Women having a non-emergency caesarean birth have double
the risk of illness or even death compared to a vaginal
birth, according to a recent study from Latin America.
However, the researchers found caesarean delivery prevented
deaths in breech born babies.
The risks linked to caesarean births (whether chosen
by the woman or her clinicians) are higher, regardless
of variables such as demographics, medical and pregnancy
history, gestational age of the foetus, pregnancy complications,
where the baby is born and the skills of those helping
to deliver the baby.
Researchers randomly selected eight Latin American countries
and from those, 120 also randomly selected health facilities
provided complete data on 97,307 deliveries of babies
during a three-month study period. These data came from
the Latin American component of the WHO Global Survey
on Maternal and Perinatal Health, specifically carried
out for this study in 2005.
They wanted to compare the risks and benefits of caesarean
delivery compared to vaginal delivery. Of the 97,307 cases,
33.7% were caesarean and 66.3% vaginal. Overall, perinatal
outcomes were good in these 120 hospitals, not far from
those in developed countries.
They found that a woman having a caesarean delivery had
twice the risk of illness and mortality (including death,
hysterectomy, blood transfusion and admission to intensive
care) as a woman having a vaginal delivery.
There was a five times higher risk of having to have
antibiotic treatment after birth for women who had a caesarean
delivery (elective or decided by clinicians) than those
who had a vaginal delivery.
Risk of having to stay in a neonatal intensive care unit
for newborn babies who were born head-first was doubled
after a caesarean delivery compared to a vaginal birth.
The authors also found that the risk of neonatal death
was also significantly increased (more than 70% higher)
up to hospital discharge for babies who were born head
first from both an elective and a clinician chosen caesarean
delivery, compared to a vaginal delivery.
However, caesarean delivery had a large protective effect
in preventing foetal deaths in cases of breech born babies
and reduced overall risks in those cases.
The authors conclude that there are no net benefits from
the very liberal use of caesarean delivery on maternal
and neonatal outcomes, both at the institutional or individual
level, and it can do harm. The exceptions are fewer postpartum
severe vaginal complications, and better foetal outcomes
among breech presentations."
An accompanying editorial says that more accurate estimates
of probabilities from other populations are needed to
support informed childbirth choices.