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First-time mothers who have unassisted deliveries fare better than those who have c-sections or assisted vaginal deliveries

Of the nearly 4 million deliveries in the United States in 1996, 22 percent were by cesarean, 14 percent were vaginal deliveries assisted by forceps or vacuum extraction, and 64 percent were spontaneous vaginal deliveries. A new study reveals that first-time mothers who had cesarean or assisted vaginal deliveries had significantly lower general health and functioning 7 weeks postpartum than women who had unassisted vaginal delivery. In fact, women with assisted vaginal deliveries reported substantially worse sexual, bowel, and urinary functioning than women with spontaneous vaginal deliveries. This information should help doctors advise women about what to expect in the postpartum recovery period, given their delivery method, conclude the researchers from the University of Washington in Seattle.

In a study that was supported in part by the Agency for Healthcare Research and Quality (National Research Service Award training grant T32 HS00034), the researchers analyzed data from a survey of maternity care at 10 hospitals in Washington State of women giving birth for the first time to a single infant in 1991. Compared with women who had c-sections, more women with unassisted vaginal delivery said they had no limitation when performing vigorous activities, such as running, lifting heavy objects, and participating in strenuous sports (65 vs. 45 percent); had no difficulty doing normal household tasks (50 vs. 34 percent); had excellent general health (32 vs. 20 percent); and had no limitations in social activities in the past month (56 vs. 45 percent).

Significantly more women with assisted vaginal delivery said they had not resumed sexual activity compared with women who had an unassisted vaginal delivery (40 vs. 29 percent) and suffered from bowel or urinary tract problems that interfered with their daily activities (50 vs. 40 percent). The mechanical trauma accompanying assisted vaginal delivery may have contributed to these women's problems following childbirth, note the researchers. They suggest that doctors should selectively substitute vacuum extraction for forceps, restrict use of episiotomy, and use more effective suture techniques and other methods to minimize the mechanical trauma of assisted vaginal delivery to improve the postpartum functioning of these women.

See "Delivery method and self-reported postpartum general health status among primiparous women," by Mona T. Lydon-Rochelle, Ph.D., M.P.H., Victoria L. Holt, Ph.D., M.P.H., and Diane P. Martin, Ph.D., M.A., in the July 2001 Paediatric and Perinatal Epidemiology 15, pp. 232-240.

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