Saturday, November 22, 2014
Inquirer Daily News

C-sections and baseball: Not a good mix

Early elective deliveries are bad for the baby and bad for the mother (and controversy about them is bad for baseball, too).

C-sections and baseball: Not a good mix

New York Mets second baseman Daniel Murphy missed opening day to be with his wife when she gave birth. Some critics said she should have had a C-section so he could make the game. Bad idea. (AP photo)
New York Mets second baseman Daniel Murphy missed opening day to be with his wife when she gave birth. Some critics said she should have had a C-section so he could make the game. Bad idea. (AP photo)

Last week the blogosphere was set on fire when former NFL quarterback and current WFAN commentator Boomer Esiason commented on the paternity leave of New York Mets' second baseman Daniel Murphy, who missed two games, including opening day, to be with his wife while she delivered their baby. “Quite frankly,” Esiason said, “I would've said, 'C-section before the season starts. I need to be at opening day.’”

The response was quick and harsh, with much of the attention focused on the rights of any father, including a major league baseball player, to take time off to be with his family during the birth of a baby. Unfortunately, less attention has focused on the suggestion that it was okay for a woman to have a voluntary Cesarean delivery, scheduled for convenience. This is an important part of the conversation – research shows that early deliveries pose serious risks for both mother and baby.

An early elective delivery is a birth that takes place before the 39th week of pregnancy without a medical reason. Even for deliveries during the 37th and 38th weeks, healthcare providers are very careful to balance any risks of bringing the pregnancy to term against the risks of an early delivery. The last weeks can be very, very challenging. But they are critical for a baby’s development Parents who would do anything for their child, including spending thousands of dollars on the right toys to stimulate her growing brain and demanding that family members never smoke around their baby, often have no idea that when they (or a sports commentator) push for an early scheduled C-section, the decision could seriously impact the development of the child’s brain, lungs, and liver.

A March 2014 brief from the National Institute for Health Care Management reported that up to 10% of pregnancies end with a non-medically indicated delivery using medication or C-section. Women or their healthcare providers may choose this route for “provider preference, convenience, or for relief of symptoms.” Between 1990 and 2012, the rate of births being scheduled early for non-medical reasons more than doubled.

What happens when a baby is born too soon? The March of Dimes reports that a baby born even a few weeks early can have serious health problems and require care in the Neonatal Intensive Care Unit. The baby may have difficulty breathing on her own, feeding, and keeping warm. She may also have difficulty with hearing, vision, sucking, and swallowing – all critical for healthy development in the first few weeks. As a result, a baby born before 39 weeks may have to stay in the hospital longer than a baby who is born later.

An early delivery can also impact the health of the mother. A medically induced labor is twice as likely to end in a C-section. Although the C-section rate in the United States makes this surgery seem very common (almost 33% in 2012), it comes with risks. Some of them, like complications from anesthesia or the possibility of infection, are associated with any major surgery. With C-sections, however, there is also an increased risk of bleeding, and of inflammation and infection in the uterus. And women who have C-sections are likely to have them again in subsequent pregnancies.

There's a financial cost, too: C-sections are 34% more expensive than vaginal deliveries. The March of Dimes reports that the average length of stay in a NICU for a baby born at 37 or 38 weeks gestation is just under 6 days, costing over $37,000. None of those figures capture the emotional cost of the anxiety and concern that the families of these babies experience.

Every expectant parent should know these facts. Organizations like the March of Dimes and the U.S. Centers for Medicaid and Medicare Services have developed materials aimed at eliminating early elective deliveries.

After being subjected to harsh and very public criticism, including a phone call from the March of Dimes, Esiason quickly apologized on his radio program for his insensitive comments.  He said that his friends at the March of Dimes had re-educated him about their mission and their work.  We trust that Esiason will now remember that a C-section scheduled for convenience is never worth the risk … let’s make sure that this message gets out to everyone who needs to hear it.


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What is public health — and why does it matter?

Through prevention, education, and intervention, public health practitioners - epidemiologists, health policy experts, municipal workers, environmental health scientists - work to keep us healthy.

It’s not always easy. Michael Yudell, Jonathan Purtle, and other contributors tell you why.

Michael Yudell, PhD, MPH Associate Professor, Drexel University School of Public Health
Jonathan Purtle, DrPH, MSc Assistant Professor, Drexel University School of Public Health
Janet Golden, PhD Professor of history, Rutgers University-Camden
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