A study of births in Latin America has found that women who have non-emergency caesarean deliveries have double the risk of illness and complications or even death compared to women who have vaginal deliveries. However, the study found that caesarean delivery prevented deaths in breech born infants.
The study is published in the Online First issue of the BMJ (British Medical Journal), and is the work of José Villar, Senior Fellow in Perinatal Medicine, Nuffield Department of Obstetrics and Gynaecology, at the University of Oxford, UK, and colleagues.
The finding that caesarean birth is linked to maternal risks were not affected by factors such as demographics, medical history of the mother and the pregnancy, gestational age of the foetus, complications of pregnancy complications, place of birth, and the expertise of the attending medical staff.
The researchers examined complete records of 97,307 deliveries of babies over a three month period. The records came from 8 randomly selected Latin American countries from which 120 health facilities were also randomly selected. Access to data was provided via the Latin American arm of the World Health Organization (WHO) Global Survey on Maternal and Perinatal Health done in 2005.
The results showed that:
- 33.7 per cent of the deliveries were caesarean and 66.3 per cent were vaginal.
- Overall, the medical results associated with deliveries in the 120 hospitals were good, and not very different to hospitals in developed countries.
- However, women who had caesarean deliveries had twice the risk of severe illnesses and complications or death compared to women who had vaginal deliveries.
- The illnesses and complications included hysterectomy, blood transfusion and admission to intensive care.
- Women who had caesarean deliveries had a five times higher risk of needing antibiotics to treat infections linked to delivery compared to those who had vaginal deliveries.
- For caesarean delivered babies who presented head first (cephalic presentation), the risk of having to stay in neonatal intensive care after birth was double that of head first babies delivered via the vagina.
- The risk of death while in hospital for head first babies delivered by caesarean was more than 70 per cent higher than head first babies delivered via the vagina.
- But babies presenting as breech had a better survival chance when delivered by caesarean than breech babies delivered via the vagina.
Villar and colleagues concluded that:
“Caesarean delivery independently reduces overall risk in breech presentations and risk of intrapartum fetal death in cephalic presentations but increases the risk of severe maternal and neonatal morbidity and mortality in cephalic presentations.”
The researchers saw no benefits in the “liberal” use of caesareans to the mother, the baby or the hospital, except in cases of breech births and severe vaginal complications.
“Maternal and neonatal individual risks and benefits associated with caesarean delivery: multicentre prospective study.”
José Villar, Guillermo Carroli, Nelly Zavaleta, Allan Donner, Daniel Wojdyla, Anibal Faundes, Alejandro Velazco, Vicente Bataglia, Ana Langer, Alberto Narváez, Eliette Valladares, Archana Shah, Liana Campodónico, Mariana Romero, Sofia Reynoso, Karla Simônia de Pádua, Daniel Giordano, Marius Kublickas, Arnaldo Acosta World Health Organization 2005 Global Survey on Maternal and Perinatal Health Research Group.
BMJ doi:10.1136/bmj.39363.706956.55 (published 31 October 2007)
Written by: Catharine Paddock