Monday, January 12, 2009

Cesareans At 38 Weeks Risks To Baby

In a recent issue of the New England Journal of Medicine (Jan 8, 2009), experts say it is common for women to undergo cesarean deliveries before the baby has reached the appropriate gestational age because of their desire to give birth and because of obstetricians' desires to schedule the procedure at a convenient time. Delaying the procedure until 39 weeks of gestation decreases neonatal morbidity.

Study authors also found, however, that delaying delivery beyond 40 weeks is linked to increased rates of adverse outcomes. Testing for fetal lung maturity can help determine whether the time is appropriate.

A study of nearly 25,000 cesarean deliveries revealed that when compared with the births at 39 weeks, births at 37 and 38 weeks experienced increased risks. "As compared with infants born vaginally, those born by cesarean section are at increased risk for adverse respiratory outcomes, especially when the delivery occurs before the onset of labor," study authors noted.

It is important for doulas, childbirth educators and office nurses to educate expectant mothers about the need to understand the growth and anatomy of the baby's development and respect that growth and development. Generally, for infants, it is best that they stay in growing in the uterus as long as possible. This means that inductions around 36 or 37 weeks need to be assessed for feasibility and the question, "what if the induction fails?" needs to be asked.

What if an induction fails at 36-37 weeks? For most women, a failed induction results in a cesarean section.

It is important here to note that cesareans are life saving surgeries. However, the rate of cesarean delivery in the United States has increased dramatically, from 20.7 percent in 1996 to 31.1 percent in 2006. And this increase has not positively impacted the maternal mortality/morbidity or infant mortality/morbidity. Hence, there is a question as to the validation of the increase.

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