01 September 2010

C-section trend worries doctors

The rate of caesarean delivery continues to rise and steps are needed to reverse the trend, a new study finds.


The rate of caesarean delivery continues to rise and steps are needed to reverse the trend, a new study finds.From 1996 to 2007  in the US the rate of caesarean delivery climbed by more than 50%, and "one in three first-time mothers are now being delivered by caesarean delivery," lead researcher Dr Jun Zhang, of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, said.
In addition, more women than ever before are having repeat C-section deliveries and the rate of medically induced deliveries is high.
"We found that 44% of women who attempt vaginal delivery have their labour induced," said Zhang, who is a senior investigator in the institute's Division of Epidemiology, Statistics and Prevention Research. "In this [induced] group the C-section rate is twice as high as women who have spontaneous labour."
He also noted that many cesarean deliveries were done at an early stage of labour, before the women even had a chance to spontaneously deliver.
The report is published in the American Journal of Obstetrics and Gynecology.

C-sections carry risks
Like any surgery, C-section comes with risks, explained Dr Salih Yasin, an associate professor of obstetrics and gynaecology at the University of Miami Miller School of Medicine.
"First, caesarean section is not just having a baby; it is having a baby through major surgery. So there is a chance of bleeding, infections and longer healing and recovery," said Yasin, who was not involved in the new study. There are also the long-term effects of repeated caesareans on the uterus. "You end up having many more cases of caesarean-related hysterectomies and transfusion and maternal death," he said.
While these consequences make up only a small percent of cases, "we are noticing an almost 10-times increase of those significant complications," Yasin said. "We need to make sure we are doing this surgery to the right patient for the reason - the right timing for the long-term health of the patient," he added.
In the new study, researchers working with the Consortium on Safe Labor collected data on cesarean delivery throughout the United States using data from almost 229,000 electronic medical records from 19 hospitals.

The findings

They found that 30.5% of all deliveries were done by caesarean section in 2007, including 31.2% of women having their first child.
Among women who underwent C-section due to an abnormal or difficult childbirth or labour (dystocia), half of the deliveries were done before the cervix had opened less than six centimetres, early in the labour process, Zhang said.
Among women who had a caesarean delivery before going into labour, about 31% had a uterine scar from an earlier pregnancy. A uterine scar can be caused by many conditions that damage the uterus. In some cases, scar tissue can prevent the uterus from fully dilating, thus resulting in a C-section.
However, almost 29% of women with a uterine scar did manage to have a normal vaginal delivery, the researchers noted. And in these cases, vaginal delivery was successful in about six out of 10 cases.

Many reasons for growing c-section rate
There are many reasons that could help explain why the number of caesarean deliveries is rising, the researchers said. These include women delaying childbirth until they are approaching middle-age, increasing obesity rates among pregnant women and the increase in multiple births due to the use of fertility treatments.
Also, when a woman has already had one C-section, doctors are likely to deliver her other children the same way. That's a practice obstetrical experts have been trying to curb, however. 

The American College of Obstetricians and Gynaecologists issued new guidelines stressing that many women who've had a C-section may be candidates for vaginal birth in future pregnancies.
Litigation concerns on the part of doctors may be driving the trend towards C-sections, as well. Many obstetricians fear being sued should something go wrong in a vaginal delivery, the researchers noted.
"To make a significant impact on the high cesarean delivery rate in the United States, the focus should be preventing unnecessary primary cesarean deliveries from several aspects," the researchers wrote.

Encourage vaginal delivery 
First, there needs to be fewer induced deliveries, and performing a C-section in cases of problem birth should not be done before the start of labour - especially in women having their first child, the researchers said.
Vaginal delivery after an earlier cesarean should be encouraged, if possible, and there needs to be an accepted standard among physicians that indicates when a cesarean is needed, they added.
"Finally, increasing access to, and patient education on, trial of labour in women with a previous uterine scar and improving the [delivery] success rate are urgently needed," the researchers said.
Zhang noted that one limitation of the study is that the sample the researchers used is not necessarily representative of the United States as a whole, since much of the data came from teaching hospitals, which tend to see more complicated pregnancies than community hospitals.
For his part, Yasin said he wasn't surprised by the findings.
"That's the way things are," he said. "We are inducing labour more than we should. We are not being patient with or giving adequate time for women who are in labour. We are intervening before giving the patient every chance possible." (August 2010)

(Copyright © 2010 HealthDay. All rights reserved.)

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