Recent Studies Show Cesareans Can Pose
Dangers to Mothers and Babies


Rising Cesarean Rate Bad for Mothers:

Top 12 Studies from 2007

  

 

 

 

1.       Maternal and neonatal individual risks and benefits associated with caesarean delivery: multicentre prospective study (Villar, et al., British Medical Journal, 2007;335:1025, 17 November)

Study Design: Researchers assessed the risks and benefits of cesarean delivery vs. vaginal delivery.
Bottom line: Cesarean carries twice the risk of injury and death for both mother and baby. Women with cesarean experience double the rate of hysterectomy, blood transfusion, admission to intensive care, prolonged hospital stay and death, compared to mother who delivered vaginally.  Babies born by cesarean were 45 percent more likely to be in the neonatal intensive care unit for 7 days and 41-82 percent more likely to die than babies born vaginally.

 

2.       Risk of Uterine Rupture and Adverse Perinatal Outcome at Term After Cesarean Delivery (Spong, et al., Obstetrics and Gynecology 2007; 110: 801-7)

Study Design:  Researchers examined the risk of uterine rupture after cesarean and what harms it may have for mothers and babies. 

Bottom line: Regardless of how the baby was delivered, the rate of uterine rupture was low and complications from rupture were also low for both mother and baby. 

 

 

3.       Maternal outcomes associated with planned primary cesarean births compared with planned vaginal births. (Declercq, et al. American Journal of Obstetrics and Gynecology. 2007 Mar; 109(3):669-77.)

Study Design: Researcher divided mothers into two groups: women with a planned cesarean after no labor and women who labored and had either a cesarean or vaginal birth and then compared rehospitalization rates.

Bottom Line:  Rehospitalizations in the first 30 days after giving birth were 2.3 times more likely in planned cesarean than with planned vaginal births. The leading causes of rehospitalization after a planned cesarean were wound complications and infection.  Hospital costs were 76 percent higher for women with planned cesarean, and hospital stays were 77 percent longer.

  

 

4.       Previous caesarean or vaginal delivery: Which mode is a greater risk of perinatal death at the second delivery?
   (Richter, et al., European Journal of Obstetrics & Gynecology and Reproductive Biology 2007; 132: 51-7)

Study Design:  Researchers compared mothers who had delivered previously by cesarean vs. vaginally, and examined the number of babies who died in the subsequent pregnancy. 

Bottom line:  A previous cesarean delivery was associated with a 40 percent increase in perinatal death (the first week after birth) and a 52 percent increase risk of stillbirth.  A vaginal or cesarean delivery in the current pregnancy did not impact the death rate.   

 

 

5.       Postcesarean delivery adhesions associated with delayed delivery of infant  (Morales, et al., American Journal of Obstetrics and Gynecology 2007; 196: 461.e1-e6

Study Design: A common complication of any surgery is overgrowth of scar tissue, called “adhesions.”  Researchers examined the frequency of adhesions with successive cesareans and whether adhesions caused by cesareans could slow down the delivery of a baby in the next pregnancy. 

Bottom line:  Researchers concluded that each successive cesarean significantly increases the incidence of adhesions and can slow down the delivery of a baby.  One prior cesarean adds 5.6 minutes to the time it takes to deliver the baby, 2 prior cesareans 8.5 minutes, and 3 prior cesareans 18.1 minutes.  This delay can compromise the health of the baby, researchers concluded.

 

 

6.       Association of caesarean delivery for first birth with placenta praevia and placental abruption in second pregnancy. (Yang, et al., British Journal of Obstetrics and Gynecology: 2007 May;114(5):609-13.)

Study Design:  Researchers examined the incidence of placenta previa (placenta blocking the cervical opening) and placental abruption (placenta separating from the wall of the uterus prematurely) in women who have had a prior cesarean vs. a prior vaginal delivery. 

Bottom line:  Compared to vaginal birth, cesarean increased the risk of placenta previa by 47 percent and placental abruption by 40 percent.  Both complications carry the risk of death for both mother and baby.  Researchers indicated that complications may be due to the cesarean scar on the uterus.

 

 

7.       Risks of adverse outcomes in the next birth after a first cesarean delivery. (Kennare, et al. American Journal of Obstetrics and Gynecology. 2007 Feb; 109(2 Pt 1):270-6.)

Study Design:  Researchers examined the complication rate of women who delivered their first baby by cesarean vs. vaginally.

Bottom line:  Women who had a prior cesarean delivery were more likely to have complications than women who had a prior vaginal delivery.  Women with a prior cesarean were more likely to have a placenta previa (odds ratio [OR] = 1.66), placenta acreta (OR = 18.79), and bleeding during pregnancy (OR = 1.23).  During delivery, women with a prior cesarean were also more likely to have a prolonged labor (OR = 5.89), uterine rupture (OR = 84.42), and need an emergency cesarean (OR = 9.37).  Babies born to women with a prior cesarean were more likely to be small for their gestational age (OR = 1.12), have a low birth weight (OR = 1.30), and to be still born (OR = 1.56).

 

 

8.       Safety and efficacy of vaginal birth after cesarean attempts at or beyond 40 weeks of gestation. (Coassolo, et al., Obstet Gynecol. 2006 Jan;107(1):205)

Study Design: Women who attempted VBAC before the estimated due date (EDD) were compared with those at or beyond 40 weeks of gestation. Researchers assessed the relationship between delivery after the EDD and VBAC failure or complication rate.

Bottom Line: The risk of uterine rupture (1.1 percent compared with 1.0 percent) or overall morbidity (2.7 percent compared with 2.1 percent) was not significantly increased in the women attempting VBAC beyond the EDD. Women beyond 40 weeks of gestation can safely attempt VBAC, although the risk of VBAC failure is increased.

 

 

9.      Incisional endometriomas after Cesarean section: a case series. (Minaglia, et al., J Reprod Med. 2007 Jul;52(7):630-4.)

Study Design: Patients were identified who were diagnosed with incisional endometriomas (functional endometrial tissue outside the uterine cavity, within the incision) after undergoing cesarean section.

Bottom Line: The overall incidence of incisional endometriomas following cesarean section was 0.08 percent. Optimal treatment is by surgical excision.

 

 

10.   Predicting Failure of a Vaginal Birth Attempt After Cesarean Delivery. (Srinivas, et al., Journal of Obstetrics and Gynecology. 2007 Apr;109(4):800-5)

Study Design: Researchers analyzed the records of women offered VBAC in 17 community and university hospitals, to identify any factors that could be used to predict failure in attempting VBAC.

Bottom Line: Prelabor and labor factors cannot reliably predict VBAC failure.

 

 

11.   Caesarean delivery and risk of stillbirth in subsequent pregnancy: a retrospective cohort study in an English population. (Gray, et al., BJOG:2007 March 114(3) 264-270)

Study Design: Researchers compared the incidence of stillbirth following a previous cesarean section with stillbirths following no previous cesarean section.

Bottom Line: Pregnancies in women following a pregnancy delivered by cesarean section are at an increased risk of stillbirth.

 

 

12.   Predicting placental abruption and previa in women with a previous cesarean delivery. (Odibo, et al., Am J Perinatol. 2007 May;24(5):299-305.)

Study Design: In women with a previous cesarean section, researchers compared those who had a placental abruption and/or previa with those who did not.

Bottom Line: Three or more previous cesarean sections was a significant risk factor for placental abruption and previa.

 

 

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