Childbirth

The debate over C-sections

The procedure has advantages as well as downsides. Science can help mothers decide what is best for them.

The take-away

  • More and more women in Europe are choosing C-sections even when the procedure is not necessary.
  • A British study shows that caesareans can lead to future pregnancy complications for mothers and heightened risk of asthma or obesity for children.

Caesarean sections have become such a safe operation that many doctors and mothers are now choosing this option even when it is not strictly necessary. Health economist Agnès Couffinhal of the Organisation for Economic Co-operation and Development (OECD) in Paris notes that in Europe the average C-section rate has risen to 27.1%, despite 2015 World Health Organization data showing that rates above 10% do not help reduce deaths in childbirth. “The range is fascinating,” she says. “It goes from 16% in The Netherlands and Finland to a staggeringly high 57% in Cyprus”.

The reasons, according to Couffinhal, range from the biological – like the risks faced by older or overweight women – to the institutional. This includes the practice of defensive medicine – departing from normal procedures to avoid litigation – and the fact that some hospitals charge more for C-sections than natural deliveries.

There are also obvious advantages for the mother. Not only can she make an appointment for the birth of her child, but caesareans can reduce the risk of pain, potential injury to the vagina and subsequent bleeding. Often these short-term benefits trump the equally well documented disadvantages of C-sections, like the increased chance of a baby being admitted to neonatal intensive care, or very rare but serious complications for the mother.

cesarian birth article - The debate over C-sections

A risk for pregnancy complications

Less well known until recently was how C-sections affected mothers and babies years after delivery. A new study led by Sarah Stock of the University of Edinburgh provides a host of factors expectant mothers and clinicians should weigh when considering a planned C-section. “Caesarean sections seem to protect women from developing pelvic floor problems,” Stock explains. “But they have a higher chance of not becoming pregnant again, and of future pregnancy complications.” The researchers also note that children born by caesarean are more likely to suffer from asthma and/or obesity in later years.

This has led some expectant mothers to try an increasingly popular procedure they hope will reduce their child’s risk: vaginal seeding. By placing a swab in the vagina just after C-section delivery and then pasting it over the baby’s mouth and eyes, the mother’s bacteria are transferred to the infant, creating a microbial community (or microbiome) similar to that of a baby born naturally. “There is some evidence you can modify these microbial communities,” explains Aubrey Cunnington of Imperial College London, co-author of an editorial in the British Medical Journal. “But there is no evidence that this modifies long-term outcomes.”

Furthermore, Cunnington warns that the seemingly simple procedure carries its own risks, as harmful bacteria like herpes simplex and Group B streptococcus may also be lurking in the vagina. “I am aware now of several cases where infections seem to have been transmitted by vaginal seeding,” he adds.

As with a planned C-section, vaginal seeding is an expectant mother’s choice. All science can do is ensure that the choice is informed.

Agnès Couffinhal (OECD), Sarah Stock (University of Edinburgh), Aubrey Cunnington (Imperial College London), WHO, British Medical Journal 352 (2016), PLOS Medicine (January 2018), OECD