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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 December 15; 335(7632): 1226.
PMCID: PMC2137075
Caesarean Section

Points raised in responses

Sharon Davies, letters editor

In her rapid response, Amy B Tuteur, an obstetrician from Sharon, Massachussetts, argues that the definition of elective is misleading in the study by Villar et al.1 2 “The study compares women who had vaginal deliveries with women who had medically indicated caesarean sections, both non-emergency and emergency. It never investigated elective caesareans and therefore it reaches no conclusions about them.”

“Equipoise exists,” writes Robert G Buist, a visiting obstetrician at the Royal Hospital for Women in Randwick, Australia. “The time has come for a large prospective long term observational study comparing outcomes for women without absolute indications for caesarean who plan to give birth by caesarean v those planning to give birth vaginally.”1

Maureen Treadwell, a Hampshire committee member of the Birth Trauma Association, highlights that the important issue of maternal mental health is almost always forgotten, despite being a leading cause of death in the year around childbirth. “We represent service users and our feedback suggests that emergency caesareans and very traumatic vaginal deliveries are the most damaging in terms of mental health. These are the two types of delivery that we should really be trying to avoid. It is important that women get all the information they need to make decisions, not that which simply leads them to make decisions which suit policy makers.”1


Competing interests: None declared.


1. Rapid responses. Maternal and neonatal individual risks and benefits associated with caesarean delivery. 2007.
2. Villar J, Carroli G, Zavaleta N, Donner A, Wojdyla D, Faundes A, et al. Maternal and neonatal individual risks and benefits associated with caesarean delivery: multicentre prospective study. BMJ 2007;335:1025-9. (17 November.) [PMC free article] [PubMed]

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