Do C-sections Risk The Lives of Mothers?

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Pregnant women who deliver by C-section are more than three times as likely to die than those who deliver vaginally, according to a French study published in September 2006.


The risk of death is linked to a heightened chance of blood clots, infection, and complications from anesthesia, according to researchers from Maternité Hopital Tenon in Paris.


Inspired by the worldwide increase of Cesarean births, researchers compared sixty-five French women who died following delivery between 1996 and 2000 with a control group of 10,244 women who delivered uneventfully in France in 1998.


Women who delivered by C-section were 3.6 times more likely to die than those who delivered vaginally, the authors state. This risk was seen whether a C-section was planned—meaning it occurred before labor—or whether a woman had an emergency Cesarean after enduring unsuccessful labor. The report concludes that physicians should develop “preventative strategies” for their patients to lower the C-section rate.


In the US, C-section rates for first-time moms rose seven years in a row to its highest rate of 23.6 percent in 2003, according to the Centers for Disease Control’s National Vital Statistics report. So should physicians start encouraging women not to have them?


“No, this study is not large enough to claim statistical significance,” says Khalil Tabsh, M.D. and chief of obstetrics for UCLA Medical Centers, Los Angeles. He also pointed out problems with studies that try to match particular patients with an extracted control group.


Furthermore, Tabsh says that women who plan C-sections for personal reasons, such as to reduce urinary, rectal, and sexual complications post-delivery, will most likely not have any difficulties as long as they are healthy.


“Because our practice is devoted to high-risk obstetrics, we have a very high Cesarean section rate. In our practice I do not remember one patient in thirty years who died or suffered a serious complication after electively choosing Cesarean. I have seen patients who died following a Cesarean for medical complications, but these cases were extreme, and very rare. Certainly not an increase of 3.6 times in mortality over those who deliver vaginally,” Tabsh explains.


This is good news for women who need C-sections, such as those who have had previous Cesareans. While some women opt for VBACs (vaginal birth after C-section), Tabsh stresses that women should not opt for one based solely on the conclusions of this study, since VBACs carry strong risks of their own.  “I have never been a fan of VBAC. Although the percentage of complications following VBACs is small, the primary concern is uterine rupture, and the consequences of this can be devastating for the mother or fetus. In addition, because of the clear benefits for future urinary, rectal and sexual well being, I cannot encourage VBACs from a medical perspective to women who have previously delivered by Cesarean. Once again, our medical complications following cesarean delivery are virtually non-existent, so this is a reasonable medical opinion and recommendation on our behalf,” Tabsh states.


While the physicians differ in their opinions, both Tabsh and Catherine Deneux-Tharaux, M.D., lead researcher of the Parisian study, agree that more studies should be explored on the topic of maternal death following cesarean.


What are your thoughts?  


Resources:
1) September 2006 “Postpartum Maternal Mortality and Cesarean Delivery” report in Obstetrics & Gynecology journal.  2) Cesarean rate information and suggested graph: National Vital Statistics Reports Centers for Disease Control’s "Trends of Cesarean Rates for First Births and Repeat Cesarean Rates for Low-Risk Women US, 1990-2003"

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