CDC Says Cesarean Triples Neonatal Death Risk
While the increased risks of cesarean section to neonatal and maternal health have long been known, an even more grim issue came to light in a study released in the September, 2006 issue of Birth Journal. The CDC conducted research on cesarean section and neonatal mortality, expecting to find that the neonatal mortality rate (defined as death within the first 28 days of life) following cesarean section correlated directly with medical complications of the mother and baby. What they found, instead, was that regardless of risk factors, babies born by cesarean section face a risk of death nearly three times that of vaginally born babies.MacDorman, et al. analyzed national birth and death data for 5,762,037 live infants and 11,897 neonatal deaths, for the years 1998-2001. The purpose of the study was to examine the neonatal outcomes of primary cesarean delivery in women who had no other known complications or medical risk factors. The logical result of this examination would seem to be comparable neonatal mortality rates among cesarean and vaginally born infants. In fact, what the results show is that cesarean independently raises the risk of neonatal death by almost three-fold - .62 per 1000 deaths among vaginal births versus 1.77 per 1000 infant deaths among cesarean babies.
Even more astounding than the simple fact that cesarean section raises the risk of infant death - regardless of the reason the cesarean was performed - is that even when the researchers adjusted for sociodemographic, medical and congenital factors, and removed infants with APGARs under 4, the risk of death was only reduced "moderately". A stark difference in the death rates between cesarean born infants and vaginally born infants remained even with no medical explanation.
We aren't talking about babies dying from the few, rare complications that can arise in childbirth. We're talking about healthy, low-risk mothers electing for a primary cesarean section with no medical indication resulting in a nearly three times higher rate of death than those who have a vaginal birth.
According to Marian MacDorman, the CDC's study leader, "These findings should be of concern for clinicians and policymakers who are observing the rapid growth in the number of primary Caesareans to mothers without a medical indication."
While the findings of this research on cesarean and neonatal mortality were reported by major media outlets upon its release, publicity for the issue quickly waned. It is evident that care providers and mothers have continued to discount the disturbing results of the CDC study on neonatal mortality and cesarean, as the rate of surgical delivery has continued to climb to a record-breaking high of 31.8% in 2007, up from 31.1% in 2006.
The World Health Organization recommends no more than a 10% cesarean rate in developed countries, based upon research indicating more harm than good to both mothers and babies when the cesarean rate tops 15%. Until mothers and obstetricians start taking the risks of elective cesarean section seriously, we will likely continue to see tragic consequences of the interference of surgery in childbirth.
MacDorman MF, Declercq E, Menacker F, Malloy MH.
Division of Vital Statistics, NationalCenter for Health Statistics, Centers for Disease Control and Prevention,
Hyattsville, Maryland20782, USA. Birth. 2006 Sep;33(3):175-82.