Caesarean births riskier than natural deliveries
Publication Date:05/11/2007
Women who choose to have their baby by caesarean section increase the risk of serious illness and even death for both themselves and their babies, a large study from Latin America has found. However, for women whose baby is in the feet-down position (breech), a caesarean delivery is the safer option.
What do we know already?
For most women, having a baby either naturally or by caesarean section is a safe and happy event. The death of a mother or baby during childbirth in the UK is thankfully very rare nowadays. But having a caesarean section carries certain risks. In general, women take longer to recover from a caesarean section than a vaginal delivery. It may be weeks or months before they can do certain things, such as drive or lift heavy objects. There's also a greater risk of needing more surgery, like an operation to repair the bladder, for example. And there are risks for future pregnancies, such as the womb rupturing during a subsequent pregnancy or delivery.
However, caesarean section reduces the likelihood of leaking urine (urinary incontinence) after childbirth. About 7 in 100 women have this problem after a vaginal birth. This compares with between 4 and 5 in 100 women who have a caesarean delivery.
In the last 20 years the number of women in the UK who had a caesarean section doubled. About 1 in 5 women in the UK now have their baby this way.
The current study was done to gather information about the risks and benefits of caesarean sections.
What does the new study say?
Women in the study who had a baby by caesarean section were twice as likely to need emergency hospital treatment or to die after giving birth than women who had a vaginal delivery. Emergency treatments included having a hysterectomy, a blood transfusion or needing treatment in intensive care. They were also twice as likely to need to stay in hospital for more than a week.
Women who had a caesarean were also fives times more likely to need antibiotics for an infection after giving birth than women who had a vaginal delivery.
There were also risks for babies. In the study, those babies who were head-down before being delivered were twice as likely to need seven or more days in intensive care if they were delivered by caesarean than if they had been delivered vaginally. They were also more likely to die after caesarean delivery.
But for babies who were lying in the breech position (feet first), delivery by caesarean reduced the risk of dying.
Tell me more about the study's findings
The researchers divided caesareans into two types: those done when the woman asked for it before going in to labour, and those done when the woman asked for it during labour. The risk of any serious illness or death was slightly higher for women who chose to have a caesarean before their labour started, compared with those women who opted for a caesarean during labour.
Even when the researchers took out the data on babies who were delivered by caesarean because the baby seemed to be distressed, they found that babies delivered by caesarean were still more likely to need intensive care treatment.
In the study, women who had a caesarean delivery had fewer vaginal complications, such as tears between the vagina and anus, or severe incontinence needing surgery.
Where does the study come from?
The countries included in the study were Argentina, Brazil, Cuba, Ecuador, Mexico, Nicaragua, Paraguay and Peru. Researchers based in those countries gathered the data, then worked with other researchers from Oxford University in the UK, the University of Western Ontario in Canada, the World Health Organization and the Karolinska Institute in Sweden to put the study together. It was published in the BMJ (British Medical Journal).
How reliable are the findings?
This was a big study that looked closely at what happened to more than 97,000 pregnant women and their babies until they left hospital. Other than the question of whether they have a caesarean section or a vaginal birth, lots of other things can make a difference to the health of mothers and babies. These things include whether the baby was premature, a woman's age and education, whether she'd had genital warts or high blood pressure during pregnancy, and whether she had previous caesarean deliveries or previous stillbirths. The researchers took account of these things when they did the study, so the findings should be reliable.
You might wonder whether the results from a study done in Latin America apply to the UK. More women in this study (34 percent) had a caesarean section than is usual in the UK. And we don't know how the antenatal and maternity care given to the women in the study compares to care in the UK.
But the numbers of babies in the study who were born alive and who needed intensive care was about the same as it is in developed countries. So, although the picture may not be exactly the same as it is in the UK, it is not hugely different.
What does this mean for me?
If you're thinking of having a caesarean section because you think it is safer than a vaginal delivery, then this study may be important for you. It shows that the commonly held belief that caesareans are safer than vaginal deliveries may not be correct.
But don't be alarmed by the findings. Childbirth in the UK is very safe for women and their babies, whether you choose a vaginal birth or caesarean section. According to the most recent figures, less than 4 babies in 1,000 die during birth. And women dying while giving birth is even rarer. For every 100,000 pregnancies in the UK, 5 women die from causes directly related to their pregnancy. Most of these deaths are because of illnesses during pregnancy, like blood clots, not from giving birth.
What should I do now?
Before you decide whether a caesarean section is the right option for you, it's important to look at the risks and benefits of having this operation. Talk to your doctor or midwife about your options. For some women, a vaginal delivery may not be possible. If you've been put off having a vaginal delivery because you've had a bad experience in the past, you may find it useful to talk about what types of pain relief you will be able to have, or whether other options are available, such as a water birth.
From:
Villar J, Carroli G, Zavaleta N, et al. Maternal and neonatal individual risks and benefits associated with caesarean delivery: multicentre prospective study. BMJ. Published online 30 October 2007.
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© BMJ Publishing Group Limited ("BMJ Group") 2007. All rights reserved
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