Planned caesareans pose no bigger threat than vaginal deliveries for either mother or baby, according to a study.
NHS doctors tend to only carry out the major procedure if it is considered the safest option because it carries several risks.
But Canadian researchers have now challenged the claims, finding that it may even be better for mothers-to-be and their babies.
Ottawa University scientists leafed through the records of 422,000 births, including 2,000 where expectant mothers chose to have a C section.
They counted how many were admitted to intensive care and compared death rates between the two groups.
Results showed women who chose to have a C section faced no greater risk, and hinted the mothers-to-be and their infants may even be better off.
Around 700,000 babies are born in the UK each year, with a quarter from C-sections. The procedure makes up a similar proportion of births in the US.
Women who have a caesarean section and their babies are no more likely to suffer poor outcomes compared to those who opt for vaginal delivery (stock)
WHAT IS CDMR?
Some expectant mothers request a caesarean before they give birth.
Doctors call this a caesarean delivery on maternal request, or CDMR.
The benefits of a vaginal delivery are well-established, including no need to recover from surgery, reduced risk of scars and an improved microbiome for the baby.
But some women still request the procedure because of concerns over giving birth, perceptions care will be better, or fears over urination or sexual issues.
The NHS says a C section can be carried out for non-medical reasons once the risks have been explained by a doctor or midwife.
‘If after discussing all the risks and hearing about all the support on offer you still feel that a vaginal birth is not an acceptable option, you should be offered a planned caesarean,’ they write online.
‘If your doctor is unwilling to perform the operation, they should refer you to a doctor who will.’
There are around 700,000 births in the UK each year, of which more than 100,000 are C-sections. In the US there are 3.75million annually, including 1.25million C-sections.
It is not clear how many C-sections are at a mothers request.
NHS guidance argues the common procedure is ‘very safe’ but comes with standard surgery risks, such as blood clots and infections.
C-sections are normally carried out because of medical reasons including babies in the wrong position, or the mother suffers pre-eclampsia.
For this reason, it is hard to compare different birthing methods because the women are already at higher risk.
Scores of women, who are often dubbed ‘too push to push’, choose to go under the knife for non-medical reasons.
Experts say mothers-to-be may opt for C-sections because of perceptions they will receive better care, improving outcomes for both them and their baby.
This is despite the benefits of vaginal delivery being well known, including no need to recover from surgery and an improved microbiome for the baby.
Researchers led by Dr Yanfang Guo, who is also part of the Ottawa Hospital Research Group, checked over official birthing records in Ontario, Canada, for the seven years to 2018.
The team marked down how many were vaginal births and ‘caesarean delivery on maternal request’ (CDMR).
Among mothers-to-be, they checked for how many suffered tears to the rectum or uterus, unanticipated operative procedures or required blood transfusions.
And among their babies they checked for adverse events such as trauma, death, and heart rate problems.
There were 18,336 (4.4 per cent) adverse events among pregnant women who opted for vaginal delivery, compared to 37 (2 per cent) in those who had C-sections.
For babies delivered by vagina there were 17,899 (4.3 per cent) adverse events, while in the C section group there were 34 (1.9 per cent).
Results suggested women who had a C section were 50 per cent less likely to suffer poor outcomes.
But academics cautioned more research was needed because this figure was based on a very small sample size.
They also found those who opted for vaginal delivery tended to be older and richer, contrary to characterisation of women that opt for a CDMR.
‘This analysis shows that planned CDMR is safe for low-risk pregnancies and may be associated with a lower risk of adverse delivery outcomes compared with vaginal deliveries,’ scientists said.
‘Although our study addresses concerns relating to the immediate implications of planned CDMR, exploration of longer-term risks is needed, including its impact on breastfeeding and the child’s risk for infection and respiratory illness.’
They added: ‘Women may prefer CDMR for many reasons, including scheduling convenience, anxiety regarding labour pain, perceptions that the quality of obstetrical care is better for women who have c-sections, and concerns about possible urinary incontinence and sexual dysfunction after vaginal delivery.’
The study was published in the Canadian Medical Association Journal.
WHAT ARE THE MEDICAL REASONS FOR A C SECTION?
There are various reasons why a doctor may recommend that you have a caesarean section instead of giving birth vaginally.
If you had complications in a previous pregnancy or birth, or in your current pregnancy, you may be advised to have what’s called a planned or elective caesarean, or a planned repeat caesarean.
If you were planning to give birth vaginally, but complications during labour or birth mean that you’re advised to give birth by caesarean, you’ll have what’s called an unplanned or emergency caesarean.
Here are some reasons why doctors may opt for a planned or emergency caesarean, rather than a vaginal birth:
- You’ve already had at least one caesarean section;
- Your baby is in a bottom-down, or breech, position;
- Your baby is in a sideways (transverse) position, or keeps changing its position (unstable lie);
- You have a low-lying placenta (placenta praevia);
- You have a medical condition, such as heart disease or diabetes;
- You have lost a baby in the past, either before or during labour;
- You’re expecting twins or more;
- Your baby is not growing as well as it should be in your womb;
- You have severe pre-eclampsia or eclampsia, making it dangerous to delay the birth.
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