CREDIT: Pregnancy photo via Shutterstock |
The low-tech approach to
delivering babies in one Amish community may offer clues on how to safely reduce
the rate of Cesarean-section deliveries in the United States, researchers say.
The study examined 418 Amish women who delivered 927 babies at a birthing
center in Southern Wisconsin, a facility that lacked an operating room. Over a
17-year period, just 4 percent of babies were born by Cesarean section at the
birthing center. In the general U.S. population, by contrast, nearly a third of
babies are born by C-section.
Despite the low C-section rate
among the Amish women, there were few complications: the rate of newborn deaths
was 5.4 deaths per 1,000 deliveries, similar to the general U.S. population's
rate of 4.5 deaths per 1,000 deliveries, the researchers said. No mothers in
the study died. One of the biggest contributors to the reduced C-section rate
was an increase in the percentage of women who gave birth vaginally after
previously having a C-section. In the Amish population, the rate was 95
percent, compared with 8 percent in the U.S. as a whole.
Historically, doctors have had
concerns that a vaginal birth after a C-section, a so-called VBAC, would
increase the risk of a rupture of the uterus. But in the study, no women
experienced this complication. In 2010, the National Institutes of Health
recommended that women with previous C-sections attempt, in subsequent
pregnancies, to delivery vaginally first, before resorting to a repeat
C-section. This study's findings suggest that following these guidelines could
safely reduce C-sections, said study researcher Dr. Lee Dresang, a professor at
the University of Wisconsin Department of Family Medicine.
Another contributor to the low
C-section rate among the Amish women was that doctors attempted to turn
breach-position (feet-first) babies around from outside the mothers' bodies, to
permit vaginal delivery. The method succeeded most of the time, Dresang said.
In the United States, 92 percent of women whose babies are in the breach
position at the end of pregnancy have a C-section.
Amish women generally give birth
at home with an unlicensed birth attendant. As a safer alternative for these
women, the LaFarge Medical Clinic in Wisconsin developed a birthing center,
staffed by a family doctor and midwife. Women were sent to a hospital 20
minutes away from the clinic if it appeared they needed a C-section or other
hospital care, but this occurred rarely. Although the rate of newborn deaths in
the study was slightly higher than that of the general population, this was not
unanticipated for the Amish population, Dresang said. This is because few Amish
women have prenatal care or undergo genetic testing before birth, he said.
The findings show that such
birthing centers can deliver babies "almost as safely as people in
hospitals do," said Dr. James Ducey, director of Obstetrics and Maternal
Fetal Medicine at Staten Island University Hospital, who was not involved in
the study. Of the 19 babies who died in the study, only one died of a condition
that could have been prevented in a hospital, Ducey said. The negative effects
for mothers that come from performing thousands more C-sections, including an
increase in maternal deaths, may outweigh the benefit of saving one extra life,
Ducey said. In 2010, a National Institutes of Health analysis showed that 3.8
maternal deaths occurred for every 100,000 VBACs, whereas 13.4 deaths occurred
for every 100,000 repeat C-sections.
It is important to note that Amish
women known to have high-risk pregnancies were not allowed to give birth at the
clinic; they were instead sent to the hospital. Therefore, the rate of
C-sections may have been higher if these women were included. While the
researchers said they do not think the C-section rate in the United States
could be brought as low as 4 percent, the lessons from the new study may help
move the country toward a lower rate, Dresang said. The study is published
today (Nov. 12) in the journal Annals of Family Medicine.
Source: My Health News
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