Study Favors Vaginal Delivery for Stalled Labor

C-sections linked to bleeding, longer hospital stays

FRIDAY, Oct. 12, 2001 (HealthDayNews) -- A new study of women with stalled labor shows that C├Žsarean sections are more likely than vaginal deliveries to result in prolonged hospitalization and serious bleeding for mothers, with no significant gain for the health of the newborn.

British researchers say women who are stuck in the middle stage of labor are better off having a vaginal delivery, even when injurious instruments are used, and that C-sections should be avoided if possible.

Study leader Dr. Deirdre J. Murphy of the University of Bristol says the findings apply only to the 10 percent to 15 percent of pregnant women who experience obstructed labor, especially the 4 percent with the most complicated deliveries.

Murphy and her colleagues followed 393 women who required either C-section or instruments such as forceps to aid their delivery of single babies. The women were stuck in second-stage labor, meaning their cervix had fully dilated, but the baby wasn't descending from the uterus.

C-section was about twice as likely for women who were obese, those who had particularly heavy babies (roughly 9 pounds or bigger) and women whose infants were in the wrong position coming through the birth canal (face up for mothers on their back), the researchers say.

Women who underwent surgery had nearly three times the risk of major bleeding during delivery than those who delivered vaginally. They also were 3.5 times more likely to stay in the hospital six or more days. Eight percent of women who delivered vaginally suffered a serious tear of their perineum, compared with none in the Caesarean group.

For newborns C-section was a mixed bag. They were 2.6 times more likely than those delivered by forceps to require intensive care, but their risk of bruises, scrapes and other injuries was 60 percent lower, the researchers say. On the other hand, 13 C-section babies had blood infections, compared with only six in the vaginal delivery group. The number with jaundice was roughly equal, but tilted more toward C-section.

The findings appear in the Oct. 13 issue of The Lancet.

Most obstetricians would rather deliver a baby who was bruised and scraped than one deprived of oxygen during a C-section procedure, Murphy says. And since C-section babies were more often placed in intensive care, they were more likely to be separated from their mother after birth.

While Murphy says the findings support vaginal delivery, she cautions that in complicated labors the delivery team must be highly experienced. "It needs a considerable degree of skill. I see many trainees without expertise wanting to go straight through to C-section."

The questions of whether and when to perform a C-section are controversial in both the United Kingdom and the United States, experts say.

"Right now things are pretty hot on this topic," says Mona Lydon-Rochelle, a women's health expert at the University of Washington in Seattle. Advocates of C-section delivery say the procedure spares women from having to have their perineum -- the tissue between the vagina and the anus -- cut to facilitate birth. That procedure, called an episiotomy, can lead to painful tears in the area later.

In a study reported last year in The Journal of the American Medical Association, Lydon-Rochelle found that women who undergo Caesarean section surgery and instrument-assisted delivery are significantly more likely be re-admitted to the hospital than those who deliver spontaneously. Most of the increased risk is due to uterine infections, gallbladder problems and irritated surgical wounds, though many women also suffer post-delivery bleeding and pelvic injury.

The Centers for Disease Control and Prevention estimates there are 7.5 maternal deaths per every 100,000 live births, or about 1,000 deaths a year, a figure that hasn't changed much since the early 1980s. Maternal mortality is a particularly troubling problem for blacks and Hispanics, who are four and 1.7 times, respectively, more likely than whites to die of pregnancy-related complications, the agency says.

What To Do

To read a history of C├Žsarean section, try the National Library of Medicine.

For more on complications during childbirth and their impact on women, try this report from the National Academy of Sciences.

To find out more about pregnancy, check About.com.

SOURCES: Interviews with Deirdre J. Murphy, M.D., consultant senior lecturer, division of obstetrics and gynecology, St. Michael's Hospital, University of Bristol, England, and Mona Lydon-Rochelle, Ph.D., M.P.H., senior research fellow, Center for Women's Health Research, University of Washington, Seattle; Oct. 13, 2001, The Lancet
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