Early Cesareans Pose Risks to Newborns

The above is a headline from the January 8, 2009 issue of the New York Times. The Times article is based on a study published that same day in the New England Journal of Medicine. The study and articles note that the increasing trend of scheduling cesarean births early for convenience poses a health risk to the baby.

The study found that babies who were born by cesarean at 37 weeks, were twice as likely to suffer respiratory complications than babies born at 39 weeks. This even though many consider 37 weeks to represent full term. Even one week makes a difference as babies born by cesarean at 38 weeks were still 50 percent more likely to suffer such problems. The articles noted that the complications included such things as respiratory distress, infections, hypoglycemia, as well as being admitted to the neonatal intensive care unit, or being hospitalized for five or more days.

The Times article noted that 30 percent of deliveries were done by cesarean section in 2006, up from 20.7 percent in 1996. Additionally, although not all are elective, about 40 percent of the 1.3 million cesareans performed in the United States each year are repeat procedures. The concern raised is that more cesareans are being scheduled early out of convenience.

Dr. Alan T.N. Tita, the study lead author and an assistant professor of obstetrics and gynecology at the University of Alabama at Birmingham, stated, "There is an understanding that for a baby born at [full] term, the risks are really very low, and many people may just assume that outcomes at 37 weeks may be the same as at 39 weeks. We know that is not true."

The study showed that 15.3 percent of babies delivered at 37 weeks suffered a complication of some kind, compared with 11 percent of those born at 38 weeks and only 7.3 percent of those born at 40 weeks. Dr. Tita recommended, "Faced with the likelihood that there is no other problem, I think its prudent to wait until 39 weeks to avoid subjecting these babies to adverse outcomes."

Dr. Michael Greene, director of obstetrics at Massachusetts General Hospital, wrote an editorial that accompanied the article in the New England Journal of Medicine. In it he notes that many doctors probably do not realize that there is a risk from this early intervention. He noted, "I would bet if you ask the first 10 obstetricians on the street if they thought it would make a difference to deliver a baby in the second half of the 38th week and the first half of the 39th week, they'd say, 'Nah, it's not a big difference'," he said. "This study, because of its size and numbers, is able to say, Yeah, it does make a difference."