On Elective C-Sections and Other Medical Stories

September 8, 2006

There were a series of medical stories this week I wanted to highlight: The first one, which ran in the New York Times found that medically unnecessary caesarean sections were riskier than vaginal deliveries.

Even after accounting for socioeconomic and other risk factors, the researchers, whose findings were published in Birth: Issues in Perinatal Care, found that the neonatal mortality rate for elective C-sections was 1.77 deaths per 1,000 births versus .62 deaths per 1,000 births for a vaginal delivery.

Part of the reason for the increased mortality may be that labor, unpleasant as it sometimes is for the mother, is beneficial to the baby in releasing hormones that promote healthy lung function. The physical compression of the baby during labor is also useful in removing fluid from the lungs and helping the baby prepare to breathe air.

The researchers suggest that other risks of Caesarean delivery, like possible cuts to the baby during the operation or delayed establishment of breast-feeding, may also contribute to the increased death rate.

As much as it offends my sensibilities to go au natural if possible, I always wrote off women who schedule their deliveries as none of my business. But one of the obstetricians in this story said the findings will force doctors to reconsider the “pros and cons of offering C-sections for convenience and promote more research into understanding why this increased risk persists.”

Speaking of risky business, women who consume illegal drugs while pregnant cannot be prosecuted under Maryland’s reckless endangerment laws, according to an article that appeared in the Washington Post this week.

The state’s high court decision, which was applauded by the ACLU and a national advocacy group for pregnant women, overturned the convictions of two mothers who consumed cocaine while pregnant. While prosecutors argued that the mothers put their babies at risk by partaking in an illegal activity, the mothers’ advocates said it would be costly to incarcerate every woman who “endangered” her unborn baby and open mothers to litigation for other activities such as driving without a seatbelt, smoking or drinking.

A National Institutes of Health study has found that maternal cocaine use can cause slightly lower birth weights and intellectual and behavior problems later in childhood. Alcohol and tobacco can be just as damaging. An array of public health, drug treatment and medical organizations filed briefs supporting the women, arguing that such prosecutions are more likely to harm than to help mothers and babies.

I agree. These mothers need treatment not jail time.

Finally, I was bummed — although not terribly surprised — that our dear governor Ahnold (gag) has said he will veto a universal health care bill drafted and passed by the Democrats, according to an Associated Press report. Schwarzenegger claims a single-payer system as proposed by Sen. Sheila Kuehl (D-Santa Monica) will “cost the state billions and lead to significant new taxes on individuals and businesses, without solving the critical issue of affordability.”

As if our bureaucracy for a system doesn’t already cost billions. Who is Ahnold talking to? Maria, knock some sense into him! Never mind the individuals who can’t afford coverage, I can’t imagine businesses not jumping at the opportunity to avoid the costly proposition of insuring their employees.