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Planned caesarean births safe for low-risk pregnancies


May 3, 2021

Dr. Darine El-Cha├órDr. Darine El-ChaârNew research shows that planned caesarean deliveries on maternal request are safe for low-risk pregnancies and may be associated with a lower risk of adverse delivery outcomes compared with planned vaginal deliveries. The study is published in CMAJ (Canadian Medical Association Journal).


The study used province-wide data from the Better Outcomes Registry & Network (BORN), Ontario’s provincial birth registry. The authors analyzed data on 422 210 low-risk pregnancies over 6 years (2012 to 2018). There were 46 533 cesarean deliveries, of which 1827(3.9%) were planned at the request of the mother. Mothers who requested caesarean delivery were more likely to be White, older than 35 years, have conceived by in vitro fertilization, delivering their first baby, and live in a higher income neighbourhood, among other characteristics.

“Our finding that caesarean deliveries on maternal request (CDMR) rates have remained stable in Ontario provides reassurance to those concerned about the potential contribution of CDMR to rising cesarean delivery rates,” writes Dr. 
Darine El-Chaâr, Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, Ontario, with coauthors.

Importantly, the findings also showed that cesarean deliveries that were performed by maternal request and vaginal deliveries were both safe delivery options for mother and baby. Adverse outcomes were rare in both groups. However, planned cesarean deliveries on maternal request were associated with a lower risk of adverse delivery outcomes in the both mother and the baby than planned vaginal births.

The authors caution that research is needed to understand potential longer-term effects of planned caesarean deliveries.
“Although our study addresses concerns related to the immediate implications of planned CDMR, exploration of longer-term risks is needed, including its impact on breastfeeding, and the child’s risk for infection and respiratory illness,” they conclude.

Funding: This study was funded by the Canadian Institutes of Health Research. All research at The Ottawa Hospital is also enabled by donor support through The Ottawa Hospital Foundation.

Full reference: 
Birth outcomes following cesarean delivery on maternal request: a population-based cohort study. Yanfang Guo, Malia Murphy, Erica Erwin, Romina Fakhraei, Daniel Corsi, Ruth Rennicks White, Alysha Harvey, Laura Gaudet, Mark Walker, Shi Wu Went, Darine El-Chaâr. CMAJ. May 3, 2021.

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