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More evidence that less is more

Evidence continues to mount that increased use of interventions in childbirth, such as induction and cesarean, are not necessarily beneficial to mothers OR babies.

In a study published this month in the Journal Maternal-Fetal and Neonatal Medicine, researchers found no evidence that higher rates of cesarean benefit babies. According to the study’s author Dr. Christopher Glantz, “Like virtually all medical therapies and procedures, these interventions entail some risk for the mother, and there is no evidence in this study that they benefit the baby…In my mind, if you are getting the same outcome with high and low rates of intervention, I say ‘Do no harm’ and go with fewer interventions.”

Here is a description of the study:

In the study, Glantz focused on pregnant women delivering in level I hospitals – those lacking a Neonatal Intensive Care Unit or NICU – because they care primarily for low-risk women who do not have major complications, such as diabetes, high blood pressure or other severe disease. The majority of women in the United States deliver in level I hospitals.

Through a birth certificate database, Glantz obtained and analyzed data from 10 level I hospitals in the Finger Lakes Region of upstate New York and calculated the rates of induction and cesarean delivery at each between 2004 and 2008. Not surprisingly, the rates varied widely.

To determine the health of newborns delivered at these hospitals, he looked at three outcomes: transfer of the newborn to a hospital with a NICU (signifying the presence of complications that required a higher level of care); immediate ventilation or breathing assistance; and a low 5-minute Apgar score (a quick assessment of the overall wellbeing of a newborn).

Using statistical models, Glantz assessed the relationship between rates of induction and cesarean delivery and rates of the three neonatal outcomes. He found intervention rates had no consistent effect on newborns: Whether a hospital did a lot or very few interventions, there was no association with how sick or healthy the infants were.

Even after a second round of analysis that accounted for differences among pregnant women that could potentially impact the results, the finding was the same – hospitals with high intervention rates had newborn outcomes indistinguishable from hospitals with low rates.