New Moms Who Have C-sections More Likely to Be Rehospitalized
May 10, 2000 -- Each year, hundreds of thousands of women in the U.S.
deliver babies by cesarean section. While most women have no complications from
the procedure, a small percentage are at risk for serious problems that can
send them back to the hospital within the first couple of months after giving
A new study published in the Journal of the American Medical
Association finds that women who give birth by C-section are nearly twice
as likely to be rehospitalized within 60 days of leaving the hospital after
giving birth, compared with women who have an uncomplicated vaginal delivery.
Women who deliver vaginally by assisted methods such as forceps or vacuum
extraction are 30% more likely to be rehospitalized.
"It's a tragedy when this happens," says Peter Bernstein, MD, MPH,
medical director of obstetrics and gynecology at Montefiore Medical Center's
Comprehensive Family Care Center in Bronx, N.Y. "When women are
rehospitalized, they usually have to be separated from their babies because few
hospitals have policies that allow the baby to go back to the hospital with the
mother." Bernstein was not involved in the study.
For the study, Mona Lydon-Rochelle, MPH, PhD, and colleagues from the
University of Washington in Seattle, examined medical records of more than
250,000 new mothers. They found that the primary reason for rehospitalization
among women with cesarean sections was infection of the uterus. Other reasons
women with C-sections needed to be rehospitalized included bleeding,
gallbladder disease, genitourinary complications, problems with the surgical
wounds, blood clots, and appendicitis.
Lydon-Rochelle says the study is a heads-up to doctors that they need to do
more to prevent infections and other complications that C-sections can cause in
otherwise healthy young women who are giving birth for the first time. One way
to do this may be to limit the number of vaginal exams performed while the
woman is in labor. Another is to try to reduce the number of unnecessary
C-sections being performed.
In the U.S., C-sections are among the most frequently performed surgical
procedures. A C-section may be necessary during a first or subsequent pregnancy
if labor is not progressing adequately, if the baby is in the breech position
(feet or rear-end first instead of head-first), or if the baby is in distress.
If the mother has had a prior C-section and the scar is at risk for tearing
during vaginal delivery, she may be scheduled for a repeat C-section.
Lydon-Rochelle and colleagues say some methods that may reduce the need for
C-sections are the use of midwives in the labor and delivery room, better pain
management during labor, and getting a second opinion when a C-section is
suggested. They also advocate the use of two methods for breech births: one in
which the doctor turns the baby within the womb to get it into a heads-down
position, and the other in which a Chinese herb is burned to stimulate
acupuncture points on the mother that cause the baby to move around.
Bernstein says the message for patients is that C-sections, while common,
are not without problems. "The odds are still very much in your favor that
you're not going to be readmitted to the hospital. But cesarean shouldn't be
passed off as a benign procedure," he tells WebMD.