Birth Injuries e-Resource

NIH on Monday opened a three-day meeting that aimed to determine what is known about the dangers and advantages of pre-planned c-sections and how to ensure that pregnant women receive appropriate information about the procedure (Kaiser Daily Women's Health Policy Report, 3/28). A panel of 18 independent experts defined an elective c-section as "a [c]aesarean delivery for a pregnancy with a single baby at the mother's request when she has no established medical indication for the procedure," according to an NIH release (NIH release, 3/29). "Limited evidence suggests that [elective c-section] is increasing, but it is unclear why," the panel wrote in the report, estimating that elective c-sections account for 4% to 18% of all c-sections performed in the U.S. (Rubin, USA Today, 3/30).

Risks, Benefits of C-Section, Vaginal Delivery
According to the report, elective c-sections substantially increase the risk of a life-threatening placenta complication in a later pregnancy and thus should be avoided by women planning to have multiple children, the AP/Forbes reports. C-sections also can increase an infant's risk of respiratory problems and doctors should perform an elective c-section only if the fetus' lungs are fully developed, the report says (Neergaard, AP/Forbes, 3/29). The benefits of c-section compared with vaginal delivery include reduced risk of hemorrhaging and certain birth injuries. The panel wrote that women "should not be motivated by unavailability of effective pain management" when deciding to have an elective c-section, adding, "Efforts must be made to assure availability of pain management services for all women" (NIH release, 3/29). If a pregnant woman requests a c-section, the health provider should counsel her on both risks and benefits, the panel said (CQ HealthBeat, 3/29).

Recommendations
The panel included several recommendations for further research to address the lack of information on elective c-sections, including:

Conducting surveys of women, providers, insurers and health care facilities before and after delivery regarding the procedure;

Creating plans to foresee the chances of a vaginal delivery without complications;

Developing accurate records of the procedure;

Evaluating existing databases to calculate previous incidences of complications and unsuccessful outcomes;

Assessing costs of the procedure (NIH release, 3/29); and

Establishing a Web site to offer information on all types of deliveries (Talan, Long Island Newsday, 3/30).

Reaction
"We don't believe [c-sections] should be discouraged or encouraged," Mary D'Alton, obstetrics chief at Columbia University Medical Center, who chaired the panel, said (AP/Forbes, 3/29). Some health advocates hailed the report for providing women with choices in how they deliver their infants, while opponents who say c-sections are risky and overused refuted the report (Washington Post, 3/30).

Newsweek Examines Increased Number of Elective C-Sections, Risks Associated With Procedure
Newsweek in its April 3 edition examines how c-sections, in spite of the associated risks, have "increasingly become a matter of choice, not necessity." Even though fewer than one in 10 c-sections is elective, the trend of scheduling c-sections because of convenience for the pregnant woman or fears associated with vaginal birth has "alarmed many" health professionals, Newsweek reports. Although the procedure, similar to any abdominal surgery, has risks -- including infections and bleeding -- there is controversy over how much risk is involved, according to Newsweek. Duane Alexander, a presenter at this week's NIH conference, said, "There are a lot of myths out there we hope to replace with strong scientific evidence" (Barrett, Newsweek, 4/3)

Several broadcast programs reported on the increasing number of elective c-sections:

ABCNews' "World News Tonight": The segment includes comments from Rebecca Brightman, OB/GYN at Mount Sinai School of Medicine, and a woman who had an elective c-section (McKenzie, "World News Tonight," ABCNews, 3/29). A related ABCNews story is available online. The complete segment is available online. Video of an expanded interview with Brightman is available online. In addition, video of an interview with Stephen Emery, OB/GYN at the Cleveland Clinic, is available online.

NBC's "Nightly News": The segment includes comments from D'Alton and a woman who had an elective c-section (Bazell, "Nightly News," NBC, 3/29). The complete segment is available online in Windows Media.

NPR's "Morning Edition": The segment includes comments from Michael Klein, family physician at the University of British Columbia; James Nicholson, a physician who attended the conference; and women who have planned or have had elective c-sections (Aubrey, "Morning Edition," NPR, 3/30).