Cesarean section and its effects on preterm birth fact sheet
What is a Cesarean section?
A Cesarean section, or C-section, is a major surgical procedure to cut through the abdomen to the uterus and deliver the baby through the abdomen. Over the past few years, the rate of Cesarean birth has increased for all births, even those that involved healthy, first-time pregnancies with a full-term, single birth. Nearly 1.2 million Cesarean sections were performed in 2005 in the United States, accounting for 29.1 percent of all births that year (one in three babies), according to the National Center for Health Statistics.
Cesarean sections and preterm birth
In 2005, more than half a million infants were born preterm (less than 37 weeks gestation). Preterm birth is the leading cause of infant death in the first month of life in the United States, and the No. 1 problem in obstetrical practice. It is a leading cause of infant and childhood death and long-term disability. Nearly one in every six babies born in Kentucky today is premature and almost half of them are born by C-section. Some experts believe that the high rate of Cesarean section may contribute to the high rate of preterm birth.
Risks and problems with C-section deliveries
- A Cesarean section is major surgery with possible risks to the mother and the baby. Risks to the mother may include infection, increased bleeding (hemorrhage), injuries to the bowel or bladder, blood clots, complications from anesthesia and, in rare cases, death. Major risks for the baby may include preterm birth, an increased need for resuscitation at birth and more likelihood of breathing problems after birth.
- A Cesarean section should only be done when the health of the mother or baby is at risk. It should not be done for convenience or for any nonmedical reason.
- A Cesarean birth is more painful, more expensive and takes longer to recover from than a vaginal birth.
- Once a woman has a Cesarean delivery, she is more likely to deliver all future babies by Cesarean, and the risks to her and her baby increase with each Cesarean delivery she has. These risks include problems with the placenta, increased risk of stillbirth, as well as increased risk for slow growth and preterm birth for the baby.
- Babies born by Cesarean section, particularly without labor, are more likely to have respiratory problems after birth.
- Cesarean sections may contribute to the growing number of babies who are born between 34 to 36 weeks gestation, called "late preterm." Usually these babies appear to be healthy, but in reality they are more likely to have medical problems than babies born a few weeks later at full term. Compared to full-term babies, late-preterm babies are more likely to have breathing problems, feeding problems, temperature problems, and have a much smaller and less developed brain at birth than a full-term baby.
- The American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) recommend that a Cesarean section, if not done because of a medical complication, should not be scheduled until 39 weeks gestation or later in order to allow enough time for the baby to develop and mature. They recommend measures be taken to help assess that the baby's proper lung development is established before delivering the baby if the baby is less than 39 weeks gestation.
Medical indications for Cesarean section
There are many medical reasons that a baby may need to be delivered by C-section, including:
- breech presentation
- fetal distress
- placental abruption, or placenta previa
- severe pregnancy-induced hypertension
- herpes virus infection
- failure of labor to progress
If a woman's health care provider suggests a Cesarean delivery for these reasons, she should be sure she understands the reason.
Women should never pressure their physicians to do a C-section or to deliver before 39 weeks. Whenever medically possible, it is best for a pregnant woman to deliver at about 40 weeks.
Healthy Babies Are Worth the Wait® is a multifaceted partnership of the March of Dimes, the Johnson & Johnson Pediatric Institute and the Kentucky Department for Public Health. The primary goal of the initiative is a 15 percent reduction in the rate of "preventable" single preterm births - particularly babies born late preterm (four to six weeks early) - in three targeted intervention sites in Kentucky: King's Daughters Medical Center in Ashland, Trover Health System Regional Medical Center of Hopkins County and the University of Kentucky Albert B. Chandler Hospital in Lexington. Health care teams at each site provide mothers-to-be with an integrated approach of education, counseling and clinical care.
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