[Knoxville Doula]

Risk to Baby Rises With Repeat C-Sections
By Kathleen Doheny
HealthDay Reporter by Kathleen Doheny
healthday Reporter Thu May 21, 7:03 pm ET

THURSDAY, May 21 (HealthDay News) -- Babies delivered by elective, repeat cesarean section delivery are nearly twice as likely to be admitted to the neonatal intensive care unit (NICU) than those born vaginally after the mother has previously had a c-section, a new study finds.

These c-section babies are also more likely to have breathing problems requiring supplemental oxygen, the researchers say.

"In addition, the cost of the birth for both mother and infant was more expensive in the elective repeat c-section group compared to the vaginal birth after c-section (VBAC) group," noted Dr. Beena Kamath, the study's lead author and a clinical instructor of pediatrics at the University of Colorado School of Medicine, Denver.

The study appears in the June issue of Obstetrics & Gynecology.

Nationwide, the c-section delivery rate keeps rising. According to the study authors, by 2006, 31.1 percent of deliveries in the United States were done this way.

Furthermore, women who have delivered once by c-section have a greater than 90 percent chance of undergoing another, the authors noted. But experts continue to debate whether these women should try labor and vaginal delivery, or automatically undergo another c-section, as there are risks are associated with each method.

To help clarify those risks, Kamath and her colleagues turned to records from the perinatal database at the University of Colorado Denver. Those records ran from late 2005 through mid-2008 and focused on babies born to 343 women who had planned a repeat, elective c-section and another 329 who planned to try vaginal birth after having previously had a baby via c-section.

The researchers looked at the differences between groups in newborn admissions to the neonatal ICU and the need for oxygen for breathing problems, as well as cost differences.

Kamath's team further divided the women into four groups. Of the 343 repeat c-sections, 104 went into labor before the c-section and 239 did not. Of the 329 women who attempted vaginal delivery, 85 failed (for various reasons) and went on to have a c-section.

Kamath's team found that 9.3 percent of the c-section babies were admitted to the NICU, but just 4.9 percent of the vaginally delivered babies were. And while 41.5 percent of the c-section babies required oxygen in the delivery room, 23.2 percent of the vaginally delivered babies did. After NICU admission, 5.8 percent of the c-section babies needed the oxygen compared to 2.4 percent of the vaginally delivered babies.

The median hospital stay was three days for babies who were delivered vaginally and four days for the other three groups. Total costs for the c-section group averaged $8,268; for the vaginal group, $6,647.

"The failed VBAC babies required the most resuscitation and had the most expensive total birth experience," Kamath concluded. But, overall, the VBAC group did better than the c-section group in terms of hospital stay and other measures, she said.

Women who opt for a repeat c-section should first understand these risks and differences before they make their decision, Kamath said.

The study results suggest another important take-home point, according to Dr. Alan Fleischman, senior vice president and medical director for the March of Dimes, based in White Plains, N.Y. "The decision to have your first c-section is very important," he said. "There should be a clear medical indication [because] your first may dictate subsequent [delivery methods]."

Women also need to know that vaginal delivery is possible for many women who have already undergone a c-section, Fleischman said. Some hospitals do not allow vaginal delivery after a prior c-section, however, so he suggested that any woman who is planning on one find out early on what her hospital's policy is.

In the same issue of the journal, other researchers found that the chance of a pregnant woman having a hypertensive disorder -- such as high blood pressure that first occurs during the pregnancy -- has risen greatly in recent years, from about 67 per every 1,000 deliveries in 1998 to more than 81 per 1,000 deliveries in 2006.

This increase, in turn, is boosting the number of hospitalizations associated with health problems in the mother-to-be, such as kidney failure or breathing problems, according to researchers at the U.S. Centers for Disease Control and Prevention.

More information

To find out more about healthy pregnancies, visit the March of Dimes.
Copyright © 2009 Yahoo! Inc. All rig

[ClarissaNassar]

I hate to read things like this because for some women, like myself and my Mom, we just do not have the ability to pass a child through the birth canal.

