Earlier this year I wrote for baby gooroo about the controversy surrounding elective cesarean birth. Two new research articles shed more light on the need for informed decision-making as it pertains to both the method and the timing of “elective” delivery of a newborn.

One article appeared in the British Medical Journal and was the subject of a recent post on baby gooroo:

Data from 97,095 births in 8 randomly selected Latin American countries showed that women who have a planned (elective) cesarean delivery put themselves, and their babies, at increased risk of serious complications and death.

The only time cesarean delivery was a safer alternative than vaginal birth was for babies who were in a breech position. But for babies in a headfirst position, the risk of the baby dying or suffering serious complications was one-and-a-half times higher when an elective (non-emergency) cesarean section was performed.

The second article was published in the November issue of the Journal of Pediatrics. Tomashek and colleagues found that late preterm infants (34 0/7 - 36 6/7 weeks gestation) are six times more likely to die during their first week and three times more likely to die during the first year compared to infants born at or after 37 weeks gestation.

The differences in mortality rates persisted even when deaths related to congenital anomalies were excluded. Overall, the mortality rate was still 2.6 times higher in late-preterm infants (4.5 versus 1.7 deaths per 1,000 live births) than among term infants.

Data published in the December 2006 issue of Clinics in Perinatology found that babies born late pre-term were at greater risk for respiratory problems, temperature instability, hypoglycemia, jaundice, and poor feeding. But despite a growing body of literature on late preterm birth, “the obstetric community is yet to fully embrace the public health impact of late prematurity,” commented Lucky Jain, M.D., of Emory University in Atlanta, in an accompanying editorial.

Late-preterm infants are often labeled “near term” reflecting the perception that they are functionally mature, he noted, “and there is a relative lack of attention to neonatal considerations when delivery at these gestations is being contemplated.”

“Although the data provide no direct link to the widespread practice of induction of labor and/or elective cesarean section, it raises questions about the recent rise in such practices, particularly in the face of uncertainty in accurate estimation of gestational age,” said Dr. Jain.