Caesareans Not Always The Best Option
Wellbeing of Women has co-funded a new ground-breaking study of women who have given birth in England, Scotland and New Zealand, which has found the strongest evidence yet that having caesarean sections does not always protect women from the common and often distressing after-effect of urinary or faecal incontinence.
The findings, just published on-line in the prestigious BJOG, international journal of Obstetrics and Gynaecology, cast doubt on the frequently-made claim that C-section deliveries protect women from incontinence, and also on the belief that having a C-section means women retain better sexual capability or function than those who have natural births.
At 12 years in length, this is the longest and most comprehensive international study into this controversial issue of whether or not caesarean births confer women with protective qualities against some of the long-term negative effects of childbirth.
It involved researchers from the University of Birmingham, the University of Aberdeen and the University of Otago, who surveyed 3,763 women at three months after giving birth, at six years and at 12 years.
Jointly funded by the UK’s leading health charity Wellbeing of Women and the University of Otago in New Zealand, the study clearly documents that having a C-section does not protect women from experiencing urinary incontinence (UI) unless women have all their babies by C-section - in which case women can be less prone to UI.
But a woman who has both a baby naturally, and a child via C-section, not necessarily in that order, has the same propensity to develop urinary incontinence as a woman who has only ever had natural births.
The results also highlight that there is no difference in levels of faecal incontinence (FI) between women who has only ever had spontaneous natural deliveries and only ever had C-sections.
Furthermore, when surveyed at six years after giving birth, there was almost no difference in women’s rating of their sexual function between those who had caesarean births and those who had natural births.
The study also found that, regardless of how they delivered their children, women who were older when they first had a baby (in the 35-year-plus age group), were heavier or had given birth more times, reported higher rates of incontinence.
One of the lead researchers, Otago’s Professor of Obstetrics and Gynaecology Don Wilson, says: "The findings of this large cohort study comprise an important new message to inform choice of delivery by caesarean section: unless women are resolved to have all their deliveries by the abdominal route (and their medical advisers agree), there is no protection from subsequent urinary incontinence with caesarean section."
Women drawn from three different maternity units, Birmingham in England, Aberdeen in Scotland and Dunedin, New Zealand, were sent questionnaires asking about loss of control of their bladder or bowel motions three months after giving birth, at six years and at twelve years after giving birth. Professor Wilson says he and his colleagues plan to follow-up the women in 2014, at 20 years after they have given birth.
Director of Wellbeing of Women, Liz Campbell comments: "As the UK’s leading research-based charity aiming to safeguard the health and wellbeing of mothers and their babies, embarking on a long-term project such as this one is hugely important both for women who are pregnant plus their medical carers. Informed choices are crucial for the safety and long term health of mothers."