Joni has felt a little pressure from her doctors to consider scheduling an elective cesarean section for her birth because it is looking like the baby is going to be above-average birthweight.
The doctor told Joni that medical journals recommend c-sections if the baby is over 4500-5000 grams. "Or 9.5 to 10 pounds." That's what he said. The implications were that if the ultrasound next week "determines" that Elias is 9.5 pounds or above, then we should opt for a c-section
However, a quick check of his math reveals that he's off:
4500 grams is 9.921 pounds, pretty darn close to 10.
5000 grams is 11.023 pounds. That's 10% heavier than the 10 pounds he stated.
So, the threshold for when you need to start thinking of having a C-section is actually 10-11 pounds, and NOT 9.5-10 pounds. His statements made it sound like above 10 pounds is getting past the safety threshold, when the journals he's quoting don't even recommend it until after 10 pounds.
"Big deal, he's 1 to 1.5 pounds off," you might say. Well, if you're fine with a 10% margin of error then you might want to move on. But, I'm not, and I decided to take it a couple steps further.
The CDC allows you to analyze all kinds of birthing information by year. Demographics, methods, mortality rates, everything. The CDC reports that in 2005 there were 159,582 births of babies who were 9.5 pounds or more, or 3.9% of all births. 10+ pound babies accounted for 1.1% of births.*
If the journal recommends 5,000 grams or 11 pounds to have a c-section, then that's not many babies. Only 4,715 babies weighed more than 5,000 grams, that's .001 of all births.
So, why is it that now 31% of all babies come by C-section, and the number of elective c-sections continue to increase?
You've probably heard that question asked on the evening news. There are a number of factors, this MSNBC article mentions about a dozen. But "there is no question that malpractice issues play a part." Doctors have been sued for not performing c-sections by parents whose babies were injured during vaginal birth. It's also more convenient for all parties involved to just schedule a c-section rather than try natural birth and end up having an emergency c-section. A couple reasons why the U.S. has the highest C-section rate in the world, higher than the World Health Organization says is necessary to improve medical service.
So, was the doctor's mistake a mathematical one or did he purposely make it sound like we need to sign some paperwork if Elias looks to be 9.5+ pounds? I don't know, but you can bet I'll be at the doctor's office for the ultrasound next week.
Through the CDC site, I was able to look up vaginal vs. cesarean births for 28 year olds and the number of injuries that occur:
In 2005, for 4500-4999 gram babies (10-11 pounds) There were 7 injuries reported in 957 vaginal births (0.7%). There was one injury reported in 730 c-sections (0.1%).
For 5000+ gram babies (11+ pounds) there were zero injuries in 76 vaginal births. There was one injury in 109 c-sections (0.9%).**
So, the risk to the baby of a healthy 28-year old like Joni giving birth naturally to a baby 10-11 pounds is pretty slim. The risk is even more slim for a c-section. But, you have to weigh the slim differences in risk (0.7% vs. 0.2% total) against all of the long-term complications and risks of having a C-section.
For one, the mortality rate for mothers is higher with a c-section than that of vaginal birth. It's a major surgery. It creates complications for having future children that have to be considered. The list goes on.
It's not something that we can say "Well, he might be 10-11 pounds, so we might as well sign up for a c-section!" as if it's something on our gift registry. And I'll be happy to point out to the doctor what the data say.
So, next week we'll have an ultrasound to try and estimate Elias' size. I imagine that the accuracy and margins of error of an ultrasound will be my next post on the subject. :-)
*(note: 2005 is the most recent year you can get detailed data. The CDC lists them in weight groupings [4000-4499 grams], so I had to multiply by the percentage difference to get to 9.5 pounds, so there is some slight estimation. So, give or take 20 babies).
** (There were more births of both types in 2005, but many did not state on the certificate whether or not injuries occured. So, the "unknowns" are left out of the analysis).