Births by cesarean section are rising worldwide. The latest figures (2016) show that 25 percent of births in Western Europe were by cesarean delivery, while in North America it was 32 percent and in South America 41 percent. Given these statistics, it’s not surprising that people are interested in new evidence that looks at the potential harms (and benefits) of this procedure. However, I read the latest review of the evidence with mixed feelings.
The review, published in PLOS Medicine, focused on three main outcomes: pelvic floor problems in the mother (such as urinary incontinence), asthma in the child, and death of the child in subsequent pregnancies (stillbirth or neonatal death). The headline findings were: Compared with vaginal delivery, there is a decreased risk of urinary incontinence and vaginal prolapse with a cesarean delivery. There is an increased risk of asthma in children delivered by cesarean section, up to the age of 12. And pregnancy after cesarean delivery was associated with increased risk of miscarriage and stillbirth but not of neonatal death.
As a scientist, I can appreciate the effort made in conducting a systematic review on the topic, but as an obstetrician, I worry that the results can be over-interpreted by patients—not to mention obstetricians and midwives—and cesarean section “marketed” as a safe way to avoid problems with the pelvic floor. The pelvic floor includes the muscles, ligaments, connective tissues and nerves that support the bladder, uterus, vagina and rectum, and helps the pelvic organs to function.
