Pregnant women need to know cesareans are risk

Canadian doctors say that pregnant women considering a cesarean section, without a clear medical reason for it, need to know that the procedure is not without risk.

In a new report Dr. Shiliang Liu from the Public Health Agency of Canada, Ottawa, and colleagues provide 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 cesarean section compared with women who planned a natural birth.

The researchers arrived at this conclusion after looking at a Canadian database with the outcomes of 46,766 women who underwent a so-called low-risk cesarean delivery and nearly 2.3 million women who underwent planned vaginal delivery between April 1991 and March 2005.

The researchers say the database did not differentiate between c-sections performed solely because the mother requested it, so they used cesarean delivery for breech presentation as a surrogate for planned elective low-risk cesarean delivery.

Because breech babies are at greater risk during vaginal birth, breech position is an accepted medical indication for planned cesarean birth.

This however may not be the case for non-breech babies and the authors express concern about the growing number of women who request delivery by cesarean section without an accepted medical indication.

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

The researchers say although the absolute difference is small, the risks should be considered by women thinking of asking for a cesarean delivery.

Dr. B. Anthony Armson of the University of Toronto says the study provides additional support to a growing body of evidence suggesting that primary elective cesarean birth may place both the mother and newborn at greater risk for adverse outcomes than planned vaginal birth.

Armson says the cesarean birth rate in Canada has increased from 5.2 percent in 1969 to 25.6 percent in 2003.

The study is published in the Canadian Medical Association Journal, February 13, 2007.