Head-First Preemie Birth Okay Either Way

Preemies in vaginal deliveries survive as well as in C sections if head first

(RxWiki News) One of the considerations in delivering an extremely early baby is how the baby will be born. Vaginal deliveries and cesarean sections each carry their own risks.

A recent study has found that very early preemies born vaginally do just as well as when born by C section — as long as they're head first.

Preemies are more likely to experience a range of possible health issues. The risk of these health problems increases the earlier the baby is born.

"Discuss birthing options with your OB/GYN."

The study was led by Uma M. Reddy, MD, MPH, of the Pregnancy and Perinatology Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). The NICHD is part of the National Institutes of Health.

The researchers analyzed data from 4,352 women who gave birth between 24 and 32 weeks of pregnancy.

A total of 2,902 of these women attempted to give birth vaginally, and their babies' outcomes were compared to those of the women who had C sections.

Babies born before the 37th week of pregnancy are preterm (preemies), and those born before the 32nd week of pregnancy are early preterm.

The health problems experienced by preemies can include cerebral palsy, developmental delays, infections, problems with sight and hearing and a higher risk of overall death.

Previously, research appeared to show that babies who were born extremely early — before 32 weeks of pregnancy — were more likely to die or have serious injury or health problems if they were delivered vaginally.

C sections were thought to be safer for the baby, though C sections have their own set of risks for a mother.

Those risks include hemorrhage (heavy bleeding), injury to the woman's bladder and complications in future pregnancies, such as a tearing of the uterus.

However, in this study, 84 percent of the women whose babies were in the head-first position successfully delivered their children vaginally.

These babies were just as likely to live as the ones who were delivered by C section.

However, babies delivered by C section were more likely to survive compared to babies born vaginally who were in the feet-first position.

Just over 77 percent of the women who were 24 to 28 weeks pregnant and whose babies were facing head first chose to have vaginal deliveries, and 85 percent of these women were successful.

The other 23 percent with head-first babies between 24 and 28 weeks chose to have C sections. These women were more likely to have other complications, such as diabetes or pre-eclampsia.

There was no difference in the likelihood of survival among the babies in these vaginal and C section groups.

Among women 24 to 28 weeks pregnant whose babies were breech (feet-first), 32 percent attempted a vaginal delivery, and only 28 percent of these women successful delivered their baby.

The breech babies were more likely to survive if they arrived by C section instead of vaginally.

Among women who were 28 to 31 weeks pregnant, 80 percent attempted vaginal delivery, and 84 percent of these women delivered their babies successfully.

These babies also did just as well as the ones who were born by C section between 28 and 31 weeks of pregnancy.

Among breech babies in women 28 to 31 weeks of pregnancy, 31 percent tried to deliver their babies vaginally, and only 17 percent of the babies survived.

The women who delivered these extremely early preemies by C section were more likely to have a successful delivery.

“The decision to deliver vaginally or by cesarean is an individual one, and must be made carefully by the woman, in close consultation with her physician,” Dr. Reddy said in the NIH release.

“Our study provides important information for women who are at risk for early preterm delivery and their physicians to take into account when making their decision," she said.

The study was published in the August issue of the American Journal of Obstetrics and Gynecology. The research was funded by the National Institutes of Health. The authors declared no conflicts of interest.

Reviewed by: 
Review Date: 
September 22, 2012