Time to consider the risks of caesarean delivery for long term child health

Caesarean delivery can improve maternal and child health, and even save lives. But the past two decades have brought a sharp growth in caesareans in many nations, raising concerns about unnecessarily high rates. Caesarean delivery on maternal request is relatively rare in the UK (1-2% of births) and US (3% of births). But in some middle income countries the rate is high and growing (20% of births in southeastern China in 2006), making it an emerging global public health concern. Another contributor to the rising rates is repeat caesarean. Although this is not necessarily medically indicated in women with otherwise low obstetrical risk, among US births to women with prior caesarean in 2006, over 90% were caesarean deliveries.

Prospective parents want a delivery that is safe for the baby.1 In emergencies, or when a fetal or maternal indication is present, the choice is clear. But in cooler moments, such as repeat or maternal choice of caesarean, it makes sense to consider the risks and benefits of caesarean versus vaginal delivery, just as we would for other medical treatments. Both modes of delivery are associated with well known acute risks. For the neonate, for example, a caesarean is associated with increased risk of admission to a neonatal intensive care unit and vaginal delivery with a greater likelihood of cephalohaematoma. To date, concerns around long term child health have largely focused on neurological impairment. But recent research points to latent risks for chronic disease: children delivered by caesarean have a higher incidence of type 1 diabetes, obesity, and asthma. We argue that a detailed assessment of these risks should be taken into …