Our Summary

This research paper reviews studies that compare the outcomes of extremely preterm infants (those born before 28 weeks) and very low birth weight infants (those weighing less than 1500 grams at birth) who were delivered either vaginally or by caesarean section. The main outcomes reviewed were death and severe brain injury. The researchers found that for extremely preterm infants, caesarean section significantly reduced the risk of death. However, for very low birth weight infants, the benefits of caesarean section were not significant, although there were some benefits for smaller weight subgroups. The results should be interpreted with caution due to the lack of randomized trials. The researchers conclude that their findings provide the best evidence currently available and should guide future research.

FAQs

  1. Does a cesarean section significantly reduce the risk of death for extremely preterm infants?
  2. What are the benefits of a cesarean section for very low birth weight infants?
  3. Why should the results of this study be interpreted with caution?

Doctor’s Tip

One helpful tip a doctor might give a patient about cesarean section is to discuss the potential benefits and risks of the procedure, especially in relation to the specific circumstances of the pregnancy. It is important for patients to have open and honest communication with their healthcare provider to make an informed decision about the best delivery method for both the mother and baby.

Suitable For

Patients who are typically recommended for cesarean section include:

  1. Women with certain medical conditions that may complicate vaginal delivery, such as placenta previa, active genital herpes infection, or certain heart conditions.

  2. Women who have had a previous cesarean section and are at risk for uterine rupture during a vaginal delivery.

  3. Women carrying multiple fetuses (twins, triplets, etc.) who may have a higher risk of complications during vaginal delivery.

  4. Babies who are in a breech or transverse position in the womb, as attempting a vaginal delivery in these cases can be risky for the baby.

  5. Women who have had a previous traumatic vaginal delivery or have a history of difficult labor, as a cesarean section may be recommended to reduce the risk of complications during childbirth.

  6. Women with certain fetal conditions that may make vaginal delivery unsafe, such as a large baby or certain birth defects.

It is important for healthcare providers to carefully assess each individual case and weigh the risks and benefits of cesarean section versus vaginal delivery in order to make the best recommendation for the patient and her baby.

Timeline

Before Cesarean Section:

  • Patient may be informed by their healthcare provider that a cesarean section may be necessary due to factors such as breech presentation, placenta previa, fetal distress, or previous cesarean section.
  • Patient may undergo preoperative testing such as blood tests, ultrasound, and anesthesia consultation.
  • Patient may receive instructions on fasting before the procedure and how to prepare for surgery.

During Cesarean Section:

  • Patient will be taken to the operating room and given anesthesia (usually regional anesthesia such as spinal or epidural).
  • The surgical team will perform the cesarean section, which involves making an incision in the abdomen and uterus to deliver the baby.
  • The baby will be monitored closely after delivery to ensure they are stable and breathing properly.
  • The patient may experience discomfort and pain during the procedure, but pain medication will be provided.

After Cesarean Section:

  • The patient will be taken to a recovery room where they will be monitored closely for any complications such as bleeding or infection.
  • The patient will receive pain medication as needed to manage postoperative pain.
  • The patient will be encouraged to start moving around as soon as possible to prevent blood clots and promote healing.
  • The patient will receive instructions on how to care for their incision and when to follow up with their healthcare provider for postoperative care.

What to Ask Your Doctor

  1. What are the reasons for recommending a cesarean section in my case?
  2. What are the risks and benefits of having a cesarean section compared to a vaginal delivery?
  3. How will a cesarean section affect my recovery time and future pregnancies?
  4. What are the potential complications of a cesarean section, and how are they managed?
  5. Will I be able to have skin-to-skin contact and breastfeed immediately after the surgery?
  6. What is the hospital’s cesarean section rate, and how experienced is the medical team in performing cesarean sections?
  7. How will pain be managed during and after the cesarean section?
  8. What are the possible long-term effects of a cesarean section on my health and the health of my baby?
  9. Are there any alternative options to a cesarean section that I should consider?
  10. What is the hospital’s policy on having a support person present during the cesarean section?

Reference

Authors: Jarde A, Feng YY, Viaje KA, Shah PS, McDonald SD. Journal: Arch Gynecol Obstet. 2020 Feb;301(2):447-458. doi: 10.1007/s00404-019-05417-0. Epub 2019 Dec 24. PMID: 31875252