What are the risks of choosing a planned primary c-section vs a planned vaginal birth?
2.5 times more likely to be rehospitalized in the first 30 days post partum 1.8 times more likely to suffer major pueperal infection 1.9 times more likely to suffer delayed and secondary postpartum hemmorrhage 2.8 times more likey to suffer infections of the genitourinary tract 14 times more likely to suffer complications of obstetrical wounds
Source for this info:
Maternal Outcomes Associated With Planned Primary Cesarean Births Compared With Planned Vaginal Births
Eugene Declercq, PhD, Marger Barger, CNM,MPH, Howard J. Cabral, MPH, PhD, Stephen R Eavns, MPH, Milton Lotelchuck, MPH, PhD, Carol Simon, MS, PhD, Judith Weiss, ScD, and Linda J. Heffner, MD, PhD
Obstetrics & Gynecology
vol109, No.3, March 2007
Objective: To compare outcomes and costs associated with primary cesarean births with no labor (planned cesareans) to vaginal and cesarean births with labor (planned vaginal)
Study Population: Hospital discharge records in the state of Massachusetts over a 6 year period
Subjects: Mothers who have not had a prior cesarean (no VBACs) and had a singleton, full term (37-41 weeks) birth with a vertex presentation, no documented prior risk (mothers who had any of 18 medical risk factors were excluded). Both the birth certificate and the hospital discharge paper were examined to identify mothers with no documented risk prior to labor.
Total mothers with no documented labor risk who had a planned cesarean delivery = 3,334
Total mothers with planned vaginal births = 240,754
Of that 240,754:
Mothers with no documented labor risk who had vaginal births = 172,329
Mothers with documented labor risk who had unplanned primary cesarean deliveries = 20,916
Mothers with documented labor risk who had vaginal births = 47,509
(documented labor risk = febrile, meconium moderate or heavy, PROM,abruptio placenta, other excessive bleeding seizures during labor, precipitous labor, prolonged labor, dysfunctional labor, CPD, cord prolapse, anesthetic complications, fetal distress, failed mechanical induction, fetal distress, unspecificed induction, obstructed labor, abnormality of forces of labor, long labor,umbilical cord complications)
Study period = 1998-2003
Birth outcomes:
- unplanned cesarean rate increased from 7.6% (1998) to 9.9% (2003)
- planned primary cesarean rate quintupled from 0.4% (1998) to 2.2% in 2003 (avg rate = 1.4% for entire period)
Births with labor (planned vaginal) n = 240,754
Total number and (rate) per 1,000 of rehospitalization
1-30 days postpartum = 1,807 (7.5) or .75%
31-180 postpartum = 2,456 (9.8) or .98%
181-365 = 2,540 (9.2) or .92%
Cause for rehospitalization (rate per 1,000)
major pueperal infection = 1.83 or 0.183%
nonpurulent mastitis = 0.73 or .073%
delayed and secondary postpartum hemmorrhage = 0.62 or .062%
infections of the genitourinary tract = 0.54 or 0.054%
complications of obstetrical surgical wounds = 0.46 or .046%
other and unspecified complications of the peurperium = 0.44 or .044%
Cost was an average of $2,487
Hopsital stay (average) = 2.4 days
Primary cesareans with no labor and no complications (planned cesareans) n=3,334
Total number and (rate) per 1,000 of rehospitalization
1-30 days postpartum = 64 (19.2) or 1.92%
31-180 postpartum = 49 (13.5) or 1.35%
181-365 = 56 (14.6) or 1.46%
Cause for rehospitalization (rate per 1,000)
major pueperal infection = 3.30 or .33%
delayed and secondary postpartum hemmorrhage = 1.20 pr .12%
infections of the genitourinary tract = 1.50 or .15%
complication sof obstetrical surgical wounds = 6.60 or .66%
care and observation = 2.40 or .24%
inflammatory disease of the uterus = 1.50 or .15%
Cost was an average of $4,372
Hospital stay (average) = 4.3 days
RESULTS
A woman with a planned primary c-section was 2.3x mor likely to be rehospitalized in the 1st month postpartum.
Hospitalizations for wound complications were 14 times higher in planned c-sections vs planned vaginal births
Postpartum infection are major cause of rehospitalization in both groups but 2x as high in planned c-section group vs planned vaginal group
Cost for planned c-section was 76% higher than initial costs for planned vaginal birth
Authors noted that planned primary cesareans increased rapidly between 1998 and 2003 and appeared to be medically elective but that does not necessarily "maternal request cesareans."
The findings of this study do NOT support the one of the rationales proposed for elective cesareans - greater maternal convenience since mothers who planned primary cesareans face outcomes they may not have anticipated including more than double the chance of being hospitalized in the first month for complications assoicted with the surgery.
Mothers who planned cesareans had a 77% longer hospital stay and 76% higher costs.
Limitations of study:
- Only used 1 state (MA) where they have a lower than average proportion of births to African American non-Hispanic mothers (planned primary cesarean highest among that group)
- The terms "no documented risk" reflects the reality that there may be some medical indications for cesareans not captured on the birth certificate or hospital discharge data used in this study
- This study could not actually measure the number of truly "maternal request" cesareans
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