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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.

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