Recent Guidelines Discourage C-Sections Due to Risks for Mother and Baby

The American College of Obstetricians and Gynecologists published new guidelines that strongly discourage cesarean sections unless they are medically indicated, on grounds that they can lead to complications for the mother as well as the newborn. The report was published in the organization’s March, 2013 edition of its journal, Obstetrics & Gynecology, and appears online on ACOG’s website.

The group states that vaginal deliveries should be the norm, and that every attempt should be made to avoid early cesarean deliveries. The recommendations are an attempt to reduce the skyrocketing rate of cesarean sections, by limiting “maternal-request” C-sections and early deliveries for presumed big babies.

Cesarean delivery rates in the United States are at their highest level ever; more than 13 million surgical deliveries were performed by doctors in 2009 — 33 percent of all births. An estimated 2.5 percent of all births in this country are maternal-request cesarean deliveries, and the rate of non-medically indicated early-term deliveries continues to rise, despite recommendations against them by ACOG and other medical organizations.

Planned cesarean deliveries are associated with risks for bladder and bowel injury, longer hospital stays, higher infection rates, as well as respiratory problems for the infant. In addition, multiple C-sections, in subsequent deliveries, have been found to increase a woman’s risk for rupturing of the uterus, hemorrhage, emergency hysterectomy, and postpartum cardiac arrest.

The ACOG adds that even when cesarean deliveries are medically indicated, doctors should make all efforts to perform them after the 39-week gestation mark, unless specific medical conditions are present, which could put the mother’s or the infant’s life in danger.

Until the 1970’s, the rule was that once a mother had had a C-section, she would always deliver surgically, due to worries about rupturing of the uterus; but as a result of the newer emerging statistics, more obstetricians are now recommending that a mother make every effort to deliver vaginally, even if she has previously delivered through C-section. A majority of women who attempt to deliver vaginally after having undergone a C-section in the past are able to do so.

Previously, doctors feared that a vaginal birth after having previously delivered through C-section could increase the risk of rupturing of the uterus. But in 2010, the National Institutes of Health recommended that women who had had C-sections attempt to deliver vaginally, before deciding to have another C-section. An analysis done by the NIH in 2010 showed that 3.8 maternal deaths occurred for every 100 thousand vaginal births after a C-section (“VBAC”), compared to 13.4 maternal deaths per 100 thousand repeat C-sections.

One 17-year study involving Amish women in Wisconsin showed that no medical complications occurred when mothers gave birth vaginally after having previously delivered through C-section. The study analyzed data from 927 vaginal births by 418 mothers. The results of this study were published in the November, 2012 journal Annals of Family Medicine.

By Marc Courtiol