If a C-section, then best for baby when close to due date

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Timing of Elective Repeat Cesarean Delivery and Neonatal Outcomes

<http://content.nejm.org/cgi/content/short/360/2/111>

As compared with deliveries at or after 39 weeks, cesarean deliveries

before 39 weeks of gestation were associated with an increased risk of a

composite primary outcome that included neonatal death, respiratory

complications, need for mechanical ventilation, treated hypoglycemia,

newborn sepsis, and admission to the neonatal intensive care unit.

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C-sections best for baby when close to due date*

By STEPHANIE NANO Associated Press Writer

01/07/2009

http://www.denverpost.com/healthcare/ci_11398827

NEW YORK---Babies do better after a scheduled Caesarean section if

they're born no sooner than seven days before their due date, a new

large study of U.S. births shows. Those delivered earlier had more

complications, including breathing problems, even though they were full

term, the researchers reported in Thursday's New England Journal of

Medicine. Even just a few days made a difference, they said.

The findings offer important guidance to the growing number of women who

face planned C-sections. And the study supports recommendations that

elective C-sections be scheduled after 39 weeks unless tests show the

infant's lungs are fully mature. Due dates are set at 40 weeks gestation

and infants are full term at 37 weeks.

" Take your due date and subtract seven and any one of those seven days

is fine, " said one of the researchers, Dr. Thorp, of the University

of North Carolina at Chapel Hill School of Medicine.

He delivered a healthy baby girl on Tuesday after persuading her mother

to wait a few more days for a C-section, even though last week would

have been more convenient for both mother and doctor.

" We bit the bullet and did it at the right time, " said Thorp.

The rate of Caesarean sections in the United States is at an all-time

high, accounting for about 31 percent of births. There are lots of

reasons: older moms, multiple births, the threat of malpractice

lawsuits, the preference of mothers and doctors and the risks of having

a vaginal birth after a previous Caesarean. In 2006, a government panel

urged women not to seek a C-section without a medical reason; surgery

brings risks and babies born by Caesarean have a greater chance for

respiratory problems.

In the new study, the researchers, led by Dr. Alan Tita of the

University of Alabama at Birmingham, examined a C-section registry from

19 academic medical centers to see how many of the surgeries were being

done before the recommended 39 weeks and if the timing made a difference

in the risk of complications.

They focused on 13,258 women who had a single child at a planned

Caesarean and who had previously given birth the same way. Excluded were

cases where medical issues warranted an early or immediate delivery. The

infants were followed until they left the hospital or for four months.

More than a third of the C-sections were performed before 39 weeks, the

researchers found. Those delivered at 37 weeks were twice as likely to

have health problems, including breathing troubles, infections, low

blood sugar or the need for intensive care. Fifteen percent of those

born at 37 weeks and 11 percent born at 38 weeks had complications,

compared to 8 percent of the babies delivered at 39 weeks. The only

death was an infant born at 39 weeks.

The biggest difference was in breathing problems, with a fourfold

increase for those born at 37 weeks compared to 39 weeks. Babies born by

C-section already have a higher risk of breathing trouble than those

born vaginally; labor helps clear the lungs of fluid.

The risk of complications also increased for births after 41 weeks, but

there were few births in that category, the researchers said.

Tita said the researchers didn't know the reasons behind the chosen

delivery dates. They speculated that some mothers might want to deliver

as soon as the fetus reaches full term, or an earlier time may have been

more convenient for the mother or doctor.

Dr. Greene, of Massachusetts General Hospital in Boston, noted

the research showed that there's even an increased risk of complications

in the last few days before the 39th week. That's something most doctors

wouldn't suspect, he said.

" I generally try to wait to 39 weeks, although I confess that I'm as

guilty as anybody else with a busy practice and scheduling being what it

is, " said Greene, who wrote an accompanying editorial in the journal. " I

really hadn't thought much about it until now. "

The study only looked at live births, and didn't account for the small

risk of the fetus dying while waiting to reach 39 weeks, Greene said.

That risk has been estimated up to 1 in 1,000, he said.

Thorp's patient in Chapel Hill, Eubanks, said she was glad that

she held off a few days to reach the 39-week threshold before having her

daughter, Kathleen Conley Eubanks. Her first child, 2-year-old Charlie,

was born by C-section.

" It was hard to wait, " said Eubanks, business manager of the political

science department at the university. " I was very over being pregnant

and ready to get the show on the road. "

And she had another reason for wanting to deliver last week.

As an accountant, " It just killed me not to have this kid in 2008 " to

get the tax deduction, Eubanks said hours after delivering.

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