Date of Award

Spring 2023

Degree Name

Master of Medical Science (Physician Assistant)

Department

Physician Assistant; College of Health Sciences

First Advisor

Zachary Weik, PA-C

Abstract

The percentage of cesarean deliveries in the United States has increased to a rate of 32.1%, double what the World Health Organization recommends as an ideal rate for maternal and fetal benefits. The majority of cesarean sections are performed on women who have never had the procedure before and this increases the risk for subsequent cesarean deliveries. Half of the indications for primary cesarean delivery were found to be non-reassuring fetal heart tracings and arrest of labor, both of which are subject to obstetric provider judgment and comfort level. Among these there is also an increasing incidence of elective primary cesarean deliveries. In order to mitigate the number of unnecessary cesarean sections, the morbidity and mortality of the surgery is necessary to consider for both patient and provider. In comparison to vaginal deliveries, cesarean deliveries carry an increased risk of overall maternal morbidity, including but not limited to thromboembolic events, abdominal adhesions, placental abnormalities in future pregnancies, hysterectomy, and longer hospital stay. Fetal risks include an overall increase in fetal mortality, decreased likelihood of breastfeeding, and emerging evidence of inappropriate immune system development. Conversely, vaginal deliveries carry an increased risk of hemorrhage requiring transfusion, perineal lacerations, and temporary urinary incontinence. These consequences, among others not identified in this article, are important for obstetric providers and patients to consider when electing between a cesarean or vaginal delivery.

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Choosing the Route of Delivery: A Discussion of Vaginal