C-section vs Vaginal birth

Yesterday, as I was browsing through some science blogs and I came across this post on 'Is C-section delivery safer for the baby than vaginal delivery?'. There was a link to a supporting study that talked about performing cranial MRI on babies delivered vaginally and the results were as follows

Ninety-seven neonates (mean age at MR imaging, 20.8 days ± 6.9 [standard deviation]) underwent MR imaging between the ages of 1 and 5 weeks. Eighty-eight (44 male and 44 female) neonates (65 with vaginal delivery and 23 with cesarean delivery) completed the MR imaging evaluation. Seventeen neonates with ICHs (16 subdural, two subarachnoid, and six parenchymal hemorrhages) were identified. Seven infants had two or more types of hemorrhages. All neonates with ICH were delivered vaginally, with a prevalence of 26% in vaginal births. ICH was significantly associated with vaginal birth (P < .005) but not with prolonged duration of labor or with traumatic or assisted vaginal birth.

What it essentially means is that, some babies that were delivered vaginally, suffered from intercranial hemorrhage, while this was not the case with babies delivered by c-section. The reason for this is as follows

In a newborn, the bones of the skull have not fused together, so the bones of the skull can shift and frequently overlap each other during vaginal delivery, to allow the baby's head to fit through the birth canal. This shifting can compress the brain or cause blood vessels to tear, which causes bleeding.

Most of the bleeds identified were very small subdural hematomas—bleeding between the brain and the thick membrane that covers the brain below the skull—and a majority of them were located in the lower, back part of the brain over the occipital lobe or the cerebellum, which is below the occipital lobe.

Typically, small bleeds resolve over time without causing problems, though larger ones may cause problems later in the child's life, including seizures, subtle learning problems or problems with motor development.

"We just don't know at this time what these bleeds may mean over the long term," Dr. Gilmore said.

Further studies must be done to measure the long-term effects of ICH in infants, but Dr. Gilmore noted that expectant parents should not rule out vaginal delivery because of these findings.

"Obviously, the vast majority of us who were born vaginally and may have had these types of bleeds are doing just fine," he said. "Humans have been born vaginally for a very long time, and our brains probably evolved to handle vaginal birth without major difficulty."

In my opinion, human beings have been delivering vaginally for a very long time. C-section is relatively new procedure. We have also managed to populate the entire planet with vaginal deliveries and most of the population seems to be doing fine. This study almost hints that parents might want to opt for a voluntary c-section because vaginal delivery causes ICH in some babies.

Now that said, there was another more extensive study on neonatal mortality rates among babies delivered via c-section which was not medically required, as opposed to those delivered vaginally. Here is what they found

Marian MacDorman as well as other researchers took a look at nearly 5.8 million live births and 12,000 infant deaths from 1998 to 2001 in order to determine the infant death risk associated with different types of birth, particularly the rates associated with voluntary c-sections compared to vaginal delivery. In order to determine as true of a set of results as possible, the study only looked at pregnant women who had no complications with the delivery.

Infant and neonatal mortality rate among babies delivered via voluntary c-section were 1.77 per 1,000. In contrast, the mortality rate for babies delivered vaginally was .62 per 1,000. A look into the causes to these starkly different figures may be linked to a number of different factors. One cause which researchers have cited is that vaginal labor and delivery releases a hormone which promotes greater and healthier lung functioning. C-sections on the other hand do not release this hormone. Researchers also stress that the force on the infant during vaginal birth pushes fluid from the lungs and prepares the young child to breathe on their own, another thing c-sections are unable to accomplish. Other causes are associated with possible cuts to the infant during the c-section procedure and delayed time before breast feeding can occur.

So this shows that infants delivered vaginally have a better mortality rate. Now why would someone voluntarily sign up for a c-section, is beyond me. I think that it works totally against nature and child birth is a natural process and according to me, should never be a scheduled surgery unless medically warranted.

The research about ICH sounds so catered to the needs of malpractice lawyers, it is not even funny. An astounding 76.5% of OBGYN's get sued at least once in their career. And about half of the claims are without merit. In some states the malpractice insurance for OBGYN's is so high that they move to states where they can actually make some money and not pay all their earnings to insurance companies. With so much pressure on them, they already tend to perform c-sections at a rate of 25 - 30% and studies like this don't really help much, neither the doctor nor the pregnant woman. It is only something malpractice lawyers can take interest in and advertise on TV to scare the public. I can almost picture a man in a dark suit with a stern face saying

" Did you deliver a baby vaginally? Did the baby suffer from intercranial hemmorhage and your doctor did not tell you that a babies delivered via a c-section do not suffer from ICH? If you think you were denied an option and wish to be compensated please call me at 1-800-lets-sue and I will do everything in my means to ease your pain. Call right now, that's 1-800-lets-sue!"

Gaah!