Maternal mortality is lowest with planned cesarean deliveries and could also be lowered for all cesareans

New research by Clark et al at the Hospital Corporation of America, Nashville, TN has concluded that "Most maternal deaths are not preventable. Preventable deaths are equally likely to result from actions by nonmedical persons as from provider error. Given the diversity of causes of maternal death, no systematic reduction in maternal death rate in the United States can be expected unless all women undergoing cesarean delivery receive thromboembolism prophylaxis. Such a policy would be expected to eliminate any statistical difference in death rates caused by cesarean and vaginal delivery."

Importantly, the study looked at the causal relationship of [all] cesarean delivery to maternal death in a series of approximately 1.5 million deliveries between 2000 and 2006. A total of 95 maternal deaths occurred in 1,461,270 pregnancies (6.5 per 100,000 pregnancies) with the leading causes of death being "complications of preeclampsia, pulmonary thromboembolism, amniotic fluid embolism, obstetric hemorrhage, and cardiac disease. Only 1 death was seen from placenta accreta." 27 deaths (28%) were deemed preventable (17 by actions of health care personnel and 10 by actions of non-health care personnel) and the rate of maternal death causally related to mode of delivery was 0.2 per 100,000 for vaginal birth and 2.2 per 100,0000 for cesarean delivery, suggesting that the number of annual deaths resulting causally from cesarean delivery in the United States is about 20.

Unfortunately, since the U.S. does not separate birth data into emergency and planned cesarean deliveries, this study has analyzed a combination of the two. However, in the UK, where birth data is separated, research earlier this year found that the lowest rate of maternal mortality occurs following a planned cesarean delivery than other birth types.

I write this not with the intention of suggesting all women should therefore be encouraged to have planned cesarean deliveries, but rather to further add to the argument that women who choose to have a cesarean in preference to vaginal delivery are making a legitimate choice.