Thursday, January 8, 2009

C-SECTIONS INCREASE BREATHING RISKS TO NEWBORN

C-SECTION INCREASE  BREATHNG RISKS TO NEWBORN

Women who choose a cesarean will place the fetus is at a higher risk for respiratory disorders. Breathing problems occur in 5% of those delivered at 38 weeks, and over 8% in those born at 37 weeks

In the past, C-sections were done only in the presence of impending fetal distress, preclampsia, or failure to progress in labor.  Caesarean sections often are medically necessary. They are done if the baby’s heart beats abnormally, or the baby is just too big. Labor can slow or stop. The placenta can be in the wrong place, or the umbilical cord can slip out first. They increase their risk of mortality by 400 percent of the rate of mortality for a natural birth

Yet, thirty one percent of all deliveries are now C-sections. Today 8 % of deliveries are elective repeat Sections.  In  1958 it was 3%, 1970 it was 5%, and in 1996 20%.

 Over a third of these operations are done over a week before the patient’s due dates (40 weeks).  The reason for earlier C-sections is the potential increase risk of the infant dying or being stillborn.  The real risk by waiting is the medical liability if a problem were to occur.  It is also more convenient for the doctor and the hospital to have the delivery during the daytime hours when the personnel at the hospital are at full staff.

No one blames a doctor for an early delivery and its fetal risks, but the legal liability of waiting to term and having a fetal problem are a lawyer dream to wealth. 

Advancements in medical technology have decreased immediate dangers of cesareans such as uterine hemorrhages or damage to surrounding organs, there are still many other health risks women should consider.

Obstetricians can attest that performing so many cesareans is certainly a lucrative business for them and it  helps the setting up a delivery schedule.

Malpractice fears, may also be pushing doctors to do c-sections sooner if any problems arise during labor.  The risk to mother and baby from either type of birth is low, but c-sections do carry greater dangers, including a higher risk that the mother will die.  Furthermore, fertility rates decrease sharply, which is discouraging for mothers who intend to have more than one child.

"A lot of women see a  c-section as just another way to have a baby. They don't see it as surgery.  Unnecessary c-sections increase the risk of a uterine rupture in the next delivery if the baby is to be born vaginally. Although not a huge risk, this is still painful and it could be prevented dramatically by the mother's willingness to undergo a vaginal birth. Scar tissue builds up, making surgery harder and making complications more likely.

In a natural childbirth, the contractions will force the baby's fluid filled lungs to expel the fluid in order to breathe normally in the outside world.  In a cesarean, however, the baby lacks this ability to strengthen its lungs. Furthermore, the transition from the womb to the outside is sudden and can increase the possibility of fetal shock.

Primary elective C-sections are chosen by the wealthy that want a scheduled date for delivery, or a patient over 35 and having her first pregnancy, or a fear of vaginal delivery, and a fear of potential loosening of the pelvic walls during delivery.   A daytime scheduled delivery   also allows the patient’s regular doctor to perform the surgery.

Other explanations patients choose C-sections include: the ease to arrange maternity leave, attempting to avoid delivery pains, fear that spouses or relatives will not keep them company, negative effects on sex life, and that c-sections are covered by their insurance.

Obstetricians can attest that performing so many cesareans is certainly a lucrative business for them.   Among other benefits for the obstetrician is the ease of setting up a delivery schedule.

 It seems today only the poor have vaginal delivery.  Over a third of first time mothers have C-sections, and then all their other pregnancies are C-sections with the increased risks of bleeding and rupture of the uterus. 

More women are requesting the procedure, and while many doctors are willing to do what they are asked, some promote a natural delivery .They think it's easier than pushing it out.  Cutting your stomach open is not something you easily get over.

Over the past 20 years, most mentors are gone who knew how to deliver vaginally, use forceps, do versions of a second twin, or deliver breaches.  The young doctors are deprived of being taught these skills during their residency training.  So for the patient’s sake, the best route today is a C-section. The patient and doctor need to discuss the tradeoff of risks and early delivery of their infant.

Source: NEJM Jan 7,2009

Visit my blog 1.08.08 "Should everyone have a C-section"

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