Practical and financial constraints on public sector hospitals could be dictating how and when babies are born. Two new studies (1,2) show that as the number of elective, planned caesarean sections rises, more and more babies are born during the week and fewer come into the world at weekends. It appears that hospitals schedule births during the week when they are fully resourced and staff is working 'normal' hours at no extra cost. These findings by Alexander Lerchl, from the Jacobs University Bremen in Germany, will be published online this week in Springer's journal Naturwissenschaften.
In one study (1), Lerchl shows a direct link between the increase in the number of elective caesarean sections and the fall in weekend births in Switzerland. By analyzing birth data from almost 3 million babies born between 1969 and 2005, Lerchl and his colleague Sarah Reinhard show that up to 18 percent fewer births than expected occur at weekends. Over the study period, nearly 100,000 fewer babies were born at the weekend than expected, as a consequence of the increasing numbers of caesarean sections and elective labor induction, which reached 29 percent and 20 percent respectively in Switzerland in 2004.
The second study (2) paints a similar picture in Germany, across all 16 states. Weekend births were consistently less frequent, with an average of 15 percent fewer births at weekends than expected.
These studies suggest that environmental influence has been superseded by social rhythms. Natural times of labor and deliveries are often not in line with the working hours of hospitals, where the majority of deliveries take place nowadays. Indeed, natural, non-induced labor onset in women is well known to peak during night hours.
However, it is more convenient and practical to schedule births at times when the hospitals are fully functional i.e. weekday daytime working hours. Weekend work is also more expensive. In Germany for instance, public service workers are paid on average 25 percent more for Sunday work. And in Switzerland, caesarean sections are almost twice as expensive as vaginal births.
1. Lerchl A & Reinhard SC (2007). Where are the Sunday babies" II. Declining weekend birth rates in Switzerland. Naturwissenschaften (DOI 10.1007/s00114-007-0305-4)
2. Lerchl A (2007). Where are the Sunday babies" III. Caesarean sections, decreased weekend births, and midwife involvement in Germany. Naturwissenschaften (DOI 10.1007/s00114-007-0306-3)
The full-text articles are available as pdfs to journalists.