January 27, 2009

New Study Questions Connection Between Rise in C-Sections and Rise in Health Complications for Mothers

As the rate of caesarean sections has risen — to more than 31 percent of all births as of 2006, up from 21 percent a decade earlier — researchers have begun to look more closely at what more surgical births means for the health of mothers and infants.

A study we discussed earlier this month found that early, elective caesarean surgeries scheduled before 39 weeks of pregnancy can be harmful to a baby’s health.

And now a new study published in the February issue of Obstetrics & Gynecology paints a worrisome though incomplete picture concerning health complications in mothers who undergo c-sections.

Less than 1 percent of women giving birth experience severe complications, but the rate has increased between 1998, when it was 0.64 percent, and 2005, when it was 0.81 percent. Researchers examined hospital discharges nationwide and discovered an increase in the rates of kidney failure, respiratory distress syndrome, shock and ventilator use associated with childbirth.

While the study was not designed to determine the cause, Dr. Susan Meikle, study co-author and medical officer at the Eunice Kennedy Shriver National Institute of Child Health and Human Development, said some complications may be associated with the rising rate of c-sections. Rising maternal age was not found to be a factor.

“We could do a better job at tracking these complications,” Meikle told USA Today. “There may be short-term trade-offs and long-term trade-offs (depending on mode of delivery). We don’t know that yet.”

HealthDay News breaks down the numbers:

The biggest jump occurred in the need for blood transfusions, which went up by 92 percent. The next biggest increase was in pulmonary embolism, which increased 52 percent during the study period.

“Pulmonary embolism is a complication associated with any type of surgery, and it’s a high contributor to maternal mortality,” Meikle said.

The percentage of women in respiratory distress after delivery jumped by 26 percent, and the rate of women who needed mechanical ventilation went up by 21 percent. The rate of women with kidney failure after delivery increased by 21 percent during the study period.

“It was just amazing the consistency .ƒ.. from vaginal delivery, where the rates were lowest, to repeat Caesareans, where we saw an increase, to primary Caesarean delivery, where the increases were the highest,” Meikle told the Chicago Tribune.

Researchers don’t know why the c-sections were performed — including whether they were elective — or if the mothers were sick beforehand. They also lacked data on race and whether the women were overweight.

“This is an interesting study, but the database isn’t complete,” Dr. Robert Welch, chairman of obstetrics and gynecology at Providence Hospital in Southfield, Mich., told HealthDay News, adding that the study highlights that the risks of c-sections “sometimes get downplayed. It’s often taken as just a step above natural childbirth, but it is a major abdominal operation that needs to be respected, and hospitals need to be prepared to deal with severe complications.”

Plus: Citizens for Midwifery points to a BBC article about the rising rates of induction in the UK, particularly in Scotland, and concerns that pregnant women are being induced “unnecessarily.” Researchers looking at a Scottish audit of 17,000 births could not find a medical or other explanation for the procedure in more than one quarter of the cases.


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