U.S. Preemie Births, Caesareans Reach Record Highs
By Steven Reinberg
HealthDay Reporter
TUESDAY, Nov. 15 (HealthDay News) -- The number of premature births in the
United States and the rate of Caesarean delivery are the highest they've
ever been, according to new government figures released Tuesday.
The report, by the U.S. Centers for Disease Control and Prevention's
National Center for Health Statistics, showed that the C-section delivery
rate rose to 29.1 percent in 2004, an increase of more than 40 percent since
1996. And more than half a million babies were born preterm last year, the
highest number ever recorded.
"Measures of maternal and infant health are not improving in the country,"
said lead author Joyce A. Martin, lead statistician at the reproductive
statistics branch of the National Center for Health Statistics in
Hyattsville, Md.
"We don't have a good sense of why that is, quite frankly," she added.
"Preterm births increased for the first time in at least two decades to more
than 500,000 births in 2004," Martin said. "The rate increased 2 percent
between 2003 and 2004, and has risen more than 18 percent since 1990."
One factor responsible for the dramatic increase in preterm birth rates is
the increase in multiple births, Martin said.
"Multiple births are much more likely to be born too early and too small,"
she said. "But there is also an increase in single preterm deliveries, and
the reasons for that are less clear."
Martian noted that low birth weight has followed a similar path. The low
birth weight rate increased from 7.9 percent in 2003 to 8.1 percent in 2004.
Since 1990, the percentage of infants born with low birth weight has risen
16 percent, according to the report.
In addition, the rate of C-section deliveries rose 6 percent in 2004 to 29.1
percent of all births, the highest rate ever reported in the United States.
"It's up 40 percent since 1996," Martin said. "It had declined in the 80s
until 1996, and there has been a strong upswing since."
Other findings in the report, which includes data from birth certificates
processed through May 2005, include a slight decrease in tobacco use among
pregnant women and no change in the number of women seeking prenatal care.
One expert sees several factors as responsible for these trends.
"The increase in the Caesarean births is due to three things -- malpractice,
malpractice, malpractice," said Dr. Joshua A. Copel, director of Maternal
and Fetal Medicine at Yale University School of Medicine.
Copel believes that the decision to do cesarean deliveries is largely based
on doctors' fear of litigation. "Not that much has changed about the
American population to account for such an increase in Caesarean birth rates
except the fear of obstetricians of being sued," he said.
In terms of the increase in premature delivery, the reasons for the increase
are not clear, Copel said. "I would speculate that you would find an
interaction between multiple birth and premature delivery and obesity," he
said. "Women who have higher body mass have higher insulin resistance, and
are more likely to ovulate infrequently and take medication to ovulate more
frequently."
Copel also noted that birth certificate data are spotty. "They must be taken
with some skepticism," he said. "The only things you can rely on in birth
certificates are date of birth, the gender and the weight."
Another expert blames current priorities in U.S. medical care.
That preterm and low birth weight babies were more common in 2004 than in
the years preceding reflects a widening of health-care disparities, as these
outcomes are more common among ethnic minorities, said Dr. David L. Katz,
director of the Prevention Research Center at Yale University School of
Medicine. "Efforts to address such disparities have apparently failed, as
the timely delivery of prenatal care was no higher in 2004 than in previous
years," he said.
"Most disturbing are data showing a steady increase in the rate of Caesarean
delivery," Katz added. "While the so-called C-section can be invaluable when
used to address complications of labor and delivery, it appears to be used
increasingly for mere convenience, or to avoid liability associated with the
natural risks of birthing."
"That we are doing more surgery, but not delivering more prenatal care, is
quite concerning," Katz said. "Pregnancy-related care should be a national
priority, and delivery a matter of Nature's timing, not the obstetrician's
convenience. The trends in this report call for a reassessment of our
priorities."
SOURCES: Joyce A. Martin, M.P.H., lead statistician, reproductive statistics
branch, National Center for Health Statistics, U.S. Centers for Disease
Control and Prevention, Hyattsville, Md.; Joshua A. Copel, M.D., professor,
obstetrics and gynecology and pediatrics, and director, Maternal and Fetal
Medicine, Yale University School of Medicine, New Haven, Conn.; David L.
Katz, M.D., M.P.H., associate professor, public health, and director,
Prevention Research Center, Yale University School of Medicine, New Haven,
Conn.; Nov. 15, 2005, CDC report
Leanne Wynne
Midwife in charge of "Women's Business"
Mildura Aboriginal Health Service Mob 0418 371862
--
This mailing list is sponsored by ACE Graphics.
Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.