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Original poster

Mumsnet hand grenade: are elective ceasars riskier for babies?

74 replies

Gizmo · 07/09/2006 18:26

I'm just a bit surprised no-one is discussing this news today.

There are some quite interesting discussions today on US Ob/gynae blogs about why this situation is arising: one theory is that elective caesars expose women to a greater risk of having their dates miscalculated and consequently delivering babies that are slightly prem.

Does anyone in the US get advised that an elective CS is riskier for the baby, I wonder? And does this research impose a duty of care on US (or even UK) doctors to mention this as a factor?

OP posts:

NotQuiteCockney · 07/09/2006 18:28

Hmm, I'd always been told that CSes were (generally) safest for babies, and most of the bad effects were on mums.

Original poster

Gizmo · 07/09/2006 18:30

Yeah, I'd thought that was the general explanation docs trot out, but there are several US Obs on the web today saying that historically C-sections tend to have worse outcomes for babies. Which of course is understandable when you take emergency C-sections into account: they're not going to save every baby in those situations.

OP posts:

Twiglett · 07/09/2006 19:08

I wonder whether this research has actually eliminated all the elective sections that were done because of the baby's (or mother's) health in the first place

elective doesn't mean you 'want' it .. elective means you've planned to have it .. and there could be any number of reasons / factors as to why you have deemed it necessary

harpsichordcarrier · 07/09/2006 19:10

yes, I think the research is pretty conclusive. I mean, the study was 5.7 million...
but obviously that is just the statistical likelihood. whether it is safer for an individual baby depends on the reasons for the C section of course.

Twiglett · 07/09/2006 19:10

take back previous post .. I didn't read news article thoroughly enough sorry

hmmmm it is quite a leap 1.77 in 1000 births as opposed to 0.57 in 1000 for vaginal deliveries

MrsApronstrings · 07/09/2006 19:13

I live in the US and had a baby here last year - I don't know what advice is generally given but I was and am really struck and shocked by the fact that hardly anyone goes to term - almost everyone I know expects to have their baby by about 38 weeks (often induced not c section I think) and I know many women who say they 'tell' their consultant they can't wait for various reasons. Birthdays, chanuka , christmas etc seem to be valid reasons to have your baby delivered early

Marina · 07/09/2006 19:19

Dd suffered a post-elective respiratory collapse that put her in SCBU for 48 hours. She only needed oxygen for half a day, but she was a healthy 9lb full-term baby. If she had been smaller/less far on, she might have had more of struggle to get her breathing stable again I guess.
I am not very surprised by this research at all tbh. Harpsi is right to point out that this basic statistical risk does not apply in individual cases. Dd was an elective because of the risk of cord prolapse, which could have really put her life at risk if I had gone into spontaneous labour. So for her the CS was less risky, but not risk-free.

motherinferior · 07/09/2006 19:21

You probably also need to factor in those pregnancies where the babies who were very unlikely to survive and a C-section was the only viable option at all, IYSWIM.

Twiglett · 07/09/2006 19:22

they say they excluded electives with health risks from the 5.2 million study though MI

Jimjams2 · 07/09/2006 19:24

The book c-section by Odent suggests that an elective - in labour section is safer than an elective 2 weeks early section. DS2 (elective at 38 weeks) did have breathing problems so for ds3 I had a carefully monitered (having had 2 previous c sections) labour followed by an in labour section at 40+ weeks.

NotQuiteCockney · 07/09/2006 19:25

Oh, DS1 had problems breathing after being born by elective CS, at 38+5. He was footling breech, so CS (after failed ECV) was the only option open to me, afaik.

DS1 was put in an incubator, and given oxygen. He was ok after about an hour, I think, but his forehead was turning blue, initially. (Which was how I spotted that all was not right. I don't think I will ever get over the fright of spotting something wrong, having DH say he was fine, and having to shout to my midwife to get them to notice he wasn't quite right!)

