Special Delivery

Study Reveals Surprising Post-Birth Complications

Approximately 4 million babies are delivered in the United States each year. For the UW study, researchers dug into the state's birth record database and compared 256,795 delivery records from 1987 to 1996. The study considered only first-time mothers who gave birth to single, live infants. Mothers with preexisting medical problems such as diabetes, chronic hypertension and other conditions that might make operative deliveries more likely were excluded.

While doctors have known for years that different forms of delivery might lead to complications, the rehospitalization study became the first to report on hard data—and reasons for the complications. For example, women who undergo assisted vaginal deliveries, such as those using forceps, run a greater risk of being rehospitalized for postpartum hemorrhages.

Obstetrics and Gynecology Professor Thomas R. Easterling, a co-author of the study, says one of the most surprising results was the link between Caesarean sections and rehospitalization for gall bladder disease.

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"You think research is supposed to answer questions, but it doesn't. It poses new ones," Easterling says. Some studies have linked abdominal surgery and the development of gall bladder disease to dehydration, fever and anesthesia. Those same elements can be associated with Caesareans.

Researchers were also surprised to see an 80 percent increase in risk of rehospitalization among C-section mothers due to appendicitis, perhaps as a result of manipulation of the abdominal contents during delivery.

While C-section mothers were twice as likely to go back in the hospital compared to those who have vaginal deliveries, their rate of rehospitalization was still markedly lower than the rate following hysterectomies.

The most notable finding was a 30-fold increase in the risk of wound infection among women who undergo C-sections, researchers say. Since every Caesarean involves surgery, the result was not a surprise, but it did spur a call for clinicians to take more preventative steps such as limiting the number of vaginal examinations during labor.

"This study gives all of us as practitioners food for thought," Easterling says. When other UW studies are completed, they will provide patients and the medical community with a broad look at mothers' delivery risks.

Lydon-Rochelle believes the strength of the research project is due in large part to the team's interdisciplinary nature. Co-author Victoria Holt is a professor of epidemiology; Diane Martin is a professor of health services.

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"What one doesn't think of another one does," she says. "It really strengthens the work."

The study recommends the use of safe, clinically appropriate steps such as a larger role for midwives and second-opinion requirements to reduce the likelihood of first-time C-sections.

The researchers are now using the same statewide data to look at other measurements of maternal health. A report on possible links between delivery methods and mortality rates for new mothers is due out this fall.

They are also planning to look at the relationship between a woman's first delivery and possible problems with the placenta during her second birth. A fourth study will focus on second births and the dangers of rupture among women who have undergone Caesareans.

"Hopefully, it will trigger more discussion and more fine-tuning of the research," Lydon-Rochelle says. "You want everyone to have a good outcome. The way to do that is to figure out who is a good candidate (for vaginal delivery) and who isn't."

Irene Svete is a Seattle-area writer specializing in business and health issues.

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