Hi All,
I thought the comment at the end of this article about "caregiver bias" very
relevant.
Leanne.
Short stature independently predicts cesareans
Issue 13: 27 Jun 2005
Source: European Journal of Obstetrics & Gynecology and Reproductive Biology
2005; 120: 175-8
Maternal short stature is an independent risk factor for cesarean section,
according to new findings. The researchers report a significantly higher
rate of cesareans among women less than 155 cm in height compared with
taller women, even after controlling for labor dystocia.
Specialists from the Soroka University Medical Center in Beer-Sheva, Israel,
analyzed the records of all 159,210 deliveries that occurred at the center
between 1988 and 2002.
In 5,822 of these deliveries (3.65 percent), the mother was of short
stature, defined as being less than 155 cm in height. These women were
almost twice as likely to have a cesarean section compared with taller women
(21.3 percent versus 11.9 percent, respectively).
Women of short stature also had significantly higher rates of previous
delivery by cesarean, intrauterine growth restriction, premature rupture of
membranes, failed induction, labor dystocia, malpresentations, and
cephalopelvic disproportion.
However, the researchers found no significant differences in perinatal
complications such as low birth weight, meconium-stained amniotic fluid,
perinatal mortality, and low 5-minute Apgar scores.
Significant and independent
Importantly, the association between short stature and cesareans persisted
even after controlling for other potentially confounding factors, including
dystocia. Writing in the European Journal of Obstetrics & Gynecology and
Reproductive Biology, the researchers report that short stature is an
independent risk factor for cesarean section, with an odds ratio of 1.7.
They say the higher rate of deliveries by cesarean among short women can be
partially attributed to caregiver bias. Whenever the attending obstetrician
realizes that the patients stature is short, even mild deviations from the
normal labor curves lead to cesarean section.
They suggest that the findings should prompt obstetricians to reconsider
their attitudes towards cesarean deliveries in mothers <155 cm, and call
for an objective evaluation of the benefits and risks of performing
cesareans in such women.
The researchers say further prospective studies investigating indications
for cesareans need to be conducted in order to help inform decisions.
Leanne Wynne
Midwife in charge of "Women's Business"
Mildura Aboriginal Health Service Mob 0418 371862
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