Caution urged over caesarean trend

The mortality rate of C-sections is often ignored according to experts Keystone

Swiss researchers have warned against early caesarean deliveries after finding the operation more than doubles the risk of mortality in newborns compared with regular childbirth.

The Geneva University Hospital team compiled health data for nearly 60,000 newborns between 1982 and 2004 – the largest ever Swiss study to compare neonatal outcomes across the different delivery methods and pregnancy times.

Over the 20-year period, 13 per cent of births were delivered by caesarean, of which one third were elective – performed on the basis of medical information or at the request of the pregnant woman – and 66 per cent were emergency C-sections.

The mortality risk in babies born by elective caesarean was reduced when the operation was carried out at full term, rather than in the 34-38 week gestational period.

The authors of the study, which is published in the review Pediatrics, say their data are evidence that elective caesarean delivery should not be performed before the end of pregnancy term.

“On the whole, this data shows that doing a C-section, and especially an elective C-section, increases the risk of mortality,” Professor Michel Berner, a member of the research team, told swissinfo.ch.

“It is clear that you have two kinds of C-section, emergency ones that you cannot avoid, and the ones that you can avoid, [where] you should be aware that if you can delay the operation to term, then it is better.

“We think the strength of the study is that there were 56,000 deliveries over 20 years. These are big numbers. There aren’t many such studies.”

Over the two decades the rate of caesareans rose from ten to 20 per cent.

Problems ignored

The study says that the worldwide escalating rate of C-sections equates to an urgent call for healthcare policy makers and professionals to investigate and monitor the operation’s “medical and social outcomes”.

Hospitals in Europe, the United Sates, South America and eastern Asia have reported caesarean delivery rates in excess of 30 to 40 per cent in recent years.

The study argues that although trials show that elective caesareans are justified in a limited number of conditions such as a breech or HIV infection, it is increasingly preferred by parents and medical staff.

It is because the maternal risks have dropped considerably, the perceived risk to the baby is small and logistical reasons make it attractive.

The authors note that neonatal mortality and morbidity in this kind of delivery are “often ignored and their importance is minimised”.

Last December, the Swiss Midwives Association called for the question of caesarean deliveries to be studied further, and in particular the consequences for children and women.

Michelle Pichon, of the association’s central committee, says this latest study points in the same direction – asking the question whether having an elective caesarean instead of a regular delivery is better for the children in the long-term.

“The issue of caesareans should be debated by health professionals and among parents,” she stated.

Alarm bells

The study also found that a caesarean delivery tended to reduce the beneficial effect labour had on a baby’s lung adaptation, thereby increasing the risk of respiratory problems.

The finding adds weight to 2007 research which showed the number of newborn babies in Switzerland suffering from respiratory distress had doubled over 30 years – an increase the researchers said could be attributed to the growing number of caesarean operations being carried out.

The head of Zurich University Hospital’s neonatology unit, Hans Ulrich Bucher, who was behind the 2007 research, said the new study confirmed that suspected link.

“I think there have been several alarms raised already and this is probably one of the strongest ones. I think this problem should be made known to the public: the relation between elective C-section, especially when it is too early, and neonatal problems.”

“My hope is that people now are aware of this problem and that there will be fewer early C-sections, but that we will have to wait a couple years to see.”

Jessica Dacey, swissinfo.ch

Key facts

The rate of caesareans in Switzerland in 2007 rose to 32.2% of births, compared with 22.7% in 1998.
In other countries it is less than 20 %.
Nearly one in two children where the mother has private insurance is born by C-section in Switzerland.

Caesarean deliveries on the rise

The Swiss Midwives Association says there is no medical explanation for the increase and have called on the government, cantons and health insurers to carry out more checks on caesarean operations in hospitals to ensure there are no irregularities.

Doctors should only recommend a caesarean for medical reasons, as the operation confers more risk than a normal birth and has an impact on the health of the baby and the mother, the association advises.

Twice as many children born by caesarean are transferred to intensive care with breathing problems, compared with naturally born babies.

Twice as many mothers also have to return to hospital for treatment after a caesarean and many have problems breastfeeding, according to the association. They are also more likely to have serious complications in later pregnancies.