Women who choose a Caesarean section for non-medical reasons are at least 10 times more likely to be admitted to intensive care than those who give birth vaginally. According to a survey published in the January 2010 issue of the Lancet medical journal, they are also almost three times more likely to suffer problems, such as excessive bleeding, than those who give birth unaided. The survey was the first in Asia to look into the risks of Caesarean sections done for non-medical reasons.
It found that vaginal deliveries that are assisted, for example by the use of forceps or vacuum, may not be as safe as was originally thought. However, the risks are still slightly lower than Caesarean sections done for non-medical reasons. But the risks are highest for women who have a surgical delivery after labour has started. They are 67 times more likely to be admitted to intensive care than those who have a vaginal delivery. The risk of babies dying during delivery or shortly after is greatest for assisted vaginal births, followed by Caesarean sections performed for a medical reason.
There is no indication that a Caesarean section performed for a non-medical reason is safer for the baby. But babies who are in a breech position are less likely to die if they are delivered by Caesarean section.
The survey analysed data of more than 100,000 deliveries in nine Asian countries – Cambodia, China, India, Japan, Nepal, the Philippines, Sri Lanka, Thailand and Vietnam. About one in four, or 27 per cent, of the deliveries were by Caesarean section. Two-thirds of the hospitals surveyed earned more money if they carried out Caesarean sections. The births were grouped into Caesarean sections that were performed before labour or once labour had started, with or without a medical need, and vaginal births that were assisted, for example, with forceps. These were compared to unassisted vaginal deliveries.
In an editorial in the Lancet last January, Dr Chong Yap Seng, senior consultant obstetrician gynaecologist at the National University Hospital, and Dr Kenneth Kwek, senior consultant at the department of maternal foetal medicine at KK Women’s and Children’s Hospital, wrote that there is nothing wrong with opting for a Caesarean section when there is a medical reason for it. However, for those who are still inclined to consider a Caesarean delivery a harmless option, the authors said: “They need to take a cold hard look at the evidence against unnecessary Caesarean section."
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