Intended for healthcare professionals

Rapid response to:


Maternal and neonatal individual risks and benefits associated with caesarean delivery: multicentre prospective study

BMJ 2007; 335 doi: (Published 15 November 2007) Cite this as: BMJ 2007;335:1025

Rapid Response:

New research finds lowest maternal mortality rate with elective cesarean delivery

Further to Consultant Obstetrician Mike Wyldes' comments on his
investigation into the CEMACH dataset ['Elective Caesarean section safest
form of childbirth', above]:-

In April 2008, the UK's Birth Trauma Association also analyzed data
taken from the latest CEMACH report, and found that planned cesarean
delivery had the lowest maternal mortality rate compared with all other
births: "of the 2,113,831 women who delivered a baby after 24 weeks
gestation between 2003 and 2005, one in 10 had a caesarean before labour
had begun. Seven women died, giving a mortality rate of 0.31 per 10,000.
This compared to 74 deaths amongst the remaining women who had a natural
birth or an emergency caesarean section, giving a mortality rate of 0.39
per 10,000."(1)

Certainly, planned cesarean delivery results in greater abdominal
morbidity than PVD, but on the other hand, PVD results in greater pelvic
floor trauma than planned cesarean delivery (see this week's news report
on the U.S. 'Fourth International Consultation On Incontinence (ICI)' for
example(2) and my comment on the cesarean benefit of protection against
fecal incontinence(3)).

Women should be honestly informed of each set of birth risks and
benefits, supported during their decision-making process and have their
final choice respected - whether it's vaginal or cesarean delivery.

Finally on this issue, a 2003 HealthGrades Quality Study(4) in the
U.S. "identified an association with higher vaginal complication rates in
those hospitals that did fewer than expected preplanned cesarean sections"
and likewise, lower vaginal complication rates in hospitals with more
preplanned cesareans than expected. The report said that this finding was
"suggestive of, but not definitive of, inappropriate under-utilization of
preplanned first time C-sections in those hospitals", and that further
studies are needed.

Frustratingly, five years after this report, the debate over planned
cesarean delivery and PVD comparisons remains hampered by a lack of
appropriate and relevant clinical studies.






Competing interests:
I am editor of the website

Competing interests: No competing interests

30 July 2008
Pauline M Hull
Writer and journalist, and editor of
PA 18055, USA