Rise in "no indicated risk" primary caesareans in the United States, 1
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《英国医生杂志》
1 Maternal and Child Health Department, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118-2526, USA, 2 Division of Vital Statistics, National Center for Health Statistics, Hyattsville, MD 20782, USA
Correspondence to: E Declercq declercq@bu.edu
Introduction
The proportion of no indicated risk primary caesareans is growing rapidly in the United States, adding to the overall rise in primary caesareans. The major limitation of this study is the quality of reporting of items on the US birth certificate.1 However, we would expect that "defensive medicine" would encourage the reporting of a risk factor associated with the resulting caesarean. Also, in the trend analysis there is no inherent reason to expect a bias that would cause a shift in the measurement of these variables at different time periods. It would also be inappropriate to equate no indicated risk caesareans with "patient choice" caesareans, as birth certificate data provide no record of the mother's intent.
Although some recent editorials have suggested that vaginal births carry risks comparable to caesarean births,2 health problems associated with caesareans have been amply documented.3 All of these risks may be easily outweighed by the potential benefits to a mother or infant with a condition that could have been avoided by a timely caesarean, but what if the caesarean was done without a medical indication? In the case of no indicated risk primary caesareans, particularly for younger mothers who plan to have more children and may be denied a vaginal birth after a caesarean,4 additional research is needed to elucidate whether the risks of a no indicated risk primary caesarean will be offset by associated benefits.
Definitions and an extra table are on bmj.com
This article was posted on bmj.com on 19 November 2004: http://bmj.com/cgi/doi/10.1136/bmj.38279.705336.0B
Contributors: ED conceived of the new measure, planned the study, and wrote the first draft. All authors were involved in analysing the data and contributed to subsequent drafts and approved the final version of the paper. All are guarantors. Funding: None.
Competing interests: None declared.
Ethical approval: Not needed; the research used de-identified secondary national data.
References
Parrish KM, Holt VL, Connell FA, Williams B, LoGerfo JP. Variations in the accuracy of obstetric procedures and diagnoses on birth records in Washington State, 1989. Am J Epidemiol 1993;138: 119-27.
O'Boyle AL, Davis GD, Calhoun BC. Informed consent and birth: protecting the pelvic floor and ourselves. Am J Obstet Gynecol 2002;187: 981-3.
Bewley S, Cockburn J. The unfacts of `request' caesarean section. BJOG 2002;109: 597-605.
Zinberg S. Vaginal delivery after previous caesarean delivery: a continuing controversy. Clin Obstet Gynecol 2001;44: 561-70.(Eugene Declercq, professor, maternal and)
Correspondence to: E Declercq declercq@bu.edu
Introduction
The proportion of no indicated risk primary caesareans is growing rapidly in the United States, adding to the overall rise in primary caesareans. The major limitation of this study is the quality of reporting of items on the US birth certificate.1 However, we would expect that "defensive medicine" would encourage the reporting of a risk factor associated with the resulting caesarean. Also, in the trend analysis there is no inherent reason to expect a bias that would cause a shift in the measurement of these variables at different time periods. It would also be inappropriate to equate no indicated risk caesareans with "patient choice" caesareans, as birth certificate data provide no record of the mother's intent.
Although some recent editorials have suggested that vaginal births carry risks comparable to caesarean births,2 health problems associated with caesareans have been amply documented.3 All of these risks may be easily outweighed by the potential benefits to a mother or infant with a condition that could have been avoided by a timely caesarean, but what if the caesarean was done without a medical indication? In the case of no indicated risk primary caesareans, particularly for younger mothers who plan to have more children and may be denied a vaginal birth after a caesarean,4 additional research is needed to elucidate whether the risks of a no indicated risk primary caesarean will be offset by associated benefits.
Definitions and an extra table are on bmj.com
This article was posted on bmj.com on 19 November 2004: http://bmj.com/cgi/doi/10.1136/bmj.38279.705336.0B
Contributors: ED conceived of the new measure, planned the study, and wrote the first draft. All authors were involved in analysing the data and contributed to subsequent drafts and approved the final version of the paper. All are guarantors. Funding: None.
Competing interests: None declared.
Ethical approval: Not needed; the research used de-identified secondary national data.
References
Parrish KM, Holt VL, Connell FA, Williams B, LoGerfo JP. Variations in the accuracy of obstetric procedures and diagnoses on birth records in Washington State, 1989. Am J Epidemiol 1993;138: 119-27.
O'Boyle AL, Davis GD, Calhoun BC. Informed consent and birth: protecting the pelvic floor and ourselves. Am J Obstet Gynecol 2002;187: 981-3.
Bewley S, Cockburn J. The unfacts of `request' caesarean section. BJOG 2002;109: 597-605.
Zinberg S. Vaginal delivery after previous caesarean delivery: a continuing controversy. Clin Obstet Gynecol 2001;44: 561-70.(Eugene Declercq, professor, maternal and)