In Pursuit of a Natural Delivery – The Reduced Trial
The safety of a mother and her unborn baby is the top priority during a delivery. When safe for a woman to labour, a natural unassisted vaginal delivery is most often the primary objective of the medical team. In most cases, a vaginal delivery offers several known benefits when compared to the Cesarean section.
While complications are less common, the Cesarean section introduces risk. These can include but are not limited to:
- Endometritis – infection of the uterus (6-11% risk)
- Wound complications (1-2% risk)
- Postpartum hemorrhage – excessive bleeding (18% risk)
- Need for blood transfusion (2-4%risk)
- Surgical injury – injury to bowel, bladder, ureters, and ligaments (0.2-0.5% risk)
- Thrombotic events – stroke, heart attack, clots in the legs/lungs (44.8 per 100,000 deliveries)
- Birth trauma to the baby (1-3% risk)
- Newborn Tachypnea – rapid breathing and breathing issues.
Cesarean Section also prolongs hospital discharge and can restrict patients from driving for several weeks. Given the above risks, vaginal delivery can offer several advantages to the Cesarean section in most women.
The rate of Cesarean section is rising in Canada and the Western World. One of the primary reasons for pregnant women requiring a Cesarean section is a prior history of Cesarean section. When a woman has had a previous Cesarean section, the choice to have a repeat Cesarean section is sometimes preferred by patients or recommended by doctors. Therefore, preventing Cesarean section in first-time numbers is an effective way of reducing the overall Cesarean section rate.
Cesarean sections are performed for a variety of reasons, including poor progress in labour. The definition of ‘poor progress’ currently used by the medical community is largely outdated and based on small numbers of patients in older studies. Newer studies have since determined that it is time to change our perspective on what constitutes poor progress. A Calgary based trial, led by Dr. Stephen Wood, is currently evaluating the effectiveness of newer progress-in-labor guidelines on reducing the Cesarean section risk, while still maintaining the safety of mother and baby. This study was initiated in March 2017 is called the REDUCED trial. Preliminary results appear to show that by exercising more patience in the various stages of labour, provided a patient and her baby are healthy, the Cesarean section can be reduced.
There are however some instances in which vaginal delivery is unsafe, and the Cesarean section is the preferable choice. These include:
- Certain twin pregnancies
- Prolapsed cord – a cord that has fallen below the baby’s head
- Previous Cesarean section in which a vertical incision is made in the uterus
- Vaginal herpes simplex
- Certain fetal positions (ex. breech, face first)
- Abnormal fetal heart rate patterns when monitoring the fetus
For medical services such as Calgary maternity care or IUD placement, get in touch with our team at (403) 281-2020 or visit our website at https://www.oakbaymedical.ca/calgary-maternity-clinic/