Once you have had a cesarean, it is more likely today for you to have another one. Even though it has been common practice to schedule the subsequent cesarean earlier than 40 weeks, new research is now showing that cesareans scheduled too early can be harmful to the baby. In essence the trade-off of performing the cesarean early (to avoid labor and potentially prevent stillbirth) also increases the baby’s chances of preterm birth.
New Research Shows Clear Evidence of Risk for Early Elective Cesareans
The January 2009 issue of the New England Journal of Medicine includes new research on the phenomenon of the early elective cesarean. This large-scale study was conducted over a 3 year period from 1999 to 2002 with over 13,000 mothers who had elective cesareans participating. In this study, over 1/3 of the mothers had an early elective cesarean prior to 39 weeks. In comparing the groups of mothers who had elective cesareans at 37, 38 and 39 weeks, the babies who were born at 37 or 38 weeks had an increased risk of the following:
- hospital stays for 5 days or longer
- respiratory/breathing complications
- neonatal sepsis (serious infection)
- mechanical ventilation (assistance with breathing)
- hypoglycemia (low blood sugar)
- admission to the NICU
In fact, mothers who have an early elective cesarean at 37 weeks have double the risk of breathing problems, low blood sugar and infection in their newborns.
New Recommendations for Mothers and their Obstetricians for Elective Cesareans
While it is recognized that scheduling cesareans is often done at a time when the mother’s obstetrician is available, the study’s lead author, Dr. Alan Tita cautions against this. “We have to not fool around with this. The baby may not be ready. This study’s findings underline that the ACOG guidelines are appropriate. In the absence of complications, it’s probably optimal to wait until 39 weeks to undergo elective Caesarean,” Tita says.
ACOG guidelines specify that that if a cesarean is recommended prior to 39 weeks, an amniocentesis should be performed to see if the baby’s lungs are mature. This research indicates that these ACOG guidelines with regard to checking for lung maturity are not currently being followed across the board.
Waiting Until Baby is Ready Before Doing a Cesarean
Another concept might be to wait until the baby is ready and also for the mother’s labor to start. While this concept holds little appeal to care providers who like to schedule surgery during the day rather that be performing cesareans at 2 am, the baby will benefit from labor.
Mother’s stress hormones secreted during labor, known as catecholamines, act to prepare the human body for “fight-or-flight'” In labor, these catecholamines help to stimulate the baby’s body to begin to function on its own. One of the most effective ways the mother’s stress hormones prepare baby is to stimulate the baby’s lungs for breathing. Catecholamines during labor remove lung fluid and increase lung surfactant to expand baby’s lungs.
Encouraging Mothers to Have a VBAC
In an age where we should be more interested in the health of mothers and babies versus convenience, we should be also encouraging more mothers (in the absence of a medical indication) to have a trial of labor and to consider VBAC – vaginal birth after cesarean. This is another way to reduce the number of neonatal complications caused by unnecessary early elective cesareans.
Are you planning to have an elective cesarean with this pregnancy? When would you like to have the cesarean performed? Leave a comment here.