Planned C-Section Deemed Safe Option for Low-Risk Pregnancies

More than 31% of all U.S. births are by cesarean section (C-section), per the most recent data from the Centers for Disease Control and Prevention (CDC). But despite the high percentage of C-section births, there’s a stigma attached to this method of delivery. It’s regarded by many as the “unnatural” option and inferior to a vaginal delivery, which can lead to feelings of shame and failure.

These feelings can be exacerbated when the C-section is planned, i.e. requested by the mother and not considered a medical necessity—as if she's taking the "easy option."

But new research published recently in Canadian Medical Association Journal (CMAJ) shows that planned cesarean deliveries on maternal request are safe for low-risk pregnancies and may even be associated with a lower risk of adverse delivery outcomes than planned vaginal deliveries. 

The Study

The researchers analyzed data on 422,210 low-risk pregnancies over 6 years, from 2012 to 2018. In total, there were 46,533 cesarean deliveries, of which 1,827 (3.9%) were planned at the request of the mother. This rate didn’t change throughout the years of the study.

“There is very little data/outcome on cesarean section by maternal request,” says study author Darine El-Chaâr, MD, Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, Ontario. “For a long time, it was difficult for a patient who requested a C-section to obtain her wish, but it is becoming something that can be discussed with your doctor after careful consideration of the benefits and risks.” 

The research showed that vaginal deliveries and cesarean deliveries that were performed following maternal request were both safe delivery options for mother and baby, with planned cesarean deliveries on maternal request being associated with a lower risk of adverse delivery outcomes for both the mother and the baby than planned vaginal births. 

Dr. El-Chaâr says that initially the researchers were surprised by the findings. “One would expect a surgical procedure to carry more risks,” she says. “However, as an obstetrician, I know that although women are all naturally programmed for vaginal delivery, there are still complications, and risks (that can be unpredictable) associated with delivery.” 

Vaginal vs C-section Delivery

It’s important to understand that both methods of delivery have risks and potential complications, says G. Thomas Ruiz, MD, OB/GYN Lead at MemorialCare Orange Coast Medical Center in Fountain Valley, California. 

“Vaginal delivery is associated with bladder problems, stress, urinary incontinence, and pelvic relaxation in later life,” he says. However, he also points out that recovery from a C-section can be more painful and make it more difficult to care for a newborn in the postpartum period. Also, if there are to be subsequent pregnancies, repeated C-sections may carry higher morbidity and complications than vaginal birth. 

“At times, C-section babies do not clear all their fluid from their lungs and sometimes require oxygen support for the first 24 hours of life,” Dr. Ruiz adds. “A baby born via vaginal birth has most of the fluid squeezed out of its lungs coming through the birth canal.” 

Dr. Ruiz believes the Canadian study is relevant for a select population of women who are very anxious about going through a vaginal birth. But in all cases, both birth options should be discussed. “Ultimately, the decision is up to the mother,” he says. In Dr. Ruiz's experience, most women choose a vaginal birth.

“The use of epidurals and labor pain medications make the labor process more comfortable for most women, and birthing classes help the prospective parents learn about the birthing process,” he says. “However, it is not our job to impart guilt on a woman who chooses an elective C-section—it is our job to provide comfort and care.”

The study authors acknowledge that further research is needed to understand the potential longer-term effects of planned cesarean deliveries, such as their impact on breastfeeding, and the child's risk for infection and respiratory illness.