With my 1st child, I was in labor for 16 hours and nothing was progressing--I was 2 weeks late and she was 8 lbs and 20" and I could not get her out--my body wouldnt even dialate to 10--I barely got to a 1 and that was WITH petocin...almost same exact situation with my 2nd child except I went into labor early--he was almost 9 lbs and his heartbeat was dropping so they got him out via c-section

I dont know why, but my babies just did not want to come out vaginally

[Chelziee]

Im with Clarissa. My kids were the same way, I had two very scary births. With my first I even had to have 2 blood transfusions. I tried very hard to have my 2 weeks past due baby (like Clarissa) with petocin and never got very far with in the natural birth process. Some women just cant do it. I was in labor for 32 hours with my first and it just was not going to happen.

[WombToBloom]

Is this geared more towards those who opt for c-section out of convenience? I'm pretty much on the sidelines here as we experienced vaginal childbirth...well, I should say my wife did, lol.

[ClarissaNassar]

ppl who choose c-sections for convienience are lucky to have a dr. who would do that! I think that your body will either do it or not, and if you are physically OK to give birth vaginally, it is a bit selfish to take the c-section route.

I wish that I could have experienced a vaginal birth at least once...but my body just wasnt having it :/

[originsdoula]

Clarissa,

I am sorry you had such difficult births. I do have to disagree that if you have a doctor who would be willing to do an elective c-section you are lucky. I think if you have a doctor who is willing to put you and your baby through an unneccesary surgery that has a higher risk of infection, injury, and even death that you should run for the hills and find another doctor.

[ClarissaNassar]

Originally Posted by originsdoula

Clarissa,

I am sorry you had such difficult births. I do have to disagree that if you have a doctor who would be willing to do an elective c-section you are lucky. I think if you have a doctor who is willing to put you and your baby through an unneccesary surgery that has a higher risk of infection, injury, and even death that you should run for the hills and find another doctor.

maybe "lucky" was the wrong word to use-- I meant that it is rare to find someone who will do it if you are OK to have a vaginal birth

No disrespect but, I really would love to see stats on c-sections being a "higher risk of infection, injury, and death" because I have no choice other than to have a c-section and it kinda makes me nervous because I really hadent heard of it being that risky.

[ClarissaNassar]

I guess my issue is that I have known at least 40 children who were born via c-section and none of them have had any problems at all..not mom and not baby

[originsdoula]

Originally Posted by ClarissaNassar

maybe "lucky" was the wrong word to use-- I meant that it is rare to find someone who will do it if you are OK to have a vaginal birth

No disrespect but, I really would love to see stats on c-sections being a "higher risk of infection, injury, and death" because I have no choice other than to have a c-section and it kinda makes me nervous because I really hadent heard of it being that risky.

Clarissa,

Here you go:

"A cesarean section poses documented medical risks to the mother's health, including infections, hemorrhage, transfusion, injury to other organs, anesthesia complications, psychological complications, and a maternal mortality two to four times greater than that for a vaginal birth. "

Cesarean Fact Sheet - Childbirth.org

" few women have one or more of these complications after a c-section:

Increased bleeding, which may require a blood transfusion
Infection in the incision, in the uterus, or in other nearby organs
Reactions to medications, including the drugs used for anesthesia
Injuries to the bladder or bowel
Blood clots in the legs, pelvic organs or lungs
A very small number of women who have c-sections die. Death is rare, but it is more likely with cesarean than with vaginal delivery."

Cesarean Birth for Medical Reasons - March of Dimes

"After cesarean section, the most common complications for the mother are:

Infection.
Heavy blood loss.
A blood clot in a vein.
Nausea, vomiting, and severe headache after the delivery (related to anesthesia and the abdominal procedure).
Maternal death (very rare). The risk of death for women who have a planned cesarean delivery is very low (about 6 in 100,000). For emergency cesarean deliveries, the rate is higher, though still very rare (about 18 in 100,000).

Cesarean risks for the infant include:

Injury during the delivery.
Need for special care in the neonatal intensive care unit (NICU).
Lung immaturity, if the due date has been miscalculated or the infant is delivered before 39 weeks of gestation."

Cesarean Section-Risks and Complications

The bottom line is that c-sections should be done when the mother or baby's health is at risk that is higher than the risk of being harmed by a c-section.

Clarissa if you need more information I am happy to help you find it. Just let me know. Often times doctors won't take the time to explain these risks to their patients. They should, but they figure that you are fine with whatever they decide for you.