For those of you who haven't heard, a study published in the current issue of the journal Birth brings disturbing, but not surprising, news that cesarean surgeries for which there is no medical indication in ultra-low-risk women increases the likelihood of neonatal death compared with vaginal birth. Here is the abstract along with the link to it on PubMed:
Birth. 2006 Sep;33(3):175-82.
Infant and neonatal mortality for primary cesarean and vaginal births to women with "no indicated risk," United States, 1998-2001 birth cohorts.
Macdorman MF, Declercq E, Menacker F, Malloy MH.
Marian MacDorman and Fay Menacker are at the Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland.
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).
PMID: 16948717 [PubMed - in process]
link to study abstract
FYI: "Primary" cesarean section means that women with prior cesarean surgeries were excluded from the population.
Note that the association remained even after excluding congenital anomalies, which could have influenced choice of delivery route and likelihood of neonatal death, and babies born in poor condition as measured by Apgar scores. As the investigators explain, Apgar score is the best way they had of getting at fetal distress in labor, another factor that would tilt towards both a cesarean and increased likelihood of newborn death. Investigators also point out that information may not always be recorded in national databases so some women with medical or obstetric complications may have been included in the trial inappropriately. However, this is less likely to occur in the cesarean group than the vaginal group because of the need to justify c/secs. Therefore, if there is any bias in recording, it favors c/sec.
This is a powerful indictment of elective cesarean surgery.
-- Henci By: Henci Goer |