Increasing cesarean section rates in very low-birth weight infants: effect on outcome

Article Abstract:

The number of infants delivered by cesarean section has increased dramatically during the past two decades. In 1965, only 4.5 percent of all deliveries were cesarean, while in 1986 the cesarean rate reached 24.1 percent. The authors investigated this trend among very low-birth weight infants (1.1 to 3.3 pounds) to see if the increased cesarean rate was improving their chances of survival. Birth and death statistics from 1980 to 1984 were evaluated for the state of Missouri, which was found to be representative of national cesarean and low-birth weight rates. Infant deaths occurring in the first day of life were considered, since they were thought most closely related to delivery method. The data revealed that cesarean sections rose substantially (from 24 to 44 percent) for very low-birth weight infants between 1980 and 1984. Significantly fewer cesarean-delivery infants died in the first day of life (33 percent) compared with babies delivered vaginally (59 percent), for the 1.1 to 1.63 pound birth weight group. However, a higher death rate for days one to six was noted for cesarean-delivery infants compared to vaginal-delivery infants. Overall, for the entire first week of life no relationship between delivery method and death rate was found. The authors state there is scant evidence that cesarean section improves survival of very low-birth weight infants. They do not support the rapid increase in cesarean sections for delivery of these tiny, high-risk infants.

Research, Case studies, Patient outcomes, Mortality, Infants (Premature), Birth weight, Low, Premature infants, Low birth weight, Infant mortality, Cesarean section

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Consumer reports in health care: do they make a difference in patient care?

Article Abstract:

Many hospitals may change or add services following the publication of a consumer report. Consumer reports are essentially report cards that rate hospitals and physicians and were created to help consumers choose health care wisely. In Missouri, consumer reports are mandated annually by law. The 1993 report was sent to all Missouri hospitals that provided obstetrical services. One-third to half of the 82 hospitals that responded to a subsequent survey said they had added services that they did not offer prior to the consumer report. Almost half rated the report as helpful and 38% believed it would help consumers.

Evaluation, Services, Medical care, Physicians, Medical professions, Hospitals, Gynecologic and obstetric, Gynecologic and obstetric hospitals

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Effectively Delivering the Message on Infant Sleep Position

Article Abstract:

A campaign to encourage mothers to place their infants on their backs or sides when sleeping needs to be expanded to low-income, minority communities. In 1992, the American Academy of Pediatrics (AAP) recommended these positions to reduce the risk of sudden infant death syndrome (SIDS). Three 1998 studies show that many low-income, minority mothers did not receive this message despite a well-publicized 1994 campaign called "Back to Sleep". However, the studies confirm that the percentage of infants placed on their stomachs has dropped, as has the incidence of SIDS.

Editorial, Prevention, Surveys, Sleep, Sudden infant death syndrome, Sleep positions

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