03 Aug 2010

Caesarean Section – Game Over?

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Reference: Maternal and neonatal individual risks and benefits associated with caesarean delivery:
multicentre prospective study. Villar et al. British Medical Journal 17th November 2007. Volume 335, page 1025.

Conclusions:
“Caesarean delivery independently reduces overall risk in breech (bottom – first) presentations and risk of intrapartum (during labour) fetal death in cephalic (head – first) presentations but increases the risk of severe maternal and neonatal morbidity (harm) and mortality (death) in cephalic presentations.”

Comment:
At first glance – or even a superficial read – this paper provides convincing evidence that for women with babies that are head first caesarean childbirth is associated with worse outcomes for both mothers and babies than vaginal birth. This finding, while true, is self evident. The authors of this study retrospectively (in hindsight) compared women who had undergone caesareans with women who had given birth vaginally. However the women who underwent caesareans did not do so because of their own choice. The women having caesareans were far more likely to have significant medical problems (heart problems, for example) and obstetric complications (high blood pressure, diabetes, bleeding in pregnancy, obstructed labour) than those who gave birth vaginally. Similarly – and critically – emergency caesareans are appropriately conducted when babies are showing signs of possible oxygen deprivation (fetal distress) so again it is unsurprising that a greater number of babies born by that method either died or came to harm.

This study however confirms our previously held view that breech, or bottom first, babies are more safely delivered by caesarean.

While this study has been greeted with great fanfare by the opponents of caesareans, it adds little to our understanding of the risks and benefits of caesareans for mothers and babies. What we need is a large study that prospectively examines women who have no major medical or obstetric complications and either plan a vaginal birth or a caesarean. The short and long term effects of those birth plans should be carefully examined for both mothers and babies.

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