Vaginal, Cesarean Deliveries Result in Same Trauma Rate, But Nature of Events Varies


SAN FRANCISCO — Birth trauma occurs at the same rate in vaginal and cesarean deliveries, but the nature of the trauma is different, according to data presented at the annual meeting of the American College of Obstetricians and Gynecologists.

Study investigators were not able to distinguish between planned cesarean deliveries and cesarean deliveries that resulted from a failed trial of labor, however.

“The group we have to pay particular attention to is women who had a failed attempt at delivery and then had a C-section. That's probably the highest risk group and may actually be contributing to the trauma in the C-section group. But we couldn't look at this, so we can't tell the whole story with this research,” said Susan Meikle, M.D., who is lead investigator of the study and works at the Agency for Healthcare Research and Quality (AHRQ), located in Rockville, Md.

The AHRQ is mandated by Congress to produce an annual National Healthcare Quality Report that compiles health care data on patient safety. The report also defines adverse events that could be preventable. This portion of the report focuses on the risks for birth trauma.

Birth trauma data were identified using discharge data from 995 nonfederal hospitals located in 35 states and were then compared with data on infants without birth trauma. The data were analyzed by mode of delivery, clinical characteristics, demographics, and hospital characteristics.

The rate of birth trauma among more than 4,000,000 neonates was about 7 per 1,000 live singleton births, Dr. Meikle said.

When analyzed according to mode of delivery, the unadjusted rate of birth trauma was the same for both vaginal and cesarean deliveries. In addition, male infants and preterm infants were were found to be at higher risk for birth trauma regardless of the mode of delivery.

After adjustment for delivery mode, vaginal delivery of infants that were large for gestational age had a higher risk of skeletal, spinal, clavicular, and brachial plexus injuries, with an odds ratio (OR) of 1.5.

Cesarean delivery was associated with a higher risk of subdural or cerebral hemorrhage (OR 1.6) and other peripheral or cranial nerve or unspecified trauma (OR 2.1).

“Birth trauma is a heterogeneous group of injuries, and it was not possible to determine whether mode of delivery was a precipitating factor,” Dr. Meikle concluded.

“Trauma occurs with both types of delivery. There's a certain element we can't predict, and you need to be careful in deciding whether you do a C-section or a vaginal delivery,” she said in an interview. “It's hard for us to predict how big babies [will be], and if we had some tools to give us better predictive ability, that would help.”

Dr. Meikle said she also recommended that neonatal birth trauma data specify the type of injury, as well as include the attempts at vaginal delivery before a cesarean section should be accounted for in an effort to facilitate research in this field.

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