C-Sections Might Put Preemies at Risk for Breathing Problems

THURSDAY, Feb. 9 (HealthDay News) — Small, premature infants
born by cesarean section are at 30 percent higher risk for serious
breathing problems than those delivered vaginally, a new study finds.

Respiratory distress syndrome, which mostly affects premature newborns
and can lead to ongoing breathing problems, blindness and brain damage,
was more common in the babies born by cesarean, or C-section, delivery,
researchers found.

“I would say that we at least showed that there may not be any benefit
to cesarean delivery in preterm births, and more research is needed before
the C-section rate goes up even further,” said study leader Dr. Erika
Werner, an assistant professor of maternal-fetal medicine at the Johns
Hopkins School of Medicine in Baltimore.

Between 2002 and 2009, cesarean deliveries in the United States rose
from 27 percent of births to 34 percent, according to a HealthGrades
report. The U.S. Centers for Disease Control and Prevention recently
reported a dip in rates to slightly under 33 percent in 2010.

Groups such as the American Congress of Obstetricians and Gynecologists
are trying to curb cesarean deliveries, but without much success.

“I’m acutely aware as a clinician that the C-section rate is rising,
and there were prior studies that really had mixed results,” Werner said.
“Some suggested an increased risk of bleeding in the brain and some
suggested increased risk of death in this population with a vaginal
delivery. So I really wanted to look at a contemporary, diverse
population.”

The researchers analyzed birth data on 2,560 small-for-gestational-age
babies delivered between 25 and 34 weeks of pregnancy in New York City
hospitals from 1995 to 2003. (Before 37 weeks is considered preterm).
Forty-six percent were delivered vaginally and 54 percent by C-section.
The study only looked at live births and excluded mothers who had a
previous cesarean delivery.

Vaginal deliveries that used forceps or vacuum were excluded from the
study, but they’re not usually a factor with such small newborns, Werner
explained.

The study found no difference in the incidence of brain bleeds, seizure
or sepsis between the two types of delivery. While cesarean-delivered
babies had lower Apgar scores — a measure of newborn health — the
difference was not significant after taking other factors into account.
But the higher risk of respiratory distress syndrome still held.

The study is slated for presentation Thursday at the annual meeting of
the Society for Maternal-Fetal Medicine in Dallas.

Dr. Diane Ashton, deputy medical director of the March of Dimes, who
was not involved in the new study, said the results echo other recent
findings.

“This particular study shows that for infants that are premature and
small-for-gestational-age, which tend to be thought of as rather fragile
infants, the cesarean delivery doesn’t offer any protection from the
adverse outcomes,” Ashton said.

In general, the March of Dimes stance “is that elective deliveries —
and that’s cesarean sections and inductions — should not occur for
infants born before 39 weeks unless there’s a medical indication,” she
noted.

“For those instances where there is a strong medical indication,
either because of the mother’s health or the fetus’ health, I think it’s
important that women understand that it’s a major surgery and that it can
be associated with complications,” Ashton added.

Werner said her team did a similar study on premature infants whose
weight fell in the normal range. “We had very similar outcomes, although
the respiratory distress was even more impressive and there was more of a
benefit to vaginal delivery,” she said.

Ashton said that vaginal birth helps babies breathe. “The process of
delivering babies vaginally and going through the birth canal and getting
the amniotic fluid out of the lungs can enhance their respiratory status,”
she explained.

While the new study found an association between cesarean deliveries
and breathing problems in preterm babies, it did not prove a
cause-and-effect relationship.

The study relied on birth certificate and hospital-discharge data. “We
don’t know if C-section just selects a population more at risk for
respiratory distress or if C-section causes respiratory distress. We can’t
tell which comes first in this kind of study,” Werner said.

Ashton said it’s not too soon for these and similar findings to
influence practice.

“Certainly there should be some review and maybe recommendations from
the American Congress of Obstetricians and Gynecologists as to where they
think practice should change,” Ashton said.

Data and conclusions presented at medical meetings should be viewed as
preliminary until published in a peer-reviewed medical journal.

More information

The U.S. National Library of Medicine has more about C-sections.

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