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New Study Indicates that Cesarean Sections May Be Over-Utilized in Twin Deliveries

As we have previously discussed, determining when a delivery should proceed through a vaginal birth or Cesarean section-either planned or emergency-is one of the most critical decisions that must be made by an expectant mother and her medical team. C-section rates in the United States are currently approximately 31%, indicating that doctors are increasingly taking a cautious approach to avoid the risks to a mother and baby that may result from a vaginal birth.

Risks from a C-section
However, although they are currently the most common surgical procedure performed in the United States, C-sections still present certain risks, which can increase significantly with each repeat C-section. For some women, repeat C-sections can result in a weakened uterine wall, which may cause problems in later pregnancies; complications with the placenta in later pregnancies, such as placenta accreta or placenta previa, which can lead to hemorrhaging by the mother or require early delivery of the baby and resultant issues; or injuries to the bladder. In extreme cases, a C-section may result in heavy bleeding that can be controlled only through a hysterectomy. Moreover, because doctors generally advise that a woman have no more than three C-sections, a C-section may impact the number of children that a couple can have. Expectant mothers should therefore be comfortable that the risks of proceeding with a vaginal delivery outweigh the risks of the C-section itself.

New Study
Adding to this calculation, recent research indicates that C-sections may not be necessary in some cases where they are traditionally performed. A new international study published in early October in the New England Journal of Medicine found that the outcomes of the deliveries in the study were the same regardless of whether the mothers and doctors planned for a C-section or for a vaginal delivery (and resorted to an emergency C-section only when a vaginal delivery would have been too dangerous). The outcomes of the deliveries that were considered included rates of injuries to the babies, such as fractures; need for oxygen by the babies; low Apgar score after delivery; infections in the mothers; and deaths of mother or baby within 28 days after delivery. To control for a common cause for emergency C-sections, women were not included in the study if the twin expected to be delivered first was in the breech position after 32 weeks of pregnancy. Ultimately, the mothers who planned for C-sections had them 91% of the time. However, mothers who planned for vaginal births needed to have C-sections only 44% of the time. Outside of the study, the C-section rate of twin births was approximately 75% in 2008, the most recent year calculated.

The discrepancy between the C-section rate in the study, where they were performed only when necessary to avoid specific risks, and in the general population indicates that C-sections are used to deliver twins far more frequently than required. Given the risks associated with C-sections, women must carefully consider whether they are necessary in their unique circumstances. Women must also ensure that they are adequately advised by their medical team of the need for a C-section.

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