Cesarean section protects babies from trauma
Supporters of maternal request C-section, will obtain valuable ammunition from an article in the current issue of Obstetrics and Gynecology. Baskett TF, Allen VM, O’Connell CM, et al. Fetal trauma in term pregnancy. Am J Obstet Gynecol 2007;197:499.e1-499.e7 is a comprehensive study of over 100,000 consecutive deliveries of singleton term neonates in the vertex position with no congenital anomalies:The potential study population in Nova Scotia for the 14-year period (1988-2001) was 153,209. Twenty-two percent of the population was excluded based on the inclusion criteria of singleton (1%), term (7%), no major anomalies (3%), no fetal deaths (0.1%), and in vertex presentation(11%) to give the actual study population of 119,432.Deliveries were grouped as follows:
... mode of delivery was defined as vaginal or cesarean, and method of delivery was defined as spontaneous vaginal, assisted vaginal (vacuum, forceps), ... and cesarean delivery (with and without labor)...The definitions of trauma were:
Fetal trauma was considered major trauma if 1 or more of the following were present: depressed skull fracture, intracranial hemorrhage, or brachial plexus palsy. Minor trauma was considered if 1 or more of the following were present: linear skull fracture, other fractures, facial palsy, or cephalhematoma.The results of the study showed that the risk of major and minor trauma was dramatically reduced by Cesarean section, particularly if the Cesarean was performed before labor began. If the risk of major trauma in a vaginal delivery is described as 1.0, the relative risk of major trauma is reduced by 82% by a C-section done in labor (RR 0.18), and reduced by 88% by a C-section done before labor begins (RR 0.12). In contrast, the risk of major trauma is dramatically increased by vacuum assisted delivery (RR 2.71) and even further increased by forceps delivery (RR 4.2). The same results also apply to minor trauma. As compared to a spontaneous vaginal delivery, the risk of minor trauma is lowered most (by 89%) for a C-section without labor (RR 0.11) and raised most by vaccum delivery (RR 5.49).
Major trauma
| type of delivery | spontaneous vaginal | vacuum assisted | forceps assisted | Cesarean in labor | Cesarean before labor |
| RR | 1.0 | 2.71 | 4.2 | 0.18 | 0.12 |
Minor trauma
| type of delivery | spontaneous vaginal | vacuum assisted | forceps assisted | Cesarean in labor | Cesarean before labor |
| RR | 1.0 | 5.49 | 2.95 | 0.70 | 0.11 |
The authors conclude:
... Major trauma was most likely to be associated with labor and assisted vaginal delivery. Cesarean delivery with and without labor was associated with significant reduction in risk of both minor and major fetal trauma.When it comes to preventing trauma in the newborn, C-section is remarkably effective and protective.
Labels: C-section
<< Home