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May 28, 2008 -- A dramatic increase in C-section deliveries in the United States is largely responsible for an equally dramatic rise in preterm births, new research reports.
One in eight babies in the U.S. is born prematurely each year, and close to one in three births overall is delivered by cesarean section.
A new analysis by the March of Dimes and the CDC shows that the two statistics are very much related.
The analysis revealed an increase of nearly 60,000 preterm deliveries among single-birth pregnancies between 1996 and 2004, with more than nine out of 10 of these deliveries performed by C-section.
Single-birth pregnancies increased by about 10% during this period, while C-section deliveries among women giving birth to just one baby increased by 36%.
Late preterm deliveries, defined as births between 34 and 36 weeks of gestation, accounted for the vast majority of the increase in preterm births among this group.
There is concern that at least some of these early deliveries may not be medically warranted, Joann R. Petrini, PhD, MPH, of the March of Dimes, tells WebMD.
Petrini is director of the March of Dimes' Perinatal Data Center.
"We know that more women over 35 are giving birth, and more pregnant women have other risk factors for problem deliveries, including hypertension, obesity, and diabetes," she says. "But studies suggest that these risk factors do not fully explain the increase in C-section deliveries."
Nor does the widely reported, but hard to pin down, practice of performing cesarean sections solely for the convenience of the mother or the physician.
The practice is widely known as C-section on demand. Ob-gyn professor Sarah Kilpatrick, MD, says it accounts for only a small percentage of surgical deliveries overall.
Kilpatrick heads the division of maternal and fetal medicine at the University of Illinois at Chicago.
"It is true that we are seeing more C-sections on demand than we saw 10 years ago, but the numbers are still pretty small," she tells WebMD.
It is more likely that the increase in C-sections is being driven by liability concerns among physicians, maternal risk factors, and the fact that fewer hospitals are performing vaginal births on women who have had prior C-sections.
But this does not explain why so many surgical deliveries are being performed before 39 weeks of gestation, Kilpatrick says.
And while the risks associated with late preterm birth have not been well documented, at least one recent study found a sevenfold increase in health problems among newborns born between 34 and 36 weeks of gestation, compared with babies born later.
In a statement issued Wednesday, March of Dimes Medical Director Alan R. Fleischman, MD, expressed concern about the medical impact of late preterm deliveries.
"We need research to determine how many C-sections that result in preterm babies are not medically indicated and may place both mother and baby at risk for little or no medical benefit," he notes.
Whatever the reason for the increase, the rate of C-section deliveries in the U.S. is now around 30% -- double the goal of 15% for uncomplicated pregnancies by 2010 set by the U.S. government eight years ago.
A special conference on the prevention of preterm births in the United States, scheduled for mid-June by the U.S. Surgeon General, should shed light on the causes and consequences of late preterm C-section deliveries, Petrini says.
She adds that pregnant women who are told they need a C-section or labor induction before 39 weeks of gestation should make sure they know why.
"One survey showed that women often couldn't identify their risk factor after having a C-section," she says.
Kilpatrick says some obstetricians may no longer consider late preterm delivery medically risky because pediatricians do such a good job of caring for babies born late in the third trimester.
"The view may be that 37 or 38 weeks is OK, but that is a dangerous notion," she says. "It is very important to have a good medical indication for performing a C-section or labor induction prior to 39 weeks."