are lots of reasons: older moms, multiple births, the threat of malpractice lawsuits, the preference of mothers and doctors and the risks of having a vaginal birth after a previous Caesarean. In 2006, a government panel urged women not to seek a C-section without a medical reason; surgery brings risks and babies born by Caesarean have a greater chance for respiratory problems.

In the new study, the researchers, led by Dr. Alan Tita of the University of Alabama at Birmingham, examined a C-section registry from 19 academic medical centers to see how many of the surgeries were being done before the recommended 39 weeks and if the timing made a difference in the risk of complications.

They focused on 13,258 women who had a single child at a planned Caesarean and who had previously given birth the same way. Excluded were cases where medical issues warranted an early or immediate delivery. The infants were followed until they left the hospital or for four months.

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More than a third of the C-sections were performed before 39 weeks, the researchers found. Those delivered at 37 weeks were twice as likely to have health problems, including breathing troubles, infections, low blood sugar or the need for intensive care. Fifteen percent of those born at 37 weeks and 11 percent born at 38 weeks had complications, compared to 8 percent of the babies delivered at 39 weeks. The only death was an infant born at 39 weeks.

The biggest difference was in breathing problems, with a fourfold increase for those born at 37 weeks compared to 39 weeks. Babies born by C-section already have a higher risk of breathing trouble than those born vaginally; labor helps clear the lungs of fluid.

The risk of complications also increased for births after 41 weeks, but there were few births in that category, the researchers said.

Tita said the researchers didn't know the reasons behind the chosen delivery dates. They speculated that some mothers might want to deliver as soon as the fetus reaches full term, or an earlier time may have been more convenient for the mother or doctor.

Dr. Michael Greene, of Massachusetts General Hospital in Boston, noted the research showed that there's even an increased risk of complications in the last few days before the 39th week. That's something most doctors wouldn't suspect, he said.

"I generally try to wait to 39 weeks, although I confess that I'm as guilty as anybody else with a busy practice and scheduling being what it is," said Greene, who wrote an accompanying editorial in the journal. "I really hadn't thought much about it until now."

The study only looked at live births, and didn't account for the small risk of the fetus dying while waiting to reach 39 weeks, Greene said. That risk has been estimated up to 1 in 1,000, he said.

Thorp's patient in Chapel Hill, Shannon Eubanks, said she was glad that she held off a few days to reach the 39-week threshold before having her daughter, Kathleen Conley Eubanks. Her first child, 2-year-old Charlie, was born by C-section.

"It was hard to wait," said Eubanks, business manager of the political science department at the university. "I was very over being pregnant and ready to get the show on the road."

And she had another reason for wanting to deliver last week.

As an accountant, "It just killed me not to have this kid in 2008" to get the tax deduction, Eubanks said hours after delivering.

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On the Net:

New England Journal: http://www.nejm.org

Comments

[GrandeLatte]

My mom labored over 17 hours to no avail, and then was ordered to have a C-section. She said the pain was unbearable, that is why I'm an only child. Her gigantic scar (vertical) is a reminder for her sacrifice.

I just think it's so much more scary to cut open a woman then pull a baby out of her. I'm planning to have a baby this year, though I can afford both options, my first choice is natural birth.

[ailbhe]

Everybody gives out about C sections but a scheduled one is far safer and less injurious and risky than an emergency one. My friend had an emergency c section when natural birth failed, she was slit hip to hip and lost so much blood she nearly died.

Another friend lost her baby because the doctors allowed her to go 11 days overdue and refused to induce until it was too late.

Doctors and nurses where I live are obsessed with forcing 'natural' over everything else, often blinding themselves to medical reality. Everybody is different, it should be between the woman and her doctors, taking everything into consideration.

[naschkatze]

Just wondering how prevalent C-sections have become and how they compare in cost to natural delivery. Does anyone know? It seems to me that with the economic crisis that many women cannot even afford hospital delivery and would be birthing at home with midwives.

[sunnybunny]

It has something to do with the things that are causing the medical crisis in the first place. 90% of women do not need any medical intervention to give birth (1 in 10 do.) But it keeps the money thing going for the medical industry to perpetuate fear of childbirth. Natural chilbirth is not only immensly healthier for both the child and the mother, but it cost a lot less (which is the main reason why they do so many C sections). I wonder how much waste of this same type occurs in other areas of the medical field - I bet a lot.

[naschkatze]

I've read that it lets the obstetrician control the situation better too because he or she can time the birth to fit in with a schedule. No more getting up in the middle of the night to deliver a baby.

[Topfeeder]

My OBGYN, told me that women don't want to have vaginal births anymore because they all want mini tummy tucks after delivery and they are afraid the births will destroy their vaginal muscles and their sex lives. They don't mind the scarring as long as it is below the bikini. I was astounded. My son is 19 and it seemed like way back then C-Sections were only for emergencies.

[naschkatze]

It sounds like a social class difference, a yuppy thing (I don't know what current expression is being used). Women with a certain income will get C-sections, and women with a lesser income will go through the immemorial way.

[pc51]

Money talks.

[minty68]

C-section babies are much cuter, too. Their heads are rounder :)

[ldavis24]

thats almost as good a reason to have one as the woman who wanted to get a tax credit for her baby being born in 2008 which is to say ITS NOT A GOOD REASON AT ALL.....

What is wrong with women (and men) in this country that they think a C-section unless absolutely necessary is ever better for the baby or mother? Note our C-section rate is ridiculously high and unjustifiable considering lesser developed countries have lower c-section rates and lower infant mortality rates than the US. This country ranks 31st in least infant mortality rates, clearly we have a problem but do nothing to fix it except perpetrate the myth that giving birth is basically a disease needing medical intervention and treatment.

[Rhyyss]

Wouldn't a much more honest headline have read "Early C-Sections pose more risks to babies" or "C-Sections less risky when close to due date"?

"C-Sections best for babies...."? Sheesh....

[omo]

Yikes. Of course major abdominal surgery is preferable to the way nature intended ! So much more convenient caring for a baby afterward too ! If a c-section is actually necessary, it is a blessing. But
just because a woman is 'very over being pregnant ' ? I thought that in the normal course of things, labor and delivery was the way to get over being pregnant. Silly me.