Elective C-sections have 3 times as many complications, infant deaths

Reuters is reporting (via MSNBC) [1] that a new study by Canadian doctors indicates elective Caesarean Sections (C-Sections) show a significant increase in risk compared to normal vaginal births.

Dr. Shiliang Liu from the Public Health Agency of Canada, Ottawa, and colleagues have evidence that the rate of severe complications, such as major bleeding, infection and blood clots, is three-fold higher overall in women having a planned Caesarean section compared with women who planned a natural birth....

Liu’s team found that the rate of severe complications in the planned Caesarean group was 27.3 cases per 1,000 deliveries, compared with 9.0 per 1,000 deliveries in the planned vaginal delivery group.

These findings follow another study released in September 2006 that noted a three fold increase in infant mortality [2] for infants delivered via C-section compared to normal births.

MacDorman and her colleagues had previously identified a 49-percent increase in C-section rates between 1996 and 2001 among women in this "no risk" category.

The risk of death in the first 28 days of life was 1.77 per 1,000 live births among women who had C-sections, compared to 0.62 per 1,000 for women who delivered vaginally. Even after analyzing the various causes of infant death, the researchers could find no clear explanation for the difference.

"Understanding the causes of these differentials is important, given the rapid growth in the number of primary Caesareans without a reported medical indication," they conclude.

Both studies note the growing popularity of elective C-sections for otherwise normal pregnancies. Caesarean rates have risen from 14.6% of all first-time births in 1996 to 20.6% of all first-time births in 2004--a 41% increase in C-sections in a 9 year period. And for women in the no-risk category C-sections (i.e. elective C-sections) rose a staggering 49% between 1996 and 2001.

To put this into perspective only 5.5% of births in 1970 were C-section [3]. From 1970 to 2005 there has been a 549% increase in C-sections per-birth in the United States.

These increases are surprising considering the efforts to bring down the C-section rate in the US. The rate of C-sections rose from 21% in 1996 to 29% in 2004 [4] , and was a record 30.2% of births in 2005 [5]. "Many experts believe a large number of C-sections are medically unnecessary and done only for the convenience of the mother or her doctor [6]."

One of the reasons for the increased Caesarean deliveries is that Vaginal Births After Caesarean (VBAC) are being discouraged [7] with 90% of Caeserean births in 2004 being repeat procedures. Compared with 2003 [8], VBACs dropped by 13% in 2004 to a total of 9.2% births. VBACs are being discouraged [9] due to malpractice issues as well as the discouraged use of prostaglandins for cervical ripening.

These are all very interesting statistics that Tammy and I have been tracking for a while. C-Sections are such a common procedure these days that we forget that it is a major surgery. As of statistics collected in 1990 [10], the risk of a woman dieing after a cesarean birth is less than 1 in 2,500, while the risk of death after vaginal birth is less than 1 in 10,000 (although individual risks may alter these odds). Women who have C-sections have a significant increase in difficulties [11] with a second delivery and it is not infrequent to have issues with later pregnancies, to the point it is recommended that women who want large familes should not seek a Caesarian [12] section as an elective.

To conclude, a doctor summerized our feelings [16] on this issue well when he said, "It's unethical to recommend a practice [elective C-sections] that leads to more patient deaths."