THE BLOG
09/05/2006 02:17 am ET Updated May 25, 2011

Do Not Have an Elective Cesarean Birth

Further Amended:

Spinoza's response at the bottom of the comments is well worth reading. I strongly disagree with Dr. Spinoza's opinions and some of his facts, but he has crafted a cogent rebuttal. (I accidentally deleted his first comment and he was kind enough to re-post.)

I have added an amendment at the bottom of this post to respond to comments and to emphasize that "elective" Cesarean deliveries are those done without medical necessity. Some babies need to be delivered by C-Section but a 50% increase in these surgeries in the past ten years has created more problems than it's solved.

Short and to the point: This study of nearly 6,000,000 births shows that " . . . Caesarean delivery among low-risk mothers who have no known medical reason for the operation" may double or even triple an infant's risk of dying.

This research does not even scratch the surface because it doesn't adequately address the lung problems of babies born too early. This can occur with miscalculation of the baby's due date but can also occur when babies are delivered even a week or two before they're supposed to arrive. I have seen severe "respiratory distress syndrome" of prematurity in big seven pound babies born a week or two before their due dates.

Obviously, there are many reasons for having scheduled or unscheduled operative births. The convenience of the mother or the doctor should not be among them.

JNG MD

AMENDED TO INCLUDE RESPONSES TO COMMENTS.

By definition, an "elective" operation is one done without medical necessity. Babies in distress, unusual positions or in danger do not receive "elective" Cesarean deliveries.

The second comment from an obstetrician is disingenuous.

I have been a pediatrician in private practice for over 27 years and have been involved in thousands of Cesarean births. Maternal mortality has long been acknowledged to be higher for these surgeries and now this study points to increases infants' deaths resulting from elective C-Sections.

Yes Cesarean delivery is a safe operation. It has saved the lives of many babies and many mothers. That is not the point of the research conclusions, the NYT article or my post. I certainly acknowledge that the decision about the need for this surgery must be made by the mother given the best information by her trusted physicians. I don't think this information is always dispensed well.

Doctor, the study eliminated the "congenital anomalies" factor and you know that.

"A decision for cesarean section is never cavalierly made" Any doctor knows this is not true. Sadly.

Below, I have excerpted a news story and the abstract of the original article. I have added my own emphases.

JNG MD

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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.

"Neonatal deaths are rare for low-risk women -- on the order of about one death per 1,000 live births -- but even after we adjusted for socioeconomic and medical risk factors, the difference persisted," said Marian F. MacDorman, a statistician with the Centers for Disease Control and Prevention and the lead author of the study.

"This is nothing to get people really alarmed, but it is of concern given that we're seeing a rapid increase in Caesarean births to women with no risks," Dr. MacDorman said.
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.

Dr. Michael H. Malloy, a co-author of the article and a professor of pediatrics at the University of Texas Medical Branch at Galveston, said that doctors might want to consider these findings in advising their patients.

"Despite attempts to control for a number of factors that might have accounted for a greater risk in mortality associated with C-sections, we continued to observe enough risk to prompt concern," he said.
"When obstetricians review this information, perhaps it will promote greater discussion within the obstetrical community about the pros and cons of offering C-sections for convenience and promote more research into understanding why this increased risk persists."

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Birth
Volume 33 Page 175 - September 2006
doi:10.1111/j.1523-536X.2006.00102.x
Volume 33 Issue 3



Infant and Neonatal Mortality for Primary Cesarean and Vaginal Births to Women with "No Indicated Risk," United States, 1998-2001 Birth Cohorts
Marian F. MacDorman, PhD1, Eugene Declercq, PhD2, Fay Menacker, DrPH, CPNP1, and Michael H. Malloy, MD, MS3
ABSTRACT: Background: The percentage of United States' births delivered by cesarean section has increased rapidly in recent years, even for women considered to be at low risk for a cesarean section. The purpose of this paper is to examine infant and neonatal mortality 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. Methods: National linked birth and infant death data for the 1998-2001 birth cohorts (5,762,037 live births and 11,897 infant deaths) were analyzed to assess the risk of infant and neonatal mortality for women with no indicated risk by method of delivery and cause of death. Multivariable logistic regression was used to model neonatal survival probabilities as a function of delivery method, and sociodemographic and medical risk factors. Results: Neonatal mortality rates were higher among infants delivered by cesarean section (1.77 per 1,000 live births) than for those delivered vaginally (0.62). The magnitude of this difference was reduced only moderately on statistical adjustment for demographic and medical factors, and when deaths due to congenital malformations and events with Apgar scores less than 4 were excluded. The cesarean/vaginal mortality differential was widespread, and not confined to a few causes of death. Conclusions: Understanding the causes of these differentials is important, given the rapid growth in the number of primary cesareans without a reported medical indication. (BIRTH 33:3 September 2006)