U.S. Preemie Births, Caesareans Reach Record Highs

U.S. Preemie Births, Caesareans Reach Record Highs
Fear of lawsuits may be driving surge in C-sections, experts say

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."

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