Compared with vaginal deliveries, cesarean deliveries have twice the risk of complications and deaths of both infants and mothers when the fetus is in the normal, head-down position, according to findings from a study conducted in Latin America.

However, if the fetus is turned around - in the breech position - the benefits of cesarean delivery outweigh the risks, Dr. Jose Villar, at the University of Oxford in the UK, and associates report in BMJ Online First.

The rising rates of cesarean deliveries in recent years are not explained by any clear benefits to the baby or mother, the authors note. “There is therefore an urgent need to provide women and care providers with information on the potential individual risks and benefits associated with cesarean delivery.”

Their study included 94,307 women who delivered at 120 health facilities in 8 Latin American countries. The investigators compared the outcomes of 31,821 women who underwent cesarean delivery, performed during labor or as an elective procedure, with 62,486 women who had a vaginal delivery.

Women in the cesarean group had twice the risk of hysterectomy, blood transfusion, admission to intensive care, prolonged hospital stay and death, compared with those delivering vaginally. They were also five times more likely to require postnatal antibiotic treatment.

The risk of remaining in the neonatal intensive care unit for 7 days was 45-percent higher for infants delivered by cesarean during labor and more than double for those delivered by elective cesarean, compared with the infants born vaginally. Similar patterns for infant mortality were observed, which increased with cesarean deliveries by 41 percent and 82 percent, respectively.

The opposite pattern was observed when the fetus was in the breech position at the time of delivery. Compared with vaginal delivery, infant mortality risk was reduced in elective cesareans by 45 percent and in cesareans during labor by 31 percent.

Overall, Villar and colleagues conclude that when the fetus is in the normal, head-down position, which represents the majority of deliveries, cesarean section is associated with higher maternal and infant complications and mortality.

SOURCE: BMJ Online First, October 31, 2007.