. . . Neonatal mortality rates were higher among infants delivered by cesarean section (1.77 per 1,000 live births) than for those delivered vaginally (0.62). The magnitude of this difference was reduced only moderately on statistical adjustment for demographic and medical factors, and when deaths due to congenital malformations and events with Apgar scores less than 4 were excluded. The cesarean/vaginal mortality differential was widespread, and not confined to a few causes of death . . .
In other words, when comparing otherwise "low-risk" deliveries (singleton, full-term, no medical risks or complications), a baby delivered by c-section has a 2.85x chance of dying in the first month. The study analyzed 11,897 deaths out of 5.7 million deliveries. That's thousands of babies who died with no discernable risk indicator other than their surgical delivery. The study doesn't ask the real question -- why are healthy mothers having surgery instead of giving birth to healthy babies? It's common knowledge that c-section rates are skyrocketing, even though this is driving up public health care costs. The American College of Obstetrics and Gynecology virtually forces repeat c-sections even though their policy doesn't save lives of mothers or babies. It's so rampant that the latest issue of "Birth: Issues in Perinatal Care" published a roundtable on the subject of Why Do Women Go Along with This Stuff?
Why?
How long before the "standard of care" for childbirth -- the legal duty we use to judge whether a doctor made a mistake -- reflects the scientific evidence? Are 3,000 dead infants enough to get someone's attention? Because that's what I see when I do the math. As long as experts tell malpractice juries that a c-section is a safe and surefire way to save a baby's life, insurance companies will be covering their own butts with their "when in doubt, cut it out" policies.
As long as our culture accepts surgical delivery as normal and healthy, we're going to keep having this "issue" with birth -- if a doubled infant death rate can be called an "issue."
UPDATE: More numbers came out today. . . this from the journal Obstetrics and Gynecology: C-section moms have a triple death rate .
2 comments:
I haven't read the report (and don't know if I'd understand it if I did), but I assume that it offers no hypothesis regarding what causes the link between c-sections and higher early mortality. Hopefully, finding such a scientific link will be the next step. And you're right: If there's ANY evidence that c-sections performed on healthy mothers with healthy babies actually causes early death, a new category of personal injury litigation will be born. (Forgive the pun.) Then the insurance carriers will have to throw out their bad baby risk-avoidance playbook.
The link between c-sections and higher maternal mortality is pretty simple. It's major abdominal surgery, with all its inherent risks (anesthesia, clotting, infection, etc.).
I would venture a guess that the link between infant mortality and c-section is going to be similar. Babies born by c-section are often born without a trial of labor. Trial of labor would indicate that baby was ready to be born--it had initiated the parturition process. Babies born by elective C, for the convenience of the mother or doctor, or C for "macrosomia" or "cephalopelvic disproportion" are often taken before term. If dates are wrong at all with the mom, or she's got a longer-baking oven, well then, you've got a pre-term baby and all those problems and risks.
Bah. I was thinking about those studies, too, and wondering what sort of play they're going to get in the US obstetrical community.
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