What the Baby's Route Out Means

Cesarian section choices in first delivery have long term effects for future pregnancies

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) When a labor delivery involves life-threatening complications, women may require a cesarean section (C-section). Other women, though, might choose a C-section even when it's not medically necessary.

A recent study looked down the road at the long-term outcomes of women who choose cesarean sections. The researchers found several risks associated with this choice.

These risks include issues such as blood clots or injuries to the woman while giving birth, but the risks were very, very low.

This study did not look at the circumstances of women who required C-sections for medical reasons. It focused specifically on women who scheduled a C-section even when there was no reason they could not attempt a vaginal delivery.

"Discuss delivery options with your OB/GYN."

The study, led by Emily S. Miller, MD, MPH, of the Department of Obstetrics and Gynecology at Northwestern University's Feinberg School of Medicine in Chicago, looked at the long-term risks to women who choose to schedule a C-section for their first delivery.

The specific outcomes the researchers examined included getting a blood transfusion, having a hysterectomy, having a blood clot, having an injury requiring an operation and death.

For the babies, the researchers looked at the likelihood of having cerebral palsy and an injury called permanent brachial plexus palsy.

Brachial plexus palsy is an injury to the the network of nerves that sends signals from your spine to your shoulder, arm and hand. It can occur when excessive force is used in delivering a baby, such as trauma to the shoulder.

The researchers used available data from published research to determine the risks for each outcome for mothers and their babies. Then they combined this data together in a mathematical model to determine how risks increased with later pregnancies.

The researchers found an extremely tiny increased risk for poor outcomes for mothers during the first pregnancy if they chose a C-section.

There was a 0.3 percent increased risk of one of the negative outcomes during the first delivery if women chose a C-section over an attempted vaginal delivery.

However, the risk for serious negative outcomes increased slightly with each additional pregnancy for women who had chosen a C-section in their first pregnancy.

By a woman's fourth pregnancy, women who had chosen a C-section for their first delivery were 10 percent more likely to have a serious problem at delivery than women who had attempted labor and a vaginal delivery.

This risk was three times higher in women choosing a first C-section than the risk in women choosing a trial of labor in their first pregnancy. "Trial of labor" means trying to go through labor with the intention of having a vaginal delivery.

According to Allison Hill, MD, an OBGYN at Good Samaritan Hospital in Los Angeles, these findings mean a woman may want to consider her future family hopes in making her birth decisions.

"In my opinion, a woman has the right to choose how she wants to give birth," said Dr. Hill, who was not involved in this study. "If she is planning a small family with one or two children, I think an elective cesarean is her choice. But if she wants a larger family, vaginal birth is clearly the less risky option."

The risks varied according to each condition examined as well. For example, 0.06 percent of women choosing an initial C-section or attempting a trial of labor had a hysterectomy during their first delivery.

For women who chose a C-section, however, this percentage increased to 0.18 percent at their second pregnancy, 0.62 percent at their third and 2.6 percent at their fourth.

Meanwhile, among those who attempted a trial of labor in their first pregnancy, 0.08 percent required a hysterectomy at their second pregnancy, 0.18 percent at their third and 0.6 percent at their fourth.

A similar pattern of increases was seen for women requiring blood transfusions at first and later pregnancies.

One reason for the increase in potential complications was possible difficulties with the placenta.

"The probability of these placentation disorders not only increases with each additional cesarean delivery, but when they do occur, the probability of a complication increases markedly," the researchers wrote.

In terms of outcomes for babies, the results were more mixed. The choice to have an initial C-section resulted in an average 5 fewer cases of cerebral palsy and almost one fewer case of brachial plexus palsy for every 20,000 women in their first pregnancy, compared to trial of labor and vaginal delivery.

This risk flipped slightly, however, by the fourth pregnancy. The risk of a poor outcome for the baby in a fourth delivery for women who first had C-section was very slightly under that of those who had chosen a trial of labor the first time.

The risk was 0.368 percent for those who chose a trial of labor the first pregnancy and 0.363 percent for those who chose a C-section the first time.

The researchers also found that the risk for stillbirth was not associated with the choice of delivery. Instead, risk of stillbirth was related to the week of pregnancy a child was born (higher risk for earlier births).

The study was published in the April issue of the journal Obstetrics and Gynecology. Information regarding funding was unavailable. The authors declared no conflicts of interest.

Reviewed by: 
Review Date: 
April 18, 2013
Last Updated:
November 21, 2013