News in brief - July 18, 2011

Rising C-section rates due to doctor, patient choices

The continued rise of cesarean delivery rates is due largely to physicians and patients choosing the method over vaginal birth based on subjective indications, rather than objective medical reasons, says a study in the July Obstetrics & Gynecology (www.ncbi.nlm.nih.gov/pubmed/21646928).

C-section rates in the U.S. have increased steadily. Suspected reasons include liability concerns among physicians, more women requesting C-sections and a rise in high-risk pregnancies. To determine common causes, researchers studied data on 32,443 live births at a Connecticut hospital between 2003 and 2009.

The study found C-section rates increased from 26% in 2003 to 36.5% in 2009. Half of the increase was due to repeat C-sections. Among first-time births, the largest reason for opting for C-sections was nonreassuring fetal heart tracing, which contributed to 32% of the increase. Other drivers were slow labor progression, multiple births, hypertension and babies with large birth weights. Women requesting C-sections in advance contributed to 8% of the increase, the study said.

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Stroke patients in underserved areas delay care

Getting effective treatment for acute stroke is a race against the clock, yet often such care is delayed among patients living in medically underserved communities, says a June study in Stroke, a journal of the American Heart Assn.

Researchers sought to understand some of the barriers to rapid stroke care through a survey of 253 residents in a predominantly black urban community of Washington, D.C. They found that although 89% of survey respondents correctly cited calling 911 as the first thing to do in case of a stroke, only 12% of stroke patients there actually called 911 first. Instead, their first call was to a relative or friend, the study said (www.ncbi.nlm.nih.gov/pubmed/21546471).

Of the 89% of patients who delayed seeking medical care for stroke, nearly 50% said they thought the symptoms weren't serious or would resolve themselves over time. Further research is needed to determine reasons behind patients' reluctance to call 911, and how to counteract those instincts, the study said.

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