From Our 2011 Archives
High C-Section Rates Aren't Linked to Healthier Babies
Researchers Don't See a Link Between High C-Section Rates and Better Health of Newborns
By Denise Mann
Reviewed by Laura J. Martin, MD
April 15, 2011 -- High rates of induction of labor and/or cesarean section delivery in low-risk pregnant women may not necessarily lead to healthier newborns, a study shows.
The study is published in the April issue of the Journal of Maternal-Fetal and Neonatal Medicine.
"Whether a hospital had high or low labor induction rates or high or low C-section rates didn't seem to make any difference to the baby," says study researcher J. Christopher Glantz, MD, MPH, a professor of maternal-fetal medicine at University of Rochester School of Medicine. "If you don't improve the health of the baby by doing these things, why not try for a lower rate?"
Glantz analyzed the rates of labor induction and C-section delivery in 10 hospitals in the Finger Lakes region of New York between 2004 and 2008. Rates of these interventions varied greatly among the 10 hospitals, but had no bearing on the health of the newborns.
Women in the study were considered low risk for complications and were delivering at hospitals without neonatal intensive care (NICU) units. Newborns were no more likely to be transferred to a nearby NICU, require help breathing, or have a low Apgar score (a measure of newborn well-being) if their hospital had high or low rates of these interventions.
"Pregnancy is a normal thing and should be able to progress on its own, and if given the chance, most of the time that is what happens," Glantz says.
There are a few ways that a doctor can induce labor, including use of medicine to help soften the cervix so it dilates.
"Labor induction can take days and sometimes it doesn't work at all and you wind up with a cesarean section that wouldn't have happened if you let nature make the call," he says.
Elective C-sections on the Rise
In recent years, rates of both labor induction and C-section have increased. "A lot of patients have become much more accepting of interventions and are asking to be induced or have a C-section," Glantz says. "Socially there is a much stronger acceptance and demand for these procedures, and some is out of convenience on the doctor and patient side."
"I am not saying that no inductions or cesarean sections are beneficial, I'm certain some are," he says. "Be clear what the reason is if your obstetrician is suggesting an induction or cesarean section," he says. "If it is done for marginal reasons or convenience, I don't think that is a good reason and women should not agree."
John Weitzner, MD, an obstetrician/gynecologist at Rush University Medical Center in Chicago, has some issues with the way the new study was designed and the conclusions.
The new study did not look at still births, which could have skewed the findings. "A vaginal delivery is preferable if everything is going well, but to say 'I'm not going to have a C-section' because of a study like this is an error in judgment," he says.
Doctors take many factors into consideration before inducing labor or performing a C-section. "We look at how labor is progressing and if the baby's heartbeat is looking good. And if there are problems that interfere with a safe vaginal delivery, a cesarean section should be performed," he says.
SOURCES: Glantz, J.C. Journal of Maternal-Fetal and Neonatal Medicine, 2011; vol 24: pp 636-642.J. Christopher Glantz, MD, MPH, professor, maternal fetal medicine, University of Rochester School of Medicine, N.Y.John Weitzner, MD, obstetrician/gynecologist, Rush University Medical Center, Chicago.