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Early Cesarean births put babies at risk, report says

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A trend towards planned early cesarean births is exposing babies to breathing problems and even behavioral problems, doctors have warned.

More and more women are opting – for no medical reason – for cesarean sections before 39 weeks gestation, posing an undue risk to babies’ health, according to a major new report.

About half (between 43% and 56%) of planned Caesarean births performed before this key period in 2017 had no medical or obstetric reason, the Fourth Australian Atlas of Health Care Variation released Wednesday revealed.

Of particular concern was the 13-19% of all planned Caesarean sections performed before 37 weeks that were not justified by a recorded medical or obstetric reason.

This despite clear scientific evidence showing that waiting to at least the 39 week mark is better for the baby if there are no medical reasons for an earlier birth.

The figures “underscore the need for a concerted effort to address this issue,” says the report, which was produced by the Australian Commission on Safety and Quality in Health Care in partnership with the Australian Institute of Health and well-being.

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The commission’s acting chief medical officer, Joint Professor Anne Duggan, said the findings were concerning.

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“If you were born early, your brain, your lungs are not mature. You are more likely to end up in intensive baby care, ”said Dr. Duggan.

She said the apparent trend could mean that many parents are unaware of how important it is for a child to reach this milestone.

“Most babies need those 39 weeks,” she says.

As a solution, the Fourth Atlas recommended universal changes to government, hospital and insurance policies to stop booking planned births before 39 weeks without medical or obstetric indication.

Waiting is better for baby

The high rates of early planned Caesarean sections in Australia without a documented medical reason indicate a deviation from evidence-based care, the report warned.

“While sometimes an early birth is necessary, it all too often happens without a medical or obstetric reason,” explained John Newnham AM, professor of obstetrics and gynecology at the University of Western Australia.

“The evidence clearly shows that waiting at least 39 weeks is the best option for a baby’s development, unless there is a medical reason for an earlier birth.”

Early birth is associated with higher risks of adverse effects for the baby, with consequences ranging from breathing problems at birth to long-term behavioral problems, Professor Newnham said.

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“Every week counts towards the end of the pregnancy,” he said.

Professor Newnham encouraged parents “to ask questions before booking an early cesarean, to make sure their delivery plans are the best for mother and baby.”

Operating room capacity questioned

Reserved operating theaters could contribute to the high volume of unnecessarily early cesarean sections.

“In some cases, a lack of capacity in the theater rosters allocated for a planned Caesarean section once a woman has reached 39 weeks gestation can lead to theater bookings at an earlier gestation,” the report says.

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Hospital policies that provide increased flexibility to access operating theaters could help reduce the rates of planned early Caesarean sections.

There are also “significant gaps in women’s knowledge about the optimal time of birth,” the report says.

“Informing parents about the differences in outcomes, in particular the effects on long-term child development, between early births and term births, could be a powerful strategy to reduce early planned births in the absence of children. medical or obstetric indications.

More than half of pregnant women surveyed in a 2015 study published in the Australian and New Zealand Journal of Obstetrics and Gynecology mistakenly believed that between 37 and 38 weeks gestation was the earliest time for a safe birth.

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Preventing stillbirth comes at a cost

Initiatives to prevent stillbirths may also help “scale up interventions in normal pregnancies,” the report says.

“Initiatives that reduce the risk of stillbirth may come at the cost of increased intervention in normal pregnancies, due to the lack of specificity in techniques to identify fetuses most at risk. This can lead to an increase in planned early births, ”the report says.

The “risk of unintended consequences” of efforts to reduce stillbirth has been highlighted in a large trial in the UK, according to the report.

Data from 409,175 pregnancies “showed significant increases in cesarean and induction rates, with no reduction in stillbirth rates.”

The report also cites the “Safer Baby Bundle” initiative launched in New South Wales, Queensland and Victoria, which aims to reduce the risk of stillbirth.

The program “includes messages about the need to consider the adverse consequences of a planned delivery before 39 weeks,” but they “can be overshadowed by the influence of measures to prevent stillbirth,” the report said.

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