The cesarean delivery rate in the United States has remained stable overall since 2009, but has declined significantly among early term babies, thanks in part to efforts to improve perinatal care quality, changes in hospital policies, and public education sponsored by the March of Dimes and its partners.
A report published today by the U.S. Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS), which examined trends in c-section rates among singleton live births in the U.S., cites a toolkit developed in partnership by the March of Dimes and others as one effort to reduce these births nationwide.
Another study published April 8 in Obstetrics & Gynecology* showed that early elective deliveries (inductions of labor and c-sections before 39 completed weeks without a medical reason) in a group of 25 hospitals that used the toolkit fell 83 percent during a one-year period.
“We’re very gratified to see that our efforts to reduce unnecessary early c-sections seem to have helped stem the rising rate of these procedures,” says Edward R.B. McCabe, MD, senior vice president and chief medical officer of the March of Dimes. “Most importantly, these initiatives seem to have contributed to decreases in early term c-sections, primarily those at 38 weeks. And coupled with previously-released data from NCHS showing declines in births at this period, we now see more babies are being born at full-term. This is so important because many of a baby’s vital organs, including the brain and lungs, are still developing during the final weeks of pregnancy.”
Dr. McCabe noted that while the NCHS report showed a 5 percent decline in c-section deliveries among babies born at 38 weeks, it also showed a 4 percent increase between 2009 and 2011 in these procedures for infants born at 39 weeks. “We’re still concerned by the continued increases at these gestational ages,” he says. “If a pregnancy is healthy, the March of Dimes urges women and their health care providers to let labor begin on its own.”
Dr. McCabe also noted that the NCHS publication uses definitions recommended by the international 2012 Defining Term Pregnancy Workgroup, published in the June 19, 2013 issue of the Journal of the American Medical Association:
- Preterm or premature birth: before 37 completed weeks gestation;
- Early term birth: 37-38 completed weeks gestation;
- Full-term birth: 39 to 40 weeks completed gestation;
- Late term birth: 41 completed weeks gestation.
The toolkit, “Elimination of Non-medically Indicated (Elective) Deliveries,” from the March of Dimes and, the California Maternal Quality Care Collaborative and the California Maternal Child and Adolescent Division within the California Department of Public Health, can be downloaded free from the March of Dimes Prematurity Prevention Resource Center at prematurityprevention.org.
Besides the toolkit, the March of Dimes Healthy Babies are Worth the Wait© campaign includes other consumer and professional education, public health interventions that augment existing public health services, and clinical interventions in the prenatal and pre-/interconception periods.
Partners in the March of Dimes Prematurity Campaign are:
- American Academy of Pediatrics (AAP);
- American College of Obstetricians and Gynecologists (ACOG);
- Association of Maternal and Child Health Programs (AMCHP);
- Association of State and Territorial Health Officials (ASTHO);
- Association of Women’s Health, Obstetric & Neonatal Nurses (AWHONN);
- National Association of County and City Health Officials (NACCHO).
In 2013, the March of Dimes celebrates its 75th anniversary and its ongoing work to help babies get a healthy start in life. About 4 million babies are born each year in the U.S., and the March of Dimes helps each one through research, education, vaccines, and breakthroughs.