Planned cesarean sections are safe for low-risk deliveries and may be associated with a lower chance of complications for both mother and baby compared with vaginal deliveries, according to the co-author of a study published Monday in the Canadian Medical Association Journal.
Still, maternal-fetal medicine specialist Dr. Darine El-Chaar said women should consult their doctor on what’s best for them, and called for more research on the long-term effects of planned caesareans, including how the health of babies born this way differs from their vaginally born counterparts.
El-Chaar said the researchers compared the outcomes of C-section deliveries that were requested and found that about 60 percent of the mothers and their babies fared better.
Researchers analyzed birth-registry data from Ontario on 422,210 low-risk pregnancies between 2012 and 2018 and found 46,533 babies were born by C-section. They focused on 1,827 cases, or nearly four percent, involving women who’d requested the procedure in advance.
They then looked for 10 common problems that can stem from labor and delivery, including rupture of the uterus, tears to the pelvic floor as well as whether the newborn was admitted to neonatal intensive care for issues such as respiratory distress.
“The findings are significant from a statistical point of view but we’d love to see this in a larger population,” said El-Chaar, associate scientist at the Ottawa Hospital.
She said multiple factors including medical history may influence someone’s decision to opt for a C-section.
The study found women who chose a cesarean delivery were more likely to be white, aged 35 or older, and live in a higher-income neighborhood. They were also more likely to have conceived by in-vitro fertilization, and be delivering their first baby.
Ontario is believed to be the only province with a birth registry that includes information on scheduled C-sections, so it’s not known how many women elsewhere in Canada ask for the procedure.
El-Chaar said some of her older patients requested a C-section to reduce the risk of complications with vaginal birth, but fear of childbirth was among the most common reasons for seeking the procedure.
“I see, as a physician, women who are just so scared of what labor is, and the pain, that they truly cannot be reasoned into the process of vaginal delivery,” El-Chaar said. “Women often are scared of it in the first pregnancy but as you talk to them, as they take prenatal classes, they are used to the idea and they are more comfortable with it.”
“There are also patients who’ve gone through traumatic sexual assault and they just don’t feel comfortable delivering,” she added. “These are very rare.”
C-sections carry their own risks, including infection, blood clots, pain, and a long recovery period.
But scheduled C-sections are sometimes medically necessary for older women who face a greater risk of complications with a vaginal birth if they have certain conditions such as high blood pressure, diabetes, and arthritis, El-Chaar said.
An abnormal fetal heart rate is the most common reason for cesarean delivery, she added.
The World Health Organization says the ideal rate of C-sections is between 10 and 15 percent.
Data from the Canadian Institute for Health Information show almost 30 percent of deliveries in Canada were by C-section between 2019 to 2020. British Columbia had the highest rate, at nearly 38 percent, and the Northwest Territories had the lowest at 19 percent. Ontario was closest to the national average.
British Columbia recently began an online interactive program to help women decide how they want to deliver after a previous C-section.
Sarah Munro, who led the research and development of the project and is an assistant professor in obstetrics and gynecology at the University of British Columbia, said the goal is to let families know about the potential benefits and harms of whatever decision they make.
“We’ve been making a lot of effort across different parts of the health-care system to improve shared decision-making, so providing patients with tools to make choices about the mode of birth and providing care providers with strategies to have those conversations.”