Re: Study Links Caesareans With Births Before Term
From: art fougner, md (evsono@pipeline.com)
Wed May 28 15:51:59 2008
At Long Island Jewish Medical Center, the section rate is about 40% in
the first quarter of this year. When surveyed, the number one response
of the OB's was Concern re: Liability. In NY State, the Liability
System has vreated a crisis environment for Women's Healthcare. It's a
pity, N.O.W. won't take up THIS cause.
Art
At Wed, 28 May 2008, Hemant Damle wrote:
>
>Gynecologists are more concrened about wellbeing of baby that is the reason
>to do more LSCS
>with some adverse maternal condition. The Statistics can be twisted any way
>on what you want to project. Blaming Doctors for doing so called un
>necessary LSCS gives maximum chance of publicity.
>
>Dr Hemant Damle
>
>Prof Of Obs/Gyn
>SKN Medical College Pune
>
>On 5/28/08, Dean Huffman . <dean@thehuffpeople.net> wrote:
>>
>> .
>>
>> Study Links Caesareans With Births Before Term
>>
>> May 28, 2008
>>
>> NY Times
>>
>> Premature single births have been increasing in the United States, mostly
>> among
>> infants delivered by Caesarean section, researchers are reporting. And they
>> say
>> some of the increase may be due to Caesareans that are not medically
>> necessary.
>>
>> Get Health News From The New York Times » The trend is worrisome because
>> premature babies are at risk for breathing and feeding disorders, delayed
>> brain
>> development, other health problems and death.
>>
>> A study of single births from 1996 to 2004 found an increase of one
>> percentage
>> point in premature deliveries, to 10.7 percent from 9.7. Ninety-two percent
>> of
>> those premature deliveries were by Caesarean. Most were "late preterm,"
>> born
>> after 34 to 37 weeks of pregnancy, instead of the normal 38 to 42 weeks.
>>
>> Late preterm babies make up more than 70 percent of all premature births in
>> the
>> United States, and are the fastest growing subgroup of preterm births, the
>> researchers found. Even though they may seem close to full-term, they still
>> face increased risks of serious problems from being born too early.
>>
>> The study focused on single births rather than multiple ones, because
>> multiple
>> births are much more likely to involve complications that require
>> Caesareans.
>>
>> The report was based on a review of birth records and previous studies,
>> conducted by the March of Dimes Foundation, Albert Einstein College of
>> Medicine
>> and the federal Centers for Disease Control and Prevention. It is to be
>> published in the June issue of Clinics in Perinatology, a medical journal..
>>
>> The researchers say they cannot be sure how much prematurity can be blamed
>> on
>> unneeded Caesareans, because it is often hard to tell from medical records
>> exactly why a Caesarean was done. The Caesarean rate has been climbing
>> steadily
>> in recent years, from 20.7 percent in 1996 to 30.3 percent in 2005.
>>
>> "The practice of obstetrics has changed so dramatically in the past 20
>> years, so
>> that induction of labor and Caesarean section have become the norm," said
>> Dr.
>> Alan R. Fleischman, the medical director and senior vice president of the
>> March
>> of Dimes.
>>
>> In observations at community hospitals across the country, researchers have
>> seen
>> obstetricians stretching diagnoses a bit to justify Caesareans that are not
>> truly necessary, Dr. Fleischman said.
>>
>> "Perhaps for convenience, perhaps out of fear of litigation, perhaps in
>> response
>> to a maternal request, they are scheduling their deliveries rather than
>> allowing
>> labor to begin," he said. "And this comes when there is an epidemic in
>> America
>> of prematurity."
>>
>> Dr. Sarah J. Kilpatrick, chairwoman of the department of obstetrics and
>> gynecology at the University of Illinois, and chairwoman of the committee
>> on
>> obstetric practice for the American College of Obstetrics and Gynecology,
>> took
>> issue with some of Dr. Fleischman's comments and said there was no proof
>> that
>> unnecessary Caesareans were occurring or leading to premature births.
>>
>> Noting that the college of obstetricians has guidelines stating strongly
>> that
>> labor should not be induced and Caesareans should not be performed before
>> 39
>> weeks unless there is a genuine medical need for it, Dr. Kilpatrick said,
>> "We
>> stand by that."
>>
>> She continued, "On the other hand, what I would agree with, I think there
>> is
>> pressure by patients on physicians to deliver early-ish when someone's
>> uncomfortable, and there is medico-legal pressure. Obstetricians are afraid
>> of
>> being sued."
>>
>> The fear of lawsuits is so great that at the first hint of a problem, Dr.
>> Kilpatrick said, obstetricians "may proceed with a Caesarean to deliver the
>> fetus when the fetus is probably fine."
>>
>> She also said that obstetricians might have grown a bit complacent about
>> delivering babies a few weeks early because pediatricians and
>> neonatologists
>> had become so good at taking care of premature infants.
>>
>> "They may let their guard down around 36 weeks because they're so sure the
>> baby
>> will be fine," Dr. Kilpatrick said. "This paper is a good reminder to
>> everybody
>> that 36 weeks is still preterm."
>>
>> http://www.nytimes.com/2008/05/28/health/research/28birth.html?ref=health
>>
--
art fougner, md
"May The Wings of Liberty Never Lose a Feather." - Jack Burton
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