Recommendation ID
CG132/5
Question
Risks and benefits of Caesarean Section (CS): What are the medium- to long-term risks and benefits to women and their babies of planned CS compared with planned vaginal birth? The main focus would be the outcomes in women, which could be measured at 1 year (medium term) and 5–10 years (long term). These outcomes could include:
• urinary dysfunction
• gastrointestinal dysfunction
• dyspareunia
• breastfeeding
• psychological health.
Infant outcomes could include medical problems, especially ongoing respiratory and neurological problems.
Any explanatory notes
(if applicable)
Why this is important:- Morbidities arising intraoperatively or in the days after a Caesarean Section (CS) have been reasonably well described in the literature. Much less is known, however, about physical and emotional outcome measures in the longer term.
The Confidential Enquiries into Maternal Deaths in the UK, most recently published as 'Saving mothers' lives 2006–2008' (Cantwell R et al. 2011), devote a significant proportion of their work to investigating 'late' causes of maternal death. These include events arising in the medium term, namely, up to 1 year after a woman has given birth, many of which originate from the preceding pregnancy. The infectious, psychiatric and other conditions arising in or related to pregnancy do not always cause death but are responsible for arguably a greater burden of morbidity in the medium and long term, long after the pregnancy is over. To provide more meaningful information to women when they are choosing their mode of birth, there is a pressing need to document medium- to long-term outcomes in women and their babies after a planned CS or a planned vaginal birth. First, it should be possible to gather data using standardised questions (traditional paper-based questionnaires and face-to-face interviews)
about maternal septic morbidities and emotional wellbeing up to 1 year after a planned CS in a population of women who have consented for follow-up. Internet-based questionnaires could also be devised to achieve the high response rates required for a full interpretation of the data. Similarly, it would be important to collect high-quality data on infant morbidities after a planned CS compared with a planned vaginal birth. A long-term morbidity evaluation (between 5 and 10 years after the CS) would use similar methodology but assess symptoms related to urinary and gastrointestinal function.

Source guidance details

Comes from guidance
Caesarean section
Number
CG132
Date issued
November 2011

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No