Cesarean delivery is associated with a lower rate of fetal trauma (Linder, 2013; Moczygemba, 2010). lexander and colleagues (2006) found that fetal injury complicated 1 percent of cesarean deliveries. Skin laceration was most common, but others included cephalohematoma, clavicular fracture, brachial plexopathy, skull fracture, and facial nerve palsy. Cesarean deliveries following a failed operative vaginal delivery attempt had the highest injury rate, whereas the lowest rate-0.5 percentoccurred in the elective cesarean delivery group. hat said, Worley and colleagues (2009) noted that approximately a third of women who were delivered at Parkland Hospital entered spontaneous labor at term, and 96 percent of these delivered vaginally without adverse neonatal outcomes.
Some evidence shows higher asthma and allergy rates in those delivered by cesarean. With the hope to improve neonatal microbiota, swabbing the newborn mouth with a gauze that was incubated in the maternal vagina 1 hour before surgery is described in preliminary studies. However, the American College of Obstetricians and Gynecologists (2017 e) does not encourage this practice due to few data and the potential for transmission of harmful organisms.
Some women request elective cesarean delivery. Data regarding the true incidence of cesarean delivey on matenal request (CDMR) are poor. Rate estimates range from 1 to 8 percent in the United States (Barber, 2011; Declercq, 2005; Gossman, 2006; Menacker, 2006).
Reasons for the request include pelvic floor protection, convenience, fear of childbirth, and reduced risk of fetal injury. Data to address these concerns are slowly accruing. One study of more than 66,000 Chinese parturients compared outcomes of those who elected planned vaginal or primary cesarean delivery (Liu, 2015). Short-term serious maternal morbidity and neonatal mortality rates were similar. For the newborns, rates of birth trauma, infection, and hypoxic ischemic encephalopathy were low in both groups but statistically lower with cesarean delivery. Respiratory distress syndrome rates were greater in the CMDR cohort. A smaller study comparing these two routes of delivery support these findings (Larsson, 2011).
he debate surrounding CDMR includes these medical points, the concept of informed free choice by the woman, and the autonomy of the physician in ofering CMDR. During the National Institutes of Health panel (2006) cited above, participants noted that most of the maternal and neonatal outcomes examined had insuicient data to permit recommendations. Despite this, the panel was able to draw a few conclusions, which are echoed by the American College of Obstetricians and Gynecologists (2017a). Namely, CMDR should not be performed before 39 weeks' gestation unless fetal lung maturity is conirmed. Cesarean delivery is ideally avoided in women desiring several children because of placental implantation abnormalities and cesarean hysterectomy risks. Finally, CMDR should not be motivated by the unavailability of efective pain management.