Scrippt’s Report: NOT safer for healthy women w/ normal pregnancies to have their baby delivered by Cesarean ~ part 1

Excerpts from Scripps Media report –  Posted: 04/01/2013 

Most IMPORTANT Information:

Strong arguments for encourage vaginal births; national efforts to reduce hospital CS rates:

C-sections typically cost about twice as much as a standard delivery.

More and more evidence indicates that natural delivery benefits infants in areas ranging from immune system development and reduced odds for asthma and allergies to early growth patterns.

Elective C-sections contribute to more preterm births. Although a full term pregnancy is considered 37 to 41 weeks, most experts recommend waiting until at least 39 weeks for delivery.

Medicaid has launched an initiative with several hundred hospitals to discourage early elective deliveries.

The American College of Obstetricians and Gynecologists recommends against early deliveries by any method before 39 weeks without sound medical need.

A study by Johns Hopkins researchers presented last year showed that C-section delivery may not protect babies who are small for their gestational age, but in fact may give INCREASE for breathing problems.

Starting next year, the Joint Commission (formerly known as JACHO) — the national accrediting organization for healthcare organizations — will require hospitals with more than 1,100 births a year to actively work toward reducing C-sections among first-time moms at low risk for complications and decreasing early elective birth rates.

While there are no benchmarks or quotas, the new measure pressures hospitals to monitor and evaluate their C-section rates and consider changes in their standard practices.

According to Lee Bowman, Scripps Howard News Service  “the nation’s medical establishment is giving some not-too-subtle encouragement for obstetricians” and mothers have normal vaginal birth instead of  cesarean section surgery.  Currently a third of babies born in is the US are delivered by C-section.

Mr Bowman reports that the Cesarean rate increased from one in five births in 1996 to one-in-three by 2007. The C-section has been steadily going up for a decade, held a at 32.9 percent in 2008 and 2009, then dipped ever so SLIGHTLY to 32.8 percent in 2010 and stayed there in 2011, which is the latest year figures are available from the Centers for Disease Control and Prevention.

The obstetrical profession frequently attributes the increasing Cesarean rate an increased number of older or heavier women giving birth. However, this Scripps article confirms reports by other researchers — that  the increase occurred “among women of all age groups and ethnic backgrounds, rising to nearly half of births by women in their 40s and older”.

This author admits this is troubling, as “Cesarean sections are the most common surgical procedure in America”. Also troubling is the dramatic variation between states and individual hospitals in the same region.

If C-sections were being performed for medical reasons, one would expect them to be relatively consistent across the country, and in fact, consistent with other developed countries. Instead they “vary widely from state to state, from as low as 25 percent in Alaska and several western states to more than 35 percent in Florida, Louisiana, Mississippi, New Jersey and West Virginia. The variation is even greater from hospital to hospital.”

This report sites researchers from the University of Minnesota, which acknowledge that reasons OTHER than medical necessity or the types of patients are driving the routine use of surgical delivery. They identify this as the “styles of practice of individual doctors or physician groups in one hospital”. However, a more truthful and informative explanation is “physician preference” — conclusions by individual obstetricians and decisions by the chief of staff for the  obstetrical department.

Sometimes this preference is the result of a consensus by obstetricians with practice privileges, who vote for hospital policies that make it difficult or impossible to use physiological management. This policies and protocols are not ‘evidence-based, but simply reflect the preference of the physicians at that particular hospital. These choices make it easier or more profitable for medical professionals but drastically increase the level of routine medicalization, C-sections and are associated with iatrogenic and nosocomial complications.

The author goes on to say that

“An analysis of nearly 600 hospitals that performed at least 100 live births in 2009 found C-section rates as low as 7 percent and as high as 70 percent, according to a study published earlier this month in the journal Health Affairs. Even among women with lower-risk pregnancies, the rates ranged from 2.4 to 36.5 percent.

Researchers at Yale reported last year on births at Yale-New Haven Hospital between 2003 and 2009, that found that traditional, objective reasons for C-sections — such as babies in difficult breech positions or complications with the placenta — have remained steady. But reports of more subjective problems, like slow progression of labor or concerns about fetal heart rate have been increasing, along with a trend to use the procedure more often with larger infants and twins.

The Yale study found that maternal choice or scheduled C-sections were responsible for only about 8 percent of the increase in procedures at the hospital. However, a small Swedish study published last year noted that women with a fear of childbirth were nearly twice as likely to have a C-section as those with no such fears, even after special counseling.

More than 90 percent of women who’ve had a C-section will repeat the procedure if they give birth again, and those deliveries account for about a third of the total each year. Many hospitals discourage attempting labor with subsequent births due to fears of complications, although this is changing in some areas.

(Contact Scripps health and science writer Lee Bowman at BowmanL@shns.com.)