Study: Early Repeat C-Sections Puts Babies At Risk

A new study published in the New England Journal of Medicine reports that elective, repeat C-sections performed earlier than the recommended 39 weeks increases the risk of complications for newborns. Dr. Catherine Spong, co-author of the study, says babies born under these conditions see double the risk of "adverse outcomes" such as nenonatal death.

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MELISSA BLOCK, host:

From NPR News, this is All Things Considered. I'm Melissa Block.

MICHELE NORRIS, host:

And I'm Michele Norris. The practice of scheduling an elective cesarean birth can increase the risk of complications for infants, particularly if the mother has had a cesarean delivery in the past. The study finds that these babies face increased risk of health problems if they're delivered before 39 weeks into the pregnancy. Dr. Catherine Spong is the chief of the pregnancy and perinatology branch at the National Institute of Child Health and Human Development. She's also the co-author of the study that appears in the current issue of the New England Journal of Medicine. Welcome to the program, Dr. Spong.

Dr. CATHERINE SPONG (Chief, Pregnancy and Perinatology Branch, National Institute of Child Health and Human Development): Thank you.

NORRIS: First, let's qualify who participated in this study. These were not women who actually required a C-section at the time of delivery. Is that correct?

Dr. SPONG: That's exactly right. So these are women who had a cesarean delivery in the past and opted to have another cesarean delivery. They had no indication for their cesarean, no obstetrical reason, no medical reason requiring a cesarean birth, and they did not experience labor. So, they're termed elective repeat cesarean deliveries.

The American College of OB/GYN recommends that when you're going to schedule an elective repeat cesarean, you wait until 39 weeks. What we found in this study was that when a baby was born early, at, say, 37 weeks or 38 weeks, by an elective repeat cesarean for no indication, they had a doubling of their risk of an adverse outcome.

NORRIS: And when we talk about adverse outcomes, what exactly are we talking about?

Dr. SPONG: The primary outcome that was studied was a composition of neonatal death as well as other adverse problems such as difficulty breathing, low blood sugar, infections such as newborn sepsis where there is an infection in the baby's blood or an evaluation for sepsis, and admission to the intensive care unit. This occurred in 15 percent of the babies who were born at 37 weeks, 11 percent of those who were born at 38 weeks, eight percent of those who were born at 39 weeks, and 7.3 percent of those who were born at term.

NORRIS: And because anyone that's heading for a cesarean will probably be listening to this conversation very carefully, I just want to be clear, there was only one death in the study, though, in 13,000 deliveries. Is that correct?

Dr. SPONG: Yes. Yes.

NORRIS: Now, these complications, how might they affect the health of the child over the long term?

Dr. SPONG: In the majority, these babies are all going to be healthy. They are from pregnancies that are uncomplicated. This study only evaluated them in the short-term outcome. Most of these outcomes would be easily treated. Some may require longer stays in the intensive care unit. Not only are there implications for the baby because of the risks, but also the interaction between the bonding of the mom and the baby, and the family and the baby and, of course, the costs required for these stays in the intensive care unit.

NORRIS: Doctor, I just want to ask you a question about the timing here. The American College of Obstetricians and Gynecologists recommends that elective C-sections not be performed before 39 weeks. A baby is considered due at 40 weeks. So, why are women and their doctors opting to schedule their surgeries earlier at 38 or even 37 weeks?

Dr. SPONG: We didn't study why these babies were born early. It may be for, as an example, if a mom were to turn 39 weeks on a Sunday and she wanted a specific doctor to deliver her and she wanted to be delivered on that Friday, one might think that it was OK to do that delivery because you're very close to the 39th week. You're two days away from it.

One of the things from this study that we found, though, we looked at those last three days - the 38 and four, 38 and five, and 38 and sixth days of pregnancy - and found that there was actually a 20 percent increase in risk, even delivering that late, that close to the 39th week.

NORRIS: Dr. Spong, thank you very much for your time.

Dr. SPONG: Thank you so much.

NORRIS: Dr. Catherine Spong is co-author of a study on the risks of early elective repeat C-sections that appears in the current issue of the New England Journal of Medicine.

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