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In Preventing Birth Injuries, is Cesarean or Vaginal Birth Better?

Recently, a committee of the American Congress of Obstetricians and Gynecologists reviewed the available research on the risks and benefits of cesarean-section births performed purely at the request of the mother. Overall, the group determined that more women experience fewer complications from vaginal birth, and the group recommended that doctors strongly encourage mothers to choose that option.

The evidence appears to be less convincing, however, when it comes to birth injuries. It appears that C-sections, while still carrying some risk, result in fewer injuries to the infant during birth.

Currently, as many as 2.5 percent of all births in the U.S. are performed by C-section for no medical reason but at the mother’s request. Often, women choosing C-sections say they’re worried about the potential for urinary incontinence or sexual function from vaginal childbirth. Others simply cite their fear that natural childbirth will be too painful.

“If [a mother’s] main concern is a fear of pain in childbirth,” the group wrote, “then prenatal childbirth education, emotional support in labor, and anesthesia for childbirth should be offered.”

As for the prevention of birth injuries, however, C-sections may be preferable. Although the procedure carries an increased risk over vaginal birth for respiratory problems, vaginal birth increases some other risks for babies, such as infections, intracranial hemorrhage, neonatal asphyxia and encephalopathy. C-sections also appeared to have a lower overall risk of fetal mortality.

At the same time, the risks and benefits to birthing mothers do appear to weigh heavily in favor of vaginal birth. Natural childbirth typically results in a shorter hospital stay, less risk of birthing complications and infections, and a lower chance of bowel or bladder injuries. C-sections do, however, offer the advantages of fewer instances of hemorrhages requiring blood transfusions and a short-term reduction in urinary incontinence. Planned C-sections also have the advantage over unplanned C-sections in having a reduced risk of surgical complications.

In an interesting development, the group found no evidence of any difference between the two types of birth in the risk of sexual dysfunction or long-term urinary incontinence. No differences were also found in the areas of postpartum pain, general pelvic pain, pelvic fistulas, or the risk of anorectal dysfunction, pelvic organ prolapsed, postpartum depression, subsequent stillbirths or maternal mortality.

Weighing all the risks and benefits together, the group concluded that the choice most likely to result in a healthy birth experience was vaginal birth. Every family, however, should work with their doctor to consider each of the risks and benefits in their individual situations.

Source: MedPage Today, “ACOG Advises Against Planned Cesareans,” Todd Neale, March 22, 2013