Cesarean Birth and SIDS

If you or someone you know is considering scheduling an elective c-section, you should know that:

"Studies have shown that infants born through elective cesarean section may be at greater risk for SIDS."

RT for Decision Makers in Respiratory Care: Cesarean Birth and SIDS

The above article cites several studies that have been done about cesarean section and SIDS, and there are some alarming findings. I'll list in a nutshell what I consider key information from the article:

What is an Elective Cesarean Section?

"A mother may undergo cesarean section electively or as the result of an emergency. In an elective cesarean section, no labor takes place. This option may be chosen for several reasons, such as to avoid the risk of labor-induced uterine rupture if a mother has undergone previous cesarean sections; as a personal lifestyle choice; or if mother has tocophobia (severe fear of labor). An emergency cesarean section, on the other hand, takes place after labor has begun. It is performed in cases of fetal distress; prolonged, unprogressive labor; breech birth; or if the mother’s life is in danger."

Why is there a higher risk of SIDS for babies born via elective c-section?

"Because of the suspected role of sleep apnea in SIDS, infants are considered at greater risk for SIDS if they have symptoms of (sleep) apnea. These respiratory alterations are more pronounced if the infant is delivered by an elective cesarean section" because of two main factors:

• Gestational age at the time of birth. Elective cesarean sections are more likely to be done at 38 to 39 weeks gestation, whereas emergency cesareans are more often done at 40+ weeks gestation. The gestational age has an impact on the infant's respiratory health. Babies that are born before 40 weeks are more likely to have respiratory problems, which can cause sleep apnea, increasing the risk of SIDS.
  
• Compression. In an elective cesarean there is no trial of labor, so the baby doesn't experience any contractions. In labor the contractions have been found to compress on the baby's body in such a way that it prepares the infant's lungs for breathing outside of the womb. Babies delivered by c-section with no labor contractions don't have this vital preparation. The article details a study done on baby rats in which they tested the impact of compression on respiratory health, and the findings are clear that compression is very important.
  

I'll share some of the facts from the rat study involving compression:

• The group of rats that were given compression initially had 5 breaths/min and it increased to about 20 breaths/min during the hour in which this group of rats were observed.
• One group of rats that were not given any compression (but had cooling) had a significantly reduced respiration rate immediately after birth (about 1–2 breaths/min) and had a smaller increase in the rate of respiration to about 3–4 breaths/min by 1 hour. The other group that had no compression (but had cord clamping) all died within an hour of observation.
• In one group of rats that had no compression only 23% of the rats were breathing by 1 hour.
• In the groups of rats that involved compression, 100% of the rats were breathing by 1 hour.
  

What can you do to lower these risks?

• Avoid an elective cesarean section. Plan to birth your baby vaginally, if possible. If you do plan to have a c-section, you may want to consider doing a trial of labor by allowing your body to labor and experience contractions and give the baby important compression before the surgery is performed. According to the article, "even a short duration of labor seems to stabilize a neonate’s respiration after birth."
• Schedule your cesarean section at 40 to 42 weeks gestation. This will give your baby more time for the lungs to develop properly before birth.
• Send your infant to the NICU if your baby was delivered by elective cesarean. This would likely be a decision made by your care giver, but it could improve the baby's chances of survival because respiration patterns could be closely monitored and periods of apnea avoided through the efforts of NICU workers.
  
• Use a home apnea monitor on the infant if your baby was delivered by elective cesarean. "Ideally, an apnea monitor could prevent an infant’s apnea from progressing to SIDS. The monitor sounds an alarm if it detects a prolonged episode of apnea, hypoxia, or bradycardia, at which point parents can arouse their infant or do cardiopulmonary resuscitation if necessary."

The article also states that more studies are needed on this subject, and I agree.

CDC Says Cesarean Triples Neonatal Death Risk

The following article offers some surprising facts about cesarean section increasing the chances of neonatal death, regardless of the risk factors of the mother and baby:

July 29, 2009, by Misha Safranski

"While the increased risks of cesarean section to neonatal and maternal health have long been known, an even more grim issue came to light in a study released in the September, 2006 issue of Birth Journal. The CDC conducted research on cesarean section and neonatal mortality, expecting to find that the neonatal mortality rate (defined as death within the first 28 days of life) following cesarean section correlated directly with medical complications of the mother and baby. What they found, instead, was that regardless of risk factors, babies born by cesarean section face a risk of death nearly three times that of vaginally born babies.

"MacDorman, et al. analyzed national birth and death data for 5,762,037 live infants and 11,897 neonatal deaths, for the years 1998-2001. The purpose of the study was to examine the neonatal outcomes of primary cesarean delivery in women who had no other known complications or medical risk factors. The logical result of this examination would seem to be comparable neonatal mortality rates among cesarean and vaginally born infants. In fact, what the results show is that cesarean independently raises the risk of neonatal death by almost three-fold - .62 per 1000 deaths among vaginal births versus 1.77 per 1000 infant deaths among cesarean babies.

"Even more astounding than the simple fact that cesarean section raises the risk of infant death - regardless of the reason the cesarean was performed - is that even when the researchers adjusted for sociodemographic, medical and congenital factors, and removed infants with APGARs under 4, the risk of death was only reduced "moderately". A stark difference in the death rates between cesarean born infants and vaginally born infants remained even with no medical explanation.

"We aren't talking about babies dying from the few, rare complications that can arise in childbirth. We're talking about healthy, low-risk mothers electing for a primary cesarean section with no medical indication resulting in a nearly three times higher rate of death than those who have a vaginal birth.

"According to Marian MacDorman, the CDC's study leader, "These findings should be of concern for clinicians and policymakers who are observing the rapid growth in the number of primary Caesareans to mothers without a medical indication."

"While the findings of this research on cesarean and neonatal mortality were reported by major media outlets upon its release, publicity for the issue quickly waned. It is evident that care providers and mothers have continued to discount the disturbing results of the CDC study on neonatal mortality and cesarean, as the rate of surgical delivery has continued to climb to a record-breaking high of 31.8% in 2007, up from 31.1% in 2006.

"The World Health Organization recommends no more than a 10% cesarean rate in developed countries, based upon research indicating more harm than good to both mothers and babies when the cesarean rate tops 15%. Until mothers and obstetricians start taking the risks of elective cesarean section seriously, we will likely continue to see tragic consequences of the interference of surgery in childbirth."

Click here to access this article on Associated Content