Last month's Caesarean News

Last month two studies hit the presses. One documented the elevated risks babies born by Caesarean section. The other detailed risks to mothers who deliver surgically.

The September 2006 issue of Birth includes an article by Marian F. MacDorman, who works in the Center for Vital Statistics at the Centers for Disease Control. Her research found that newborn babies were more likely to die when born by Caesarean section than by vaginal delivery. Nearly three times more likely.

The elevated risk to babies was present even when the study population was controlled for pre-existing medical and socio-economic factors.

MacDorman concludes that the hormonal and mechanical process of labor and delivery may better prepare the baby for life outside the womb. She refers to earlier studies that show improved outcomes for babies born vaginally, particularly in the area of respiration:

Labor induces the release of fetal catecholamines and prostaglandins that promote lung surfactant secretion. In addition, epinephrine release during labor, as well as the physical compression of the infant, helps to remove fetal lung fluid and facilitates postnatal lung adaptation. Other risks of cesarean delivery include delayed neurologic adaptation, possible laceration of the infant during the performance of the cesarean surgery, and delayed establishment of breastfeeding.

Babies are not the only ones at increased risk from surgical delivery. In the September 2006 issue of Obstetrics and Gynecology, Dr. Catherine Deneux-Tharaux reports mothers are three and a half times more likely to die if their babies are born by Caesarean section rather than vaginally.

Caesarean delivery brings with it a host of associated complications. Dr. Deneux-Tharaux found that the risk of death was primarily caused by “complications of anesthesia, puerperal infection, and venous thromboembolism.”

Both MacDorman and Deneux-Tharaux situate their research squarely in the middle of today’s debate over rising Caesarean rates. Deneux-Tharaux concludes,

Although cesarean delivery is increasingly perceived as a low-risk procedure, the present study suggests that it is still associated with an increased risk of postpartum maternal death as compared with vaginal delivery, even when performed before labor. This needs to be taken into account by clinicians and women when balancing the risks against the benefits of the different methods of delivery.

Similarly, MacDorman says [emphasis added],

Timely cesareans in response to medical conditions have proved to be life-saving interventions for countless mothers and babies. At present we are witnessing a different phenomenon—a growing number of primary cesareans without a reported medical indication. Although the neonatal mortality rate for this group of low-risk women remains low regardless of the method of delivery, the resulting increase in the cesarean section rate may inadvertently be putting a larger population of neonates at risk for neonatal mortality for reasons that remain uncertain.

For many of women, doulas may be the only source of information available during their pregnancies about these risks. We must see to it that women -- particularly those who have only seen the apparent simplicity of Caesarean birth portrayed in the media -- know that Caesarean birth should be their last resort option, not their first.