The controversial topic of elective C-sections just keeps making news. As many of you may have read, a new study has come out comparing planned primary C-sections to vaginal deliveries. The results were really not surprising or new: C-sections require a longer hospital stay and cost more than vaginal births. They also have a higher rate of complications, such as infections, that require rehospitalization within 30 days of delivery. From my experience, women who choose C-sections are usually aware of all that. What this study did not examine is the difference between planned C-sections and emergency C-sections, and almost every one of the women I interviewed who chose the surgical option did so because they believed they were at a higher risk of ending up with a C-section after a long labor, because of their age or other factors. It also did not examine the long-term effects of vaginal labor on pelvic floor health. The current research on that is still inconclusive, but it is another reason why some women chose to go under the knife.
This is clearly a topic that will be furiously debated as long as women have babies, but I thought the most interesting thing about the New York Times' coverage of it was this quote from Dr. Edmund Funai: "In a very general sense, Caesarean delivery tends to be modestly more safe for the baby, while more risky for the mother." Ironically, much of the mom-to-mom criticism I have heard about elective C-sections is that it is a selfish choice by women who don't want to be inconvenienced by painful labor. But according to Dr. Funai, women who choose it are putting their baby's health ahead of their own. Of course, this contradicts a previous study that showed that C-section babies have a slightly higher risk of neonatal mortality than babies born vaginally. It's all a lot to chew on, and yet another reason to do all the research and come to your own conclusion before you decide what is best for you and your baby. What do you think?
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It is very important to understand that the authors of this study and the MacDorman study that you also mention are being very disingenous. When the authors refer to C-sections with "no documented prenatal risk" they are referring to C-section where the risk was not DOCUMENTED, not C-sections where there was no risk.
The DeClercq study used birth certificates and hospital discharge records. The MacDorman study (of which DeClercq was a coauthor) used only birth certificates. However, it is well known that birth certificates are very unreliable for determining prenatal risk factors. There are papers written about this exact issue:
How Well Do Birth Certificates Describe the Pregnancies They Report? The Washington State Experience with Low-Risk Pregnancies, Dobie, Baldwin, et al., Maternal Child Health Journal, 2:3, September 1998.
Conclusions: Because birth certificates significantly underestimated the complications of pregnancies, number of interventions, number of procedures, and prenatal visits, use of these data for health policy development or resource allocation should be tempered with caution.
The reporting of pre-existing maternal medical conditions and complications of pregnancy on birth certificates and in hospital discharge data, American Journal of Obstetrics and Gynecology, Volume 193, Issue 1, 125-134, July 2005, M. Lydon-Rochelle, V. Holt, et al. Results Birth certificate and hospital discharge data combined had substantially higher true-positive fractions than did birth certificate data alone for cardiac disease (54% vs 29%), acute or chronic lung disease (24% vs 10%), gestational diabetes mellitus (93% vs 64%), established diabetes mellitus (97% vs 52%), active genital herpes (77% vs 38%), chronic hypertension (70% vs 47%), pregnancy-induced hypertension (74% vs 49%), renal disease (13% vs 2%), and placenta previa (70% vs 33%)... Conclusion In Washington, most medical conditions and complications of pregnancy that affect mothers are substantially underreported on birth certificates,...
Looking at the results of this study, we see that for virtually every serious pregnancy complication, more than half the cases appeared on the birth certificate as having no risk factors. It seems pretty clear that there is a serious problem with relying on birth certificate data to determine pregnancy complications.
Unfortunately, both the DeClercq paper and the MacDorman paper only tell us that C-sections which fail to list the existing risk factors are more dangerous than vaginal deliveries. That is meaningless. Unless and until the authors go back and review the medical records to remove all the cases with prenatal complications, we have learned nothing.
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