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More women die following c-section than vaginal birth, probably due more to preexisting conditions than the surgery itself

Although reducing maternal deaths following childbirth has been identified as a high priority in recent national research and policy agendas, very little is known about the relationship between method of delivery—cesarean section or vaginal birth—and risk of maternal death following childbirth. Five recent studies have reported conflicting results; three reported a significantly higher death rate among women who underwent c-sections compared with those who had vaginal births, and two others found just the opposite.

A new study that was supported in part by the Agency for Healthcare Research and Quality (National Research Service Award training grant T32 HS00034) and conducted by researchers at the University of Washington may shed some light on the issue. It found that women in Washington State who had cesarean deliveries were four times as likely to die a pregnancy-related death following delivery as women who had vaginal deliveries. However, there was no difference in pregnancy-related maternal death rates after adjustments were made for maternal age and severe preeclampsia (a serious complication that occurs late in pregnancy and can lead to convulsions and coma).

According to Mona Lydon-Rochelle, M.P.H., Ph.D., and her colleagues, cesarean delivery may be more of a marker for serious preexisting maternal problems such as preeclampsia that increase maternal risk of death, rather than a risk factor for death in and of itself. The researchers analyzed Washington State maternally linked birth certificate, hospital discharge, and death certificate data to examine the association between method of delivery and maternal death within 6 months of delivery among women giving birth for the first time.

The rate of women who died from pregnancy-related problems was higher among women who had c-sections than among women who delivered vaginally (10.3 vs. 2.4 per 100,000 women). However, the women who died were more likely than those who survived to have had cardiac, renal, mental health, or severe preeclampsia complications and to have had medically indicated induction or labor. Also, compared with women who delivered vaginally, women who had c-sections were not at a significantly higher risk of death overall after adjustments were made for their age. Nor were they at increased risk of either pregnancy-related death after adjustment for their age and the presence of severe preeclampsia or pregnancy-unrelated death after adjustment for their age and marital status, compared with women who had vaginal deliveries.

More details are in "Cesarean delivery and postpartum mortality among primiparas in Washington State, 1987-1996," by Dr. Lydon-Rochelle, Victoria L. Holt, M.P.H., Ph.D., Thomas R. Easterling, M.D., and Diane P. Martin, M.A., Ph.D., in the February 2001 Obstetrics & Gynecology 97(2), pp. 169-174.

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