There is a big controversy among doctors and patients as to the wisdom of C-section vs. vaginal delivery. It is a complex issue.
For the first birth, there is no evidence that I am aware of that C-section or vaginal delivery are superior to one another with respect to the child’s health. Still, this is a point that is endlessly disputed in malpractice proceedings against obstetricians. You can always argue that the failure to do a C-section resulted in this or that problem in the baby. (We’ll get back to that.)
From the mother’s point of view, C-section can have numerous and severe consequences for the mother — it is a surgical procedure after all — but so can vaginal delivery. Damage to the pelvic floor during vaginal delivery can cause problems with urinary retention and sexual side-effects that many women find unacceptable. This is not even mentioning the ass load of pain involved.
The number of C-sections has been increasing over the last several decades in part due to elective C-section at the first pregnancy and in part due to C-section following a previous C-section. The reason for the second group is because, depending on the type of incision used in the earlier C-section, there is a chance that the uterus will tear if the woman follows a C-section with vaginal delivery. Controversy exists as to the costs and benefits in this case.
I can’t really speak with authority either for or against the use of C-sections in any specific case, but this article caught my eye. The researchers performed MRIs on asymptomatic newborns after vaginal delivery. They found that there was a higher incidence of intracranial bleeding in the infants delivered vaginally:
The first researchers to use magnetic resonance imaging (MRI) to study the brains of a large group of babies soon after birth found a small amount of bleeding in and around the brains of one in four babies who were delivered vaginally. The study appears in the February issue of Radiology.
“Small bleeds in and around the brain are very common in infants who are born vaginally,” said John H. Gilmore, M.D., professor of psychiatry and Vice-Chair for Research and Scientific Affairs at the University of North Carolina School of Medicine in Chapel Hill. “It seems that a normal vaginal birth can cause these small bleeds.”
For the study, 88 asymptomatic infants, equally divided between male and female, underwent MRI between the ages of one and five weeks. Sixty-five had been delivered vaginally and 23 had been delivered by cesarean section. MR images showed that 17 (26 percent) of the babies who had been delivered vaginally had intracranial hemorrhages (ICH), or small bleeds in and around the brain. Seven infants had two or more types of ICH. Prior studies have shown a smaller incidence–approximately 10 percent–of intracranial hemorrhage associated with vaginal birth.
While ICH was significantly associated with vaginal birth, it was not dependent on prolonged duration of labor or on traumatic or assisted vaginal birth.
“In our study, neither the size of the baby or the baby’s head, the length of the labor, nor the use of vacuum or forceps to assist the delivery caused the bleeds,” Dr. Gilmore said. “The bleeds are probably caused by pressure on the skull during delivery.”
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. (Emphasis mine.)
Here is a link to the article in Radiology.
This is the first study that I have read suggesting that C-section might have health benefits for the child, but I emphasize the last sentence because we really don’t know what the consequences of these bleeds may be for the child over the long-term.
However, the fact that we don’t know what the consequences is not likely to discourage malpractice attorneys from suing OBs based on studies like this. Unfortunately, I feel like any study related to problems in newly born infants will be inevitably misused.
The more important concern is to not let that fact discourage us. We need to see studies like this through to the end. We need to actually determine whether these bleeds are affecting the infants in a negative way. If they are, we need to do something about it. Just because science is going to be misused does not free us from the need to find answers not based on speculation.