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PREGNANCY & CHILDBIRTH | New York Times Examines Risks of Elective Pre-Term C-Sections

PREGNANCY & CHILDBIRTH | New York Times Examines Risks of Elective Pre-Term C-Sections
[Jan. 9, 2009]

The New York Times on Friday examined a recent study that found infants born via elective repeat Caesarean sections at around 37 weeks' gestation -- which is considered full term -- were twice as likely to suffer complications as those born after 39 weeks' gestation. In addition, the study -- funded by the National Institute of Child Health and Human Development -- found that more than one-third of women who undergo elective c-sections chose to do so earlier than recommended medical guidelines. Alan Tita, lead author of the study and assistant professor of obstetrics and gynecology at the University of Alabama, said that there is an "understanding" that "risks are really very low" for infants born at full term and that "many people may just assume that outcomes at 37 weeks may be the same as 39 weeks." He added, "We know that is not true." According to the Times, the study found that respiratory distress syndrome was 4.2 times more likely to occur in infants delivered by c-section at 37 weeks' gestation than 39 weeks, and infants were 3.3 times more likely to be treated for hypoglycemia. Infants delivered by c-section at 37 weeks' gestation also were more than twice as likely to be hospitalized for five days or more, be admitted to the neonatal intensive care unit or to develop an infection. Tita said that he "think[s] it's prudent to wait until 39 weeks to avoid subjecting these [infants] to adverse outcomes." According to the Times, "Doctors noted even when babies born by [c-section] are delivered at the same week of pregnancy as babies delivered vaginally, they are at higher risk of respiratory difficulties because the process of labor and delivery primes the fetus for breathing air."

According to the Times, reactions to the story were mixed. Michael Greene, director of obstetrics at Massachusetts General Hospital, applauded the study for quantifying "differences in risk that many physicians may not be aware of." At the same time, he said, "The apparent simple message from this study is too simplistic," noting that the study "only reviewed live births and did not weigh the risk of a potential still birth that could occur with a longer pregnancy against the risk of a complication resulting from an earlier [c-section]" (Caryn Rabin, New York Times, 1/9).

~ NPR's "All Things Considered" on Thursday examined the study and featured comments from its co-author Catherine Spong, who said infants born through elective repeat c-sections face twice the risk of "adverse outcomes," including neonatal deaths ("All Things Considered," NPR, 1/8).