Report Sheds New Light on Benefits, Harms of Cesarean Deliveries

Soon-to-be mothers and their clinicians need to thoughtfully consider the positive and negative outcomes, for both mothers and babies, of cesarean delivery on maternal request, according to a new report by researchers at the RTI International-University of North Carolina at Chapel Hill (RTI-UNC) Evidence-based Practice Center. Cesarean delivery on maternal request is a procedure done when no factors, for either the mother or the infant, make it medically necessary, and the number of such procedures, like cesarean deliveries generally, appears to be increasing.

The report finds no major differences in results between a first-time cesarean delivery at the mother's request and a planned vaginal delivery. The authors caution, however, that the evidence is too weak to warrant a firm conclusion that absolutely no differences exist between the cesarean and the vaginal options. For example, available data often does not distinguish between cesarean deliveries done at the request of the mother and other planned cesareans performed for factors such as breech presentation.

The report, funded by the Agency for Healthcare Research and Quality (AHRQ), provides for the first time a comprehensive framework through which health-care professionals and their patients can better understand the tradeoffs in potential benefits and risks between planned cesarean delivery and planned vaginal delivery. Key maternal outcomes studied include bleeding, infection, surgical complications, urinary incontinence and length of hospital stay. Important neonatal outcomes include breathing problems and birth trauma.

The authors note that, if a woman chooses to have a cesarean for her first delivery, she is more likely to have her subsequent deliveries by cesarean. They point out, as well, that risks are likely to increase with the number of repeat cesareans.

Dr. Anthony G. Visco, the clinical director of the review and associate professor in the UNC School of Medicine's department of obstetrics and gynecology, said, "Doctors and researchers need to take many factors into account to accurately assess the benefits and harms of planned cesarean compared with those associated with planned vaginal deliveries." He adds that "we really have no simple answers about a woman's choice to request a cesarean delivery. Making this choice involves many questions unique to her, including her plans for future childbearing. Such decisions should always be made in consultation with a medical professional."

A major limitation of the available literature is that studies typically combine outcomes from emergency cesareans and planned cesarean deliveries. In addition, the evidence base does not distinguish between planned cesarean deliveries performed at the request of the mother and other planned cesareans performed for factors such as breech presentation. These shortcomings likely create an incomplete picture of the positive and negative outcomes of the procedure for both mothers and babies.