Pregnant women considering a cesarean section, with no clear medical reason for it, should know that the procedure is not without risk, Canadian doctors caution in a report published this week.
A three-fold rate of severe complications overall is reported among women having a planned cesarean section compared with those who planned a vaginal delivery. Liu and colleagues studied women who delivered a child between 1991 and 2005 in Canada (excluding Quebec and Manitoba).
The rate of severe complications in 46,766 healthy women who had a non-urgent cesarean delivery for a breech baby was compared with that among 2,292,420 healthy women who delivered (non-breech) babies vaginally. The rate of severe complications (such as major infection and blood clots) in the planned cesarean group was found to be 27.3 per 1000 deliveries, compared with 9.0 per 1000 deliveries in the planned vaginal delivery group.
Because breech babies are at greater risk during vaginal birth, breech position is an accepted medical indication for planned cesarean birth. This may not hold true for non-breech babies, however, and the authors express concern about the growing number of women who request delivery by cesarean section without an accepted medical indication.
In a related commentary, Armson notes that in Canada, the cesarean birth rate has increased from 5.2% in 1969 to 25.6% in 2003. He reviews the complex interplay of obstetric and nonobstetric factors that contribute to this trend.