This relates to my older post about Preterm babies and my inquiry as to why they weren’t talking about sections.  ”There are increases across the board,” she (CDC epidemiologist Joyce A. Martin) said — in all age groups, for most race and ethnic groups and in all states. Overall, the rate of preterm births increased from 6.8 to 8.1 percent, according to the report. The percentage of induced late preterm births more than doubled between 1990 and 2006, from 7.5 to 17.3 percent, according to the report. The percentage of late preterm births delivered by cesarean rose by 46 percent, from 23.5 to 34.3 percent.

The report goes on to highlight the problems with preterm births, including the higher instance of respiratory problems and long-term neurological problems.  They mention how advances in monitoring and subsequent identification of ‘problems’ with babies (distress) are leading to these higher rates, but also the fact that technological advances have made health care providers more ‘comfortable’ with delivering preterm babies.

I guess doctors feel it’s better to avoid the lawsuit involved with knowingly letting a premature ‘distressed’ baby keep going through labor than to potentially deal with the consequences of the long term effects of premature birth. (Most likely they won’t be held accountable there, after all, they can prove that they did everything to get that baby out.) No studies that I know of are addressing the issue of premature induction-which is causing most of these c-sections.

If a baby is not full term, and the mother is induced, could it be possible that the baby will experienced undo stress simply because they are not ready to come out?  Even if a mother is supposedly full term, and an induction of labor results in fetal stress, should we not attempt to stop the labor and wait another week or so (providing that the baby is not showing signs of distress in absence of contractions).  Could it be possible that the dates are wrong?  In other words, could babies experience stress during labor simply because they are not full term?

In many other aspects of our lives, we all know that ‘staying the course’ is not the best practice when evidence shows that there is a better way to achieve the goal.  Why is it that doctors feel the need to keep going-seeing their only option as c-section?  Why not stop the induction and wait?  We have the technology to do that.

Preterm birth is defined as a baby born before 37 weeks gestation.  In the United States alone, the cost of caring for preterm babies and their associated health problems tops $26 billion annually.  Second only to Africa, North America (US and Canada) has the highest instance of preterm births in the world!

What I found interesting about this white paper is that the key contributing factors were the rise in the number of pregnancies in women over age 35, and the increase in multiple births due to ‘assisted reproduction techniques’.   Not one mention of the increase in C-sections.  NOT ONE!

Now, I don’t even need statistics to know that C-sections were the single largest cause of pre-term birth at my little hospital here in Santa Fe.    If I had a dollar for each c-section baby whose gestational assessment came under 37 weeks, and who was sectioned for post-dates…..it makes me want to scream.  Oh, and for those of you who are statistics-minded, the c-section rate in the US hovers around 30%.  Another older study from the CDC and March of Dimes cited that most of those single premature deliveries — a staggering 92% — were by C-section, with the majority being born late preterm (between 34 and 36 weeks).

In my observations, the most frequent reason for c-section was induction for post-dates that lead to a ‘failure to progress’ (that cervix just wasn’t moving fast enough for said dinner date).  I would say maybe 5% of those babies were over-cooked.  Seriously.  There’s a reason why the cervix wasn’t opening.  The baby simply wasn’t ready to come out yet.

There are of course instances where c-section is a life saver, for either mom, baby or both.  Public health issues do need to be addressed.  The fact that american women are the heaviest they’ve ever been leads to heavy babies that can’t be delivered vaginally.  Maternal smoking leads to premature labor and birth.  Twins, triplets and octuplets (!) are more frequent with the advent of ‘assisted reproduction’ techniques.  Advanced maternal age certainly contributes to more difficult labor and delivery.

But someone needs to be looking long and hard at our astronomical c-section rate, and the real reasons why that rate is so high.  Moms and practitioners need to make a more concerted effort to pay attention to dates of conception… and like the article points out there needs to be an internationally accepted classification of preterm birth and better reporting and birth surveillance across the board.

Then there is the whole malpractice issue forcing practitioners to make the ‘safe’ decision to section. But that’s a whole can of worms for another day….

Preterm birth is not good for babies, and c-sections are definitely a contributing factor that needs to be looked at more closely.

If your a mom-to-be who wants to avoid going down the wicked road of possible c-section, consider a midwife. If you really need a c-section, you’ll still get one, but you won’t get one if you don’t need it!