If you are considering an elective or non-emergency Cesarean section for the birth of your infant, make sure that the timing is right. Infants tend to do better after a scheduled Caesarean section if they are born no sooner than seven days before their due date.
Those that are delivered earlier than their due date had more complications, such as breathing problems, even though they were full term. Just a few days can make a difference.
These facts were reported by researchers in Thursday’s New England Journal of Medicine. The findings offer important guidance to the growing number of expectant mothers who face planned C-sections. Also, the study supports the recommendations that elective C-sections be scheduled after 39 weeks into the pregnancy unless tests show that the infant’s lungs are fully mature. The due date is normally set at 40 weeks gestation and infants are considered full term at 37 weeks.
One of the researchers, Dr. John Thorp from the University of North Carolina at Chapel Hill School of medicine, stated that he delivered a healthy baby girl on Tuesday after persuading her mother to wait just a few more days for the C-section, even thought the last week would have been more convenient for both the doctor and the mother. Thorp said that they both bit the bullet and did the C-section at the right time.
The rate of Caesarean sections today in the United States is at an all-time high, accounting for approximately 31 percent of all births. There are many reasons for this fact: the threat of malpractice lawsuits, older mothers, preference of mothers, multiple births, the doctor, and the risk of having a vaginal birth after having a previous Caesarean. In 2006, a government panel urged women not to settle on having a C-section without having a medical reason because surgery brings risks and babies that are born by Caesarean have a greater chance of respiratory problems.
In the recent study, the researchers led by Dr. Alan Tita of the University of Alabama at Birmingham examined a registry for C-sections from 19 academic medical centers to see how many of the procedures were being performed before the recommended 39 weeks and if the timing made any difference in the risk for complications. They focused on 13,258 women who had a single child with a planned Caesarean and who had previously gave birth the same way. Some cases where medical issues warranted the early or immediate delivery were excluded. The infants were then followed until they left the hospital or for four months.
The researchers found that approximately more than one-third of all the C-sections were performed before 39 weeks gestation. Those that were delivered at 37 weeks were twice as likely to have health problems such as infections, low blood sugar, breathing problems, or be in need of intensive care. Fifteen percent of the babies born at 37 weeks and 11 percent that were born at 38 weeks had complications in comparison to the 8 percent of babies delivered at 39 weeks. There was only one death of an infant that was born at 39 weeks.
The biggest difference was in the breathing problems, with a fourfold increase for those born at 37 weeks compared to those that were delivered at 39 weeks. Babies delivered by C-sections are already at a higher risk of breathing trouble than those born vaginally because the act of labor help clear the lungs of fluid.
The researchers stated that the risk for complications also increased for the babies born after 41 weeks, but there were few births that were in this category.
Tita said that the researchers did not know the reasons behind the chosen delivery dates, but they speculated that some of the mothers might want to deliver as soon their baby reached full term or that an earlier time may have been more convenient for the physician or mother.
Dr. Michael Greene, from the Massachusetts General Hospital in Boston, noted that the research showed that there is even an increased risk of complication within the last few days before the 39th week of gestation. He also said that this is something most doctors would not suspect. “I generally try to wait to 39 weeks, although I confess that I’m as guilty as anybody else with a busy practice and scheduling being what it is. I really hadn’t thought much about it until now,” said Green, who wrote an accompanying editorial in the journal in which the study was published.
The new study only looked at the live births, and did not account for the small risk of the baby dying while waiting to reach the 39 weeks. That risk has been estimated up to 1 in 1,000 births.
