Abstract

Objective:

To estimate the impact of cesarean delivery on the incidence of selected neonatal outcomes.

Patients and Methods:

A 15-year, population-based, cohort study (1988-2002) using the Nova Scotia Atlee Perinatal Database compared neonatal outcomes in term newborns born by spontaneous and assisted vaginal delivery, with newborns born by cesarean delivery, with and without labor, using multiple logistic regression.

Results:

From a total of 142,971 deliveries, there were 27,263 cesarean deliveries, 61% of which were performed in labor. Relative risks were adjusted for year of birth, maternal age, parity, smoking, maternal weight at delivery, hypertensive diseases, diabetes, previous cesarean delivery, use of regional anesthesia, induction of labor, gestational age at delivery and large and small for gestational age, where significant. Cesarean in labor, but not cesarean without labor, had increased risks for depression at birth and neonatal respiratory conditions compared to spontaneous or assisted vaginal delivery. Compared to spontaneous vaginal delivery and assisted vaginal delivery, the risk of major neonatal birth trauma was decreased for infants following cesarean delivery with labor (OR 0.34, 95% CI 0.21-0.56 and OR 0.07, 95% CI 0.04-0.11, respectively) and cesarean delivery without labor (OR 0.20, 95% CI 0.08-0.52 and OR 0.04, 95% CI 0.02-0.10, respectively).

Conclusion:

Cesarean delivery in labor, compared to vaginal delivery, is more likely to be associated with an increased risk for respiratory conditions and depression at birth than cesarean delivery without labor. Cesarean delivery appears protective against neonatal birth trauma, especially when performed without labor.