Weighing The Pros And Cons Of Cesarean Delivery
Obstetricians and moms have long debated the pros and cons of giving birth
by elective (non-emergency) cesarean section versus vaginal delivery, a debate
which has been supported on both sides by various research. Now, two additional
studies have been published adding additional support to both sides of the argument.
One study from the journal Obstetrics and Gynecology (Aug. 2003)
showed that women who deliver by cesarean are less likely to develop pelvic
support problems than are women who deliver vaginally. However, a second study
in the same issue found that there is actually a greater risk of pregnancy-related
death associated with cesarean delivery than with vaginal birth. This evidence
must be considered in evaluating patient requests for cesarean deliveries.
The first study of 169 pregnant women confirmed what obstetricians have long
suspected: that women who give birth vaginally are more likely to experience
pelvic-organ prolapse than are women who deliver by cesarean. Pelvic-organ prolapse
is a condition in which the uterus, bladder, rectum, or small bowel protrudes
into the vagina. This can cause discomfort and urinary or even stool incontinence.
Among vaginal deliveries, those that involved forceps or vacuum extraction produced
the highest risk of pelvic-organ prolapse, with risk from forceps use being
higher than vacuum extraction use.
The second study examined the association between pregnancy-related death and
health care services, including maternity care coordination, nutritional services,
sources of prenatal care (public vs private), the number of prenatal visits,
and method of delivery. It found that a cesarean delivery significantly increased
a woman's risk of experiencing a pregnancy-related death (35.9 deaths per
100,000 deliveries with a live-birth outcome) compared to a woman who delivered
vaginally (9.2 deaths per 100,000). Pregnancy-related mortality rates were higher
among women with cesarean delivery when all causes of death were analyzed.
Importantly, this study also found that women who received regular prenatal
care significantly decreased their risk of death.
The researchers involved conclude that the
number of pregnancy-related deaths could be reduced by removing barriers to
and actively promoting the need for routine prenatal care services as well as
lowering the overall number of cesarean deliveries.
How does this information apply to you? If you are pregnant or planning to
become pregnant, it underscores the importance of prenatal care. If you are
considering having an elective cesarean section, it may make you think twice.
Created: 9/22/2003  - Donnica Moore, M.D.