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Elective Early Deliveries Pose Risks for Babies
Date:12/18/2008

C-sections done too soon can lead to respiratory trouble, other problems, doctors say

THURSDAY, Dec. 18 (HealthDay News) -- The rise in Caesarean deliveries could be fueling the increase in the number of preterm babies, and these early births carry risks, including respiratory problems, jaundice and developmental problems.

That was the message delivered Tuesday during a March of Dimes conference in New York City on the health risks facing preterm babies.

While babies are considered preterm if they are born before 37 weeks of gestation, even those born before 39 weeks -- called early term -- could be missing out on the last benefits of gestation, the doctors said.

"There is more and more data suggesting that there is lots of development between 37 and 39 weeks [of gestation]," said Dr. Laura E. Riley, medical director of labor and delivery at Massachusetts General Hospital, who spoke at the conference. It's in the best interest of the baby to stay in the womb for a full-term delivery, she said.

"It is very important for lay people to understand that every week counts, and that they shouldn't be cavalier about delivering early," added Dr. Lucky Jain, medical director of Emory Children's Center at Emory University School of Medicine in Atlanta. During the last weeks in the womb, the "fetus is going through last-minute preparations for a safe landing," he said.

From 1996 to 2004, there was an increase of almost 60,000 preterm deliveries -- those before 37 weeks of gestation -- among single-birth pregnancies. And more than 90 percent of those deliveries were done by Caesarean section, according to an analysis by the March of Dimes and the U.S. Centers for Disease Control and Prevention.

There could be several reasons for the increase in early C-sections, said Dr. Bryan T. Oshiro, chief of maternal-fetal medicine at Loma Linda University School of Medicine, in Loma Linda, Calif., who spoke at the conference. They include more surveillance to prevent stillbirths; changes in maternal demographics, including the fact that women weigh more; a rise in elective deliveries; and a presumption that after 34 weeks of gestation, there is little risk, he said.

But Oshiro and the other doctors said that, while many early C-sections are medically necessary for the health and safety of both the baby and the mother, families opting to deliver early for personal reasons need to know these early deliveries could put their babies at risk.

Oshiro said the pressure for elective deliveries can often come from families. "I find it hard when a woman wants to deliver before her husband goes to Iraq," he said. And obstetricians are busy and usually lack the time often needed to persuade a family that a full gestation is in the best interests of the baby.

"It's hard, because the odds are that the babies will be fine. Nine out of 10 are OK," he said. "But for medical issues, that's not good enough."

According to the March of Dimes, a baby's brain at 35 weeks' gestation weighs only two-thirds of what it will weigh at 39 weeks, and other organs like the lungs and liver are still growing late in pregnancy. Babies born at full term are also less likely to have vision and hearing problems. They also weigh more, making it easier for them to stay warm, the doctors said.

The doctors emphasized the importance of having a correct due date, especially if making a decision to deliver early. Try to remember the date of onset of the last menstrual period and have an ultrasound during the first 13 weeks of pregnancy. An early ultrasound will allow a doctor to predict an accurate delivery date, Oshiro said.

Oshiro pilots a program based in Utah that reduced preterm and early term C-sections from 27 percent to 5 percent from 1999 to 2005.

Key to the program's success, he said, has been discussing with doctors why they are recommending early C-sections, and alerting them to American College of Obstetricians and Gynecologists' guidelines that call for elective C-sections and inductions to be scheduled only after 39 weeks of gestation.

More information

Learn more about the risks of early delivery from the March of Dimes.



SOURCES: Laura E. Riley, M.D., medical director of labor and delivery, Massachusetts General Hospital, Boston; Lucky Jain, M.D., M.B.A., medical director, Emory Children's Center, Emory University School of Medicine, Atlanta; Bryan T. Oshiro, M.D., associate professor, and chief, department of gynecology and obstetrics, Loma Linda University School of Medicine, Loma Linda, Calif.; Dec. 16, 2008, March of Dimes conference, "C-Sections: A Critical Factor in the Rise of Preterm Birth?", New York City


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