More C-sections, More Complications?

June 7, 2006 -- C-section delivery on demand is still somewhat uncommon in the U.S., but it is increasing as more women who have no medical need for surgery choose it over vaginal delivery.

Now new research suggests that surgical delivery may not be a good idea for women planning to have large families.

The government-funded study showed that the more cesarean births a woman had the greater her risk of developing potentially serious pregnancypregnancy complications.

The findings were based on outcomes from 30,132 cesarean deliveries performed across the country from 1999 to 2002.

The incidence of delivery-related hysterectomies was more than five times higher for women undergoing their fourth cesarean birth than for women having their second C-section.

And women delivering by C-section for the sixth time or more required blood transfusions 10 times as often as women having their second C-section birth.

?We are not in the business of telling women how many kids to have,? University of Utah obstetrics professor Robert M. Silver, MD, tells WebMD. ?But women who want to have more than one or two children need to think carefully about having cesarean births unless they are medically necessary.?

C-Sections on the Rise

Cesarean deliveries continue to increase in the U.S., with the most recent figures showing that nearly 30% of babies are now delivered surgically.

Although most planned or emergency surgical deliveries are considered medically necessary, the issue of elective C-section by maternal request is the subject of much debate within the medical community.

A panel convened by the National Institutes of Health to address the risks and benefits of elective C-sections vs. vaginal births concluded late in March that surgical delivery on demand is a reasonable option for many women, but not for women planning to have many children.

The panel also concluded that planned, elective C-sections should never be performed before 39 weeks gestation.

Panel chairwoman Mary D?Alton, MD, tells WebMD that the risk of delivering prematurely and the risk for life-threatening complications to the mother do appear to be greater for women who have multiple C-sections.

?There are risks and benefits to both cesarean and vaginal deliveries,? she says. ?But if I had a patient who wanted to have more than two children I would recommend against cesarean delivery on maternal request,? D?Alton says.

C-Section Complications

The most commonly seen complication with repeat C-sections in the newly reported study was attachment of the placenta too deeply into the uterine wall, a potentially life-threatening condition called placenta accreta.

Scar tissue that forms following a first surgical delivery increases the risk for placenta accreta with subsequent pregnancies.

Just 0.31% of the women in the study delivering by C-section for the second time developed the condition, compared with 2.13% of women who had a fourth surgical birth and 6.74% of women who had six or more cesarean deliveries.

Emergency hysterectomies at delivery were required in just 0.42% of women having their second cesarean delivery, compared with 2.41% of women having their fourth and 8.99% of women having their sixth or more.

The study is published in the June issue of the journal Obstetrics and Gynecology.

Silver and D?Alton agree that not enough good studies have been done to fully understand the risks vs. benefits of elective surgical delivery vs. vaginal delivery.

?But we need to counsel patients right now based on the knowledge that we do have,? D?Alton says. ?It is important to keep in mind that it is the complicated vaginal deliveries and the C-section deliveries done under emergency circumstances that pose the most risk to both mother and baby.?

SOURCES: Silver, R.M. Obstetrics and Gynecology, June 2006; vol. 107: pp. 1226-1232. Robert M. Silver, MD, professor of obstetrics, University of Utah; chief, division of maternal and fetal medicine, University of Utah Medical Center. Mary D?Alton, MD, chair, obstetrics and gynecology, Columbia University, New York City. ?Elective C-Section Under Spotlight,? WebMD, March 29, 2006.