NotQuiteCockney · 07/09/2006 19:26

Oh, and with an elective in-labour section, the baby is ripe, your body is ready to bf, the baby is ready to come out etc etc. DS2 was an "emergency" section, after waters broke etc. Ok, no real labour, but still, he was absolutely cooked and much more ready for life outside.

rustybear · 07/09/2006 19:31

The article in the Times says "The cases chosen were those with no known medical reason for the procedure, or with no special complications during labour"
It also suggests that the 'squeezing' a baby undergoes during labour may force fluid out of the lungs and the process of labour may release hormones that promote healthy lung function - apparently thr majority of problems are with breathing.

Original poster

Gizmo · 07/09/2006 19:35

Sorry, had to wander off and feed DS (honestly children, they're so demanding...).

But anyway, I think you're right, MI, the study appears to be excluding children where there is an 'elective' ceasar after labour has commenced. I do find it surprising that people who want an elective caesar (and I can quite see how it seems like the safer option for many situations) are able to book them up to two weeks before term: surely there's enough time to arrange a c-section even if you go into labour before your due date?

OP posts:

NotQuiteCockney · 07/09/2006 19:45

Gizmo, it depends on the reason for the section. If, with a footling breech baby, I'd gone into a bit of labour, or even dilated, and a foot got out, and he decided he was out of the womb and needed to breathe, well, you can work out the outcome.

If you have placenta prevaria, labour can be quite dangerous for mother and baby.

Blandmum · 07/09/2006 19:50

NQC my ds was a footling breach too! I also had pre eclapsia so in the end be was born two weeks early. Was completly fine with an initial apgar of 9, blue hands and feet, but he pinked up quickly.

Was also 9 2, so quite a big lad!

MrsFio · 07/09/2006 19:51

I agree with MI. I dont think it has taken into account that alot of elective sections are done for very good reasons, healthwise in regard to either the mother or the baby. Another black and white argument

NotQuiteCockney · 07/09/2006 19:52

Ah, have just noticed - this isn't about babies dying during labour or CS at all - only in the 28 days after. Dunno what the low-risk rates of death in labour are during CS and during vaginal ... probably both very low, though.

ruty · 07/09/2006 21:13

i had an emergency c section at 41`weeks and intend to have elective caesar next time if we have another. Can you just ask the hospital to do an elective during labour or do you just have to go with their policy?

Jimjams2 · 07/09/2006 21:19

ruty- I opted for a trial of labour with no interventions (so no speeding up, no water breaking) and early switch to c-section. As it was my waters went and labour was progressing really slowly, - they couldn't speed it up and were worried about me needing a section in the middle of the night, so I had one at 5pmish instead. It wasn't hurried it was fine, and we didn't have all the breathing problems ds2 had (who was born before he was cooked).

My sections were for non-progression though- which is very different from seciton for other conditions!

IdrisTheDragon · 07/09/2006 21:21

I know of a baby who was born by elective section (on his due date I think) and had breathing problems for a while after birth. I think they were told that this sort of thing is more likely to happen in babies born by CS.

IWorshipAtTheShrineOfCod · 07/09/2006 21:25

Fio - "The cases chosen were those of women with no known medical reason for the procedure, or with no special complications during labour. "
so I think that factor is adeuqautely discounted.

NQC, there are well established increased risks to elective sections, including a greater risk of maternal death (3-5 times),and increased risk to the baby.
again, these are statistical risks

morocco · 07/09/2006 21:32

the French study published last week (same article) is pretty worrying too - a 3.6 times higher chance of mother dying after c section than vaginal birth, no pre existing problems in either group.

IWorshipAtTheShrineOfCod · 07/09/2006 21:35

absolutely morocco
there are also increased risks to future fertility and future babies
imo we should be concentrating all our resources on reducing the C section rates and assisting women to have vaginal births

Jimjams2 · 07/09/2006 22:59

HAving had 3 sections - and haviing opted really with ds3 for an in labour section (I thought the chances of vaginal delivery were stacked against me) I would recommend them where possible ds3's whole birth and early weeks were far erasier than my puffy, breathing problems ds2.

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