Birth patterns

By LEE BOWMAN
Scripps Howard News Service
Wednesday, October 03, 2007

Docs are people, too, of course. They've got lives outside medicine, families, mortgages, tee times. And they, like most of us, would prefer not to work weekends.

But when the medical procedure involves the birth of babies, it's something of an open question as to whether the preferences of the obstetrician, the mother or the baby set the agenda.

Several things are apparent from recent government reports and studies in the United States and in Europe.

One is that traditional childbirth -- a delivery that's not medically hastened nor done surgically through Caesarean section -- happens slightly less than half the time in most developed countries.

In the United States, the latest available birth records, from 2005, show that 30.2 percent of live births were Caesarean and another 21.2 percent involved labor being induced.

The stats also indicate that newborns are less likely to come into the world on weekends than the workweek. Census Bureau figures for 2004 show only about 57 percent as many babies are born on the average Sunday in this country as on the biggest birthing day of the week, Tuesday. Delivery rooms are only 65 percent as busy on Saturdays compared with Tuesday.

A pair of recent studies published online by the German journal Natural Sciences document similar patterns in Switzerland and Germany. Researchers note that C-sections accounted for 29 percent of Swiss newborns in 2004, and elective labor induction was done for another 20 percent.

Overall, the researchers found there were about 18 percent fewer births on weekends in Switzerland, and 15 percent fewer in Germany, than would ordinarily occur. Researcher Alexander Lerchi of Jacob University also noted that fewer births than expected are happening at night all days of the week, even though many studies have shown that women's natural hormonal cycles tend toward labor starting at night.

He argues that it's more convenient and practical -- even cheaper -- to schedule birth when hospitals are fully staffed.

Some doctors do give prospective moms who know in advance they're strong candidates for a C-section or even induced labor some choice in the timing -- but seldom offer to come in weekends.

And actually, another recent study suggests that, at least for hospitals that deliver relatively few babies, keeping banker's hours in the maternity ward is probably safer for the baby.

Texas researchers reported to a meeting of the American College of Obstetricians and Gynecologists (ACOG) last May that the greater number of babies delivered at a hospital, the lower the risk of death to a baby in the first few weeks of life.

Particularly among hospitals that delivered about 4,000 to 7,700 babies a year, there was a 51 percent greater risk of death for a baby born on a weekend than on a weekday.

The risk didn't show up for babies born in hospitals delivering fewer than 4,000 infants a year, probably because those hospitals lack an infant ICU and are more likely to airlift an infant having difficulty to a larger facility at the first sign of trouble.

Officially, the OBGYNs on several occasions have had committees consider the issue of elective C-sections in light of the growing rate of the procedures overall, which are at an all-time high for a variety of reasons, including the fact that there are more women with risk factors such as having multiple infants, being obese or being older, than ever before.

On the other hand, women undergoing the surgery also face risks of infection, blood clots, complications from anesthesia and potential problems with future pregnancies.

When ACOG last visited the issue in May 2006, the committee said there just wasn't enough evidence to fully evaluate the risks and benefits of Caesarean delivery by maternal request as opposed to a vaginal delivery, and suggested, for now, the decision remain an individual one between physician and well-informed patient.

On the Net: http://www.acog.org