New Moms Who Have C-sections More Likely to Be Rehospitalized

May 10, 2000 -- Each year, hundreds of thousands of women in the U.S. deliver babies by cesarean section. While most women have no complications from the procedure, a small percentage are at risk for serious problems that can send them back to the hospital within the first couple of months after giving birth.

A new study published in the Journal of the American Medical Association finds that women who give birth by C-section are nearly twice as likely to be rehospitalized within 60 days of leaving the hospital after giving birth, compared with women who have an uncomplicated vaginal delivery. Women who deliver vaginally by assisted methods such as forceps or vacuum extraction are 30% more likely to be rehospitalized.

"It's a tragedy when this happens," says Peter Bernstein, MD, MPH, medical director of obstetrics and gynecology at Montefiore Medical Center's Comprehensive Family Care Center in Bronx, N.Y. "When women are rehospitalized, they usually have to be separated from their babies because few hospitals have policies that allow the baby to go back to the hospital with the mother." Bernstein was not involved in the study.

For the study, Mona Lydon-Rochelle, MPH, PhD, and colleagues from the University of Washington in Seattle, examined medical records of more than 250,000 new mothers. They found that the primary reason for rehospitalization among women with cesarean sections was infection of the uterus. Other reasons women with C-sections needed to be rehospitalized included bleeding, gallbladder disease, genitourinary complications, problems with the surgical wounds, blood clots, and appendicitis.

Lydon-Rochelle says the study is a heads-up to doctors that they need to do more to prevent infections and other complications that C-sections can cause in otherwise healthy young women who are giving birth for the first time. One way to do this may be to limit the number of vaginal exams performed while the woman is in labor. Another is to try to reduce the number of unnecessary C-sections being performed.

In the U.S., C-sections are among the most frequently performed surgical procedures. A C-section may be necessary during a first or subsequent pregnancy if labor is not progressing adequately, if the baby is in the breech position (feet or rear-end first instead of head-first), or if the baby is in distress. If the mother has had a prior C-section and the scar is at risk for tearing during vaginal delivery, she may be scheduled for a repeat C-section.

Lydon-Rochelle and colleagues say some methods that may reduce the need for C-sections are the use of midwives in the labor and delivery room, better pain management during labor, and getting a second opinion when a C-section is suggested. They also advocate the use of two methods for breech births: one in which the doctor turns the baby within the womb to get it into a heads-down position, and the other in which a Chinese herb is burned to stimulate acupuncture points on the mother that cause the baby to move around.

Bernstein says the message for patients is that C-sections, while common, are not without problems. "The odds are still very much in your favor that you're not going to be readmitted to the hospital. But cesarean shouldn't be passed off as a benign procedure," he tells WebMD.

作者： L.A.McKeown 2006-6-27