Forceps delivery has been shown to be the single independent factor associated with trauma to the anal sphincter, and most women who sustain anal sphincteric damage do so in their first pregnancy.2-10
Maternal age has not been shown to have any bearing on the vaginal delivery rate, even after a caesarean section.2-11
Most developmental delays are unrelated to the method of delivery, so a policy of elective caesarean sections would not necessarily prevent long term disability. An elective caesarean section does, however, avert the need for episiotomies, prolonged and painful labours, and difficult instrumental deliveries. Trauma to the pelvic floor and to the urethral and anal sphincters, associated with long term predisposition to genital prolapse and urinary and anal incontinence, would also be avoided.2-12
Caesarean sections are not without complications and consequences. Maternal risks in the short term include haemorrhage, infection, ileus, pulmonary embolism, and Mendelson’s syndrome. The prevalence of hysterectomy due to haemorrhage after caesarean section is 10 times that after vaginal delivery, and the risk of maternal death is increased up to 16-fold.2-12
Long term morbidity—including formation of adhesions, intestinal obstruction, bladder injury, and uterine rupture—is often underestimated during subsequent pregnancy. There is evidence suggesting decreased fecundity, increased risk of ectopic pregnancy, placenta praevia, and worse infant outcome in subsequent pregnancies, although the effect on non-reproductive health is unclear and contradictory.2-13
Feelings of inadequacy, guilt, and failure in not completing a natural process may affect bonding between mother and infant, particularly if the operation was conducted under general anaesthetic.
No proper data exist about the risks and benefits of elective caesarean section versus labour in uncomplicated pregnancies, looking at multiple medical outcomes as well as psychological, social, and economic implications. Obstetricians do not always know best; no doctor can say whether a mother or fetus will be damaged in labour; and current surveillance tests are not always reliable indicators of poor outcome. Despite these uncertainties, it is the responsibility of the healthcare professional to impart information to women and their partners that is accurate and readily understandable.