Non-emergency caesareans double the risk of women dying or developing severe complications, according to a study conducted in Latin America.

The large study, led by Dr Jose Villar, an obstetrician at the University of Oxford, also shows that in some cases caesareans increased the risk of death to newborn babies by 70%.

“The message is it is an intervention that is not clinically needed and increases problems for the mother and babies,” says Villar, reporting in the British Medical Journal.

“That is something that should be confronted.”

Caesareans are favoured when doctors think vaginal delivery could cause medical complications, but have become increasingly common for what would be considered normal births.

Villar’s study used data on nearly 100,000 births from 120 Latin American hospitals that came from a global World Health Organization survey. It marks one of the largest studies looking at casesarean risks, he says.

The study found about a third of the deliveries were caesareans, about the same number as occurs in European countries and the US. The number of non-emergency caesareans also approached the 15% rate seen in developed countries, says Villar.

“We have had reports from single hospitals but this is the first time we have looked at a large number of hospitals,” says Villar.

Complications

The research showed caesareans doubled the risk of dying and of developing severe complications, such as hysterectomies, blood transfusions, or admission to intensive care regardless of age, medical history, or where the baby was born.

The procedure increased the chances of a newborn landing in intensive care while the risk of death was 70% higher for babies born head first from both elective and non-elective caesareans, the researchers found.

But the study also showed caesareans had benefits, helping to save the lives of breech babies and reducing the overall risks in cases where the mother or baby was in danger.

“Physicians are under pressure to play it safe with C-sections [caesareans],” says Villar. “We are saying we might have to rethink that policy.”

Need for more research

Australian expert, Dr Allison Shorten of the University of Wollongong says the proportion of caesareans in Australia climbed from 19.4% of all births in 1994 to 29.1% by 2004.

In an editorial accompanying the new study, Shorten says it adds to a growing body of evidence that cautions against high rates of caesarean delivery.

One 2006 study from France published in the journal Obstetrics & Gynecology found that caesareans more than tripled risk of death from blood clots, infection or complications from anaesthesia.

Shorten says many women choose a caesarean because they hope it will prevent them from getting incontinence from damaged pelvic floor muscles.

But she says it is not clear that caesareans can prevent incontinence.

“Women with no other indication for casesarean section would need to weigh up the possible but uncertain benefit of preventing urinary problems in the future against the increased chance of problems related to surgery in themselves or their baby.”

Shorten says more data is needed to make more informed choices about how they give birth.

Michael Kahn
Reuters