Risks for the mother
The mortality rate for both Caesarian sections and vaginal birth, in the Western world, continues to drop steadily. In 2000, the mortality rate for Caesareans in the United States were 20 per 1,000,000. The UK National Health Service gives the risk of death for the mother as three times that of a vaginal birth.
However, it is misleading to directly compare the mortality rates of vaginal and caesarean deliveries. Women with severe medical conditions, or higher-risk pregnancies, often require a Caesarean section which can distort the mortality figures.
A study published in the 13 February 2007 issue of the ''Canadian Medical Association Journal'' found that the absolute differences in severe maternal morbidity and mortality was small, but that the additional risk over vaginal delivery should be considered by women contemplating an elective caesarean delivery and by their physicians.
As with all types of abdominal surgery, a Caesarean section is associated with risks of post-operative adhesions, incisional hernias (which may require surgical correction) and wound infections. Other risks include severe blood loss (which may require a blood transfusion) and post spinal headaches.
It is difficult to study the effects of caesarean sections because it can be difficult to separate out issues caused by the procedure itself versus issues caused by the conditions that require it. For example, a study published in the February 2007 issue of the journal ''Obstetrics and Gynecology'' found that women who had just one previous caesarean section were more likely to have problems with their second birth. Women who delivered their first child by Caesarean delivery had increased risks for malpresentation, placenta previa, antepartum hemorrhage, placenta accreta, prolonged labor, uterine rupture, preterm birth, low birth weight, and stillbirth in their second delivery. However, the authors conclude that some risks may be due to confounding factors related to the indication for the first caesarean, rather than due to the procedure itself.
Risks for the child
This list covers the most commonly discussed risks to the child. Some risks are rare, and as with most medical procedures the likelihood of any risk is highly dependant on individual factors such as whether other pregnancy complications exist, whether the operation is planned or done as an emergency measure, and how and where it is performed.
- Neonatal depression: babies may have an adverse reaction to the anesthesia given to the mother, causing a period of inactivity or sluggishness after delivery.
- Breastfeeding problems: babies born by Caesarean section are less likely to successfully breastfeed than those delivered vaginally.
- Potential for early delivery and complications: One study found an increased risk of complications if a repeat elective Caesarean section is performed even a few days before the recommended 39 weeks.
Risks for both mother and child
Due to extended hospital stays, both the mother and child are at risk for developing a hospital-born infection.
In Italy the incidence of Caesarean sections is particularly high, albeit it varies from Region to Region. In Campania reportedly 60% of 2008 birth occurred via Caesarean sections. In the Rome region, the mean incidence is around 44%, but can reach as high as 85% in some private clinics. In the United States the Caesarean rate has risen 48% since 1996, A 2008 report found that fully one-third of babies born in Massachusetts in 2006 were delivered by Caesarean section. In response, the state's Secretary of Health and Human Services, Dr. Judy Ann Bigby, announced the formation of a panel to investigate the reasons for the increase and the implications for public policy.
Among developing countries, Brazil has one of the highest rates of caesarean sections in the world. In the public health network, the rate reaches 35%, while in private hospitals the rate approaches 80%.
Studies have shown that continuity of care with a known carer may significantly decrease the rate of Caesarean delivery but that there is also research that appears to show that there is no significant difference in caesarean rates when comparing midwife continuity care to conventional fragmented care.
Research into reasons for emergency cesareans found that 66% occur between the 25% of day shift hours of 8 AM and 3 PM, and the least between 5 AM and 6 AM leading the authors to conclude that physician convenience is a leading cause of "emergency cesareans." (Goldstick O, Weissman A, Drugan A.The circadian rhythm of "urgent" operative deliveries.Isr Med Assoc J. 2003 Aug;5(8):564-6.)
Dr S. Bewley has written extensively about the issues surrounding these procedures, which are often given the misnomer: 'cesarean by choice'.(Bewley S, Cockburn J. The unfacts of 'request' caesarean section. BJOG. 2002 Jun;109(6):597-605.) A caesarean is a life threatening medical procedure that is obviously ultimately decided upon by a doctor or several doctors.
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