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Group says to cut planned C-sections despite birth injury risk

In the U.S., and estimated 2.5 percent of all births occur by cesarean section at the mother's request and for no medical reason. Many women fear the pain of labor, while others are concerned that vaginal birth will cause incontinence or problems with sexual functioning. When a C-section isn't medically recommended, however, it can have some risks. On the other hand, vaginal birth carries risks, too, particularly of birth injury. So what should expectant mothers do?

In advance of the upcoming issue of Obstetrics & Gynecology, a committee of the American College of Obstetricians and Gynecologists hopes to answer that question. The group released a statement urging obstetricians to be more effective at recommending vaginal birth to their patients.

"Given the balance of risks and benefits, the [committee] believes that in the absence of maternal or fetal indications for cesarean delivery, a plan for vaginal delivery is safe and appropriate and should be recommended to patients," the statement reads.

There hasn't been much research done on the risks and benefits of C-sections versus vaginal birth, however so the issue must be considered seriously by individual mothers-to-be and their doctors. Both do carry risks of both maternal and fetal injury, so here's a rundown of what science currently says are the risks benefits of each:

Planned C-sections
Baby                               Mother

Vaginal births
Baby                               Mother  

Lower risk of:

Fetal mortality

Infection

Intracranial hemorrhage

Birth injury

Neonatal respiratory morbidity

Lower risk of:

Hemorrhage

Need for blood transfusions

Surgical complications than unplanned C-sections

Urinary incontinence (short-term)

Lower risk of:

Surgical complications

Surgery-specific injuries

Shorter hospital stay and recovery

Lower risk of:

Uterine rupture, bowel or bladder injuries

Infection

Complications or placental implantation issues in future pregnancies

The group particularly called out the fact that there is little evidence that C-sections prevent any of the problems most feared by expectant mothers. No differences were observed between the risk of postpartum pain, sexual dysfunction, anorectal dysfunction, organ prolapsed, postpartum depression, later stillbirths or maternal mortality.

However, C-sections -- especially multiple C-section births -- do expose women to a greater risk that a hysterectomy will be needed.

The type of birth you choose should be up to you. That said, you should carefully consider the best evidence about risks and benefits with your doctor before making any decision.

Source: MedPage Today, "ACOG Advises Against Planned Cesareans," Todd Neale, reviewed by Zalman S. Agus, MD, March 22, 2013

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