The news today that early elective cesarean sections pose serious risks to newborns should have every pregnant woman on high alert. The study, published in the New England Journal of Medicine , found that babies delivered via a scheduled C-section before the 39th week of pregnancy were more likely to have breathing problems that required a ventilator, infections, and low blood sugar.
There's nothing new in that finding. Previous studies have shown the same thing—which is why the American College of Obstetricians and Gynecologists recommends against scheduling C-sections more than a week before a woman's due date. What's highly troubling, though, is that 36 percent of the more than 24,000 elective C-sections studied (in which the surgery was performed for no good medical reason) were done before 39 weeks—in flagrant disregard of ACOG's sensible guidelines.
Many of the news reports, like this one in the Wall Street Journal, blame women for having their C-sections too early. They say that women schedule delivery early to get the doctor of their choice or because they can't stand being pregnant once they've reached full term, defined as 37 weeks.
Yet, the reporting I've done on this issue suggests otherwise. C-sections have risen precipitously in recent years from 1 in 5 deliveries a decade ago to 1 in 3 today. Much of this rise can be attributed to doctors who like the predictability of C-sections; they're faster, neater, and generally simpler than vaginal births and less likely to lead to expensive malpractice suits. And while it's true that an estimated 3 percent of women actually request to have C-sections over vaginal deliveries—for the convenience or to avoid the pain of labor—the rest of us prefer to give birth the natural way, thank you very much.
As for scheduling those elective C-sections early, the onus falls on the obstetrician to follow the best medical practices. Clearly, many aren't, and they shouldn't be placing the blame on their patients. I think if women understood the real risks to their babies, they'd be happy to settle for a different doctor.
On a separate issue, the researchers also pointed out that babies born via C-section are—even when delivered on their due dates—at increased risk of respiratory problems, especially if they're delivered before a woman goes into labor. (This could be because certain stress hormones released right before and during labor help with a baby's lung maturation.) Many doctors are reluctant to allow a woman to go into labor if they know she's going to have a C-section.
So what should you do if you're pregnant and facing a C-section? Discuss the new research with your doctor, and come up with a delivery plan that's safest for both you and your baby. Doctor choice, timing, and convenience should be low down on your priority list. And your doctor's, too.