‘Significant’ fall in caesarean births since start of Covid pandemic

Caesarean section births and induced deliveries in the US have seen a “significant” fall since the start of the coronavirus pandemic, according to a new study.

The first large-scale examination of delivery data during the onset of the virus showed premature births through C-sections and induced deliveries fell by 6.5 per cent during the first month of the pandemic.

Researchers said this remained consistently lower throughout the pandemic, and the reason for the fall is likely down pre-natal visits being reduced in an effort to slow the spread of Covid.

Dr Daniel Dench, the lead author of the study, said: “While much more research needs to be done, including understanding how these changes affected foetal deaths and how doctors triaged patient care by risk category during the pandemic, these are significant findings that should spark discussion in the medical community.”

In a separate observational study that appeared in the International Journal of Gynecology & Obstetrics, one third of women were said to have had inadequate pre-natal visits during Covid, partially due to patients getting the virus and also because of lockdown policies.

Researchers concluded that although the virus did not directly impact pregnancy outcomes “it has indirect adverse effects on maternal and child health”.

Dr Dench and his colleagues examined records of nearly 39 million births in the United States from 2010 to 2020.

They used the datas to forecast expected premature births - defined as babies born before 37 weeks of pregnancy - from March to December 2020. Then they compared the predictions to the actual numbers.

The team found that in March 2020 - when the World Health Organisation (WHO) declared Covid-19 a pandemic - preterm births from C-sections or induced deliveries immediately fell from the forecasted number by 0.4 percentage points.

From March 2020 to December 2020, the number remained on average 0.35 percentage points below the predicted values, translating to 350 fewer preterm C-sections and induced deliveries per 100,000 live births, or 10,000 fewer overall.

Before the pandemic, the number of preterm C-sections and induced deliveries had been rising.

Spontaneous preterm births - those that were not induced or Caesarean - also fell by a small percentage in the first months of the pandemic, but much less than births involving the two factors. The number of full-term Caesarean and induced deliveries increased.

Dr Dench, an assistant professor at Georgia Tech’s School of Economics in the US, said: “If you look at 1,000 births in a single hospital, or even at 30,000 births across a hospital system, you wouldn’t be able to see the drop as clearly.

“The drop we detected is a huge change, but you might miss it in a small sample.

“We know for certain that doctors’ interventions cause preterm delivery, and for good reason most of the time.

“So, when I saw the change in preterm births, I thought, if anything changed preterm delivery, it probably had to be some change in how doctors were treating patients.”

He said the findings, published in the journal Pediatrics, raised a “critical” question about whether the pre-pandemic level of doctor intervention was necessary.

Dr Dench said: “It’s really about, how does this affect foetal health?

“Did doctors miss some false positives - did they just not deliver the babies that would have survived anyway? Or did they miss some babies that would die in the womb without intervention?”

He now plans to use foetal death records from March to December 2020 to answer the question. Dr Dench added: “This is just the start of what I think will be an important line of research.”