Recent research on cesarean sections

Pre-term elective cesareans:
Elective cesarean before 39 weeks worsens neonatal outcomes. Source: Alan T.N. Tita, et al. "Timing of Elective Repeat Cesarean Delivery at Term and Neonatal Outcomes." NEJM 360.2 (Jan 8, 2009): 111-120. Email me for full text.

There have been several news reports about this recent study in the New England Journal of Medicine.

• The Wall Street Journal reports Why Every Week Counts
• The New York Times discusses why Early Cesareans Pose Risks to Newborns
• Michael McGuire, CEO of UnitedHealthcare of New Jersey, mentions the link between pre-term cesareans and NICU stays in his op-ed piece Pre-term Cesarean Birth. (Thanks to Kathy for the link to this one).

I think Jennifer Block's response, Can We Please Stop Blaming Women for C-Sections?, is spot on.

Elective implies freely chosen, life-enhancing. Laser eye surgery is elective. Tattoos are elective. But the vast majority of so-called "elective" cesarean sections are not, and it is inappropriate and disingenuous to call them so in the medical literature, as did the recent study in this month's New England Journal of Medicine, "Timing of Elective Repeat Cesarean Delivery at Term and Neonatal Outcomes."...

[I]n spite of the true risk, VBACs are often vehemently discouraged. In fact, many obstetricians now refuse to attend them, and hundreds of hospitals have officially banned them. And malpractice liability fears are a strong motivation to schedule the surgery early, so as to avoid the possibility of labor—and vaginal birth. The fact is that VBAC is inaccessible to most women.

So, if a woman with a scar from a previous cesarean goes to her OB and is recommended to schedule a repeat cesarean—and is told that a vaginal birth would be risky, and that anyway it won't be done by this doctor, this practice, or this hospital—can the surgery possibly be called "elective?"

ICAN is currently compiling a database of all US hospitals' VBAC policies. So far, out of more than 1,600 hospitals, close to 1/3 have an outright ban on VBACs. Several hundred more restrict the practice with de-facto bans; even though the hospital might not have a written policy forbidding VBACS, in actual practice no physicians will attend them. I feel that access to VBAC is one of the most pressing issues in US maternity care today.

Cesareans and Serious Maternal Complications:
The increase in cesarean rates also seems to be tied to a rise in severe obstetric complications. Here are a few articles discussing the recent research article Severe Obstetric Morbidity in the United States: 1998-2005 in the Feb 2009 issue of Obstetrics & Gynecology. (Email me if you'd like to see the full text).

• The Washington Post: Severe Obstetric Complications on the Increase
• The Chicago Tribune: Complications of childbirth increase; researchers blame Cesarean sections
• ABC News: Study Examines Moms' C-Section Complications
  
• The Guardian: Rise in US Caesarean procedures may be linked to childbirth complications

Benefits of Maternity Leave:
Maternity leave benefits moms and babies. Maternity leave before pregnancy is connected with much lower c-section rates. And taking more leave afterwards is beneficial for breastfeeding (big surprise, right?). Email for the full text of the following two articles:
Sources: Sylvia Guendelman et al. "Maternity Leave In The Ninth Month of Pregnancy and Birth Outcomes Among Working Women." Women's Health Issues 19.1 (January-February 2009): 30-37.
Sylvia Guendelman et al. "Juggling Work and Breastfeeding: Effects of Maternity Leave and Occupational Characteristics." Pediatrics 123.1 (January 2009): e38-e46.

Canada's C-Section rate at Record High:
From The Calgary Herald:

Canada’s pregnancy specialists are calling on doctors to curb the fast-growing use of caesarean sections to deliver babies, saying the worrisome trend is exposing mothers and infants to more risk, not less. With one in four births now occurring by C-section - 92,799 babies a year - it is time to get “back to the basics,” says Dr. Vyta Senikas, associate executive vice-president of the Society of Obstetricians and Gynaecologists of Canada.

The group is urging doctors and women to choose a C-section only when there is a medical reason to justify one. “Safety of a woman and a baby should be the driving decisions here,” Senikas said. “We have to come back to the basics, and the basics are that 90 per cent of women will have a nice vaginal delivery without any problems to produce a healthy mother and baby.”