Archive for the ‘elective caesarean delivery’ Category

Nationwide Push to Curb Elective Early Deliveries

Wednesday, March 16th, 2011

Image by SoulPrintsPhotography

I recently overheard a mother talking about her child’s upcoming birth.  She was pregnant with her fourth child and was a few days away from her due date.  Another mother was asking her about whether she was concerned about when she would go into labor.  The pregnant mother explained that she was scheduled to have a planned caesarean section, since for medical reasons her prior three children had already been born via caesarean section.  What was interesting and surprising about this conversation was that the mother went on to explain that she was scheduled to give birth to the baby a week later, four days after her due date.

The mother clearly stated that she specifically requested a delivery date after her due date.  I was surprised and impressed by this mother’s decision and the explanation that she gave to the other mother about her choice.  She said that her first child was born by unscheduled caesarean section following an attempted induction two weeks after her due date.  She then had each of her subsequent children by planned caesareans – the next on the due date, the third a few days after the due date and this one planned for 4 days after the due date.  She explained that she liked to wait as long as possible before having the caesarean sections for each of her children.  I don’t know if this mom was up to date on the recent research in this area or if she had other reasons that she chose to delay delivery.  However, her choices seem very sound based on current research that shows that too many moms are having elective deliveries before their due dates.  These deliveries before a baby is full term can increase the risk of complications to mother and baby and lead to longer hospital stays.

A recent article on a Wall Street Journal Health Blog discusses the current nationwide push to inform mothers about the risks of elective delivery before 39 weeks of gestation.  Another Wall Street Journal article highlights what a large number of births this might impact as “’early term’ elective inductions…[now] account for about a quarter of births, up from less than 10% in 1990.”  The number of elective deliveries is large and so are the complications:

Now, a growing body of medical evidence indicates that gestation even a few days short of a full 39 weeks can lead to short- and long-term health risks. Public health officials, safety advocates, private insurers and employer groups are stepping up pressure to sharply reduce early term deliveries. The practice drives up costs of neonatal intensive care and leads to a higher rate of caesarean sections. C-sections are more expensive than natural deliveries and result in longer hospital stays and more risks for the mother, including infection. A study last year estimated that reducing early term births to 1.7% could save close to $1 billion annually.

The current research, including a study published in the Journal of Reproductive Medicine, is influencing a campaign to stop doctors and hospitals from allowing elective deliveries before 39 weeks to better protect mothers and babies, as well as to cut unnecessary costs.

What do you think?  I can certainly sympathize with mothers who are uncomfortable at the end of a pregnancy and are ready for delivery.  However, I cannot imagine that many mothers, faced with the information about risks to themselves and their babies, would not be willing to stay pregnant for another week or two.  I wonder if a clear and widespread public education campaign targeted at mothers would not dramatically decrease the number of elective early deliveries?