Caesarean section for non-medical reasons at term

Lavender T, Hofmeyr GJ, Neilson JP, Kingdon C, Gyte GML

Published Online:

July 8, 2009

No trials to help assess the risks and benefits of caesarean section for women with no conventional medical indication for a caesarean.

Childbirth is a profound and powerful human experience. Women often describe feelings of empowerment, elation and achievement, although other women's experiences include trauma, fear, pain, and loss of control. The way women give birth, either vaginally or by caesarean section, is likely to impact on their feelings. In recent years, caesareans have become safer due to improved anaesthesia and improved surgical techniques, along with the routine use of drugs at surgery to combat the increased risk of infection and blood clots in the mother. However, caesarean section remains a surgical procedure accompanied by abdominal and uterine incisions, scarring and adhesions. This review found no trials to help assess the risks and benefits of caesarean section when undertaken without a conventional medical indication, and the authors strongly recommend alternative research methods to gather data on the outcomes associated with different ways of giving birth.

Abstract (click to read)

Background:

Caesarean section rates are progressively rising in many parts of the world. One suggested reason is increasing requests by women for caesarean section in the absence of clear medical indications, such as placenta praevia, HIV infection, contracted pelvis and, arguably, breech presentation or previous caesarean section. The reported benefits of planned caesarean section include greater safety for the baby, less pelvic floor trauma for the mother, avoidance of labour pain and convenience. The potential disadvantages, from observational studies, include increased risk of major morbidity or mortality for the mother, adverse psychological sequelae, and problems in subsequent pregnancies, including uterine scar rupture and greater risk of stillbirth and neonatal morbidity. An unbiased assessment of advantages and disadvantages would assist discussion of what has become a contentious issue in modern obstetrics.

Objectives:

To assess, from randomised trials, the effects on perinatal and maternal morbidity and mortality, and on maternal psychological morbidity, of planned caesarean delivery versus planned vaginal birth in women with no clear clinical indication for caesarean section.

Search strategy:

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (April 2009).

Selection criteria:

All comparisons of intention to perform caesarean section and intention for women to give birth vaginally; random allocation to treatment and control groups; adequate allocation concealment; women at term with single fetuses with cephalic presentations and no clear medical indication for caesarean section.

Data collection and analysis:

We identified no studies that met the inclusion criteria.

Main results:

There were no included trials.

Authors' conclusions:

There is no evidence from randomised controlled trials, upon which to base any practice recommendations regarding planned caesarean section for non-medical reasons at term. In the absence of trial data, there is an urgent need for a systematic review of observational studies and a synthesis of qualitative data to better assess the short- and long-term effects of caesarean section and vaginal birth.

This record should be cited as:

Lavender T, Hofmeyr GJ, Neilson JP, Kingdon C, Gyte GML. Caesarean section for non-medical reasons at term. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD004660. DOI: 10.1002/14651858.CD004660.pub2

Assessed as up to date:

April 28, 2009

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Primary Review Group:

Pregnancy and Childbirth Group

Health topics:

Pregnancy & childbirth > Care during childbirth > Routine intrapartum care

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Caesarean section for non-medical reasons at term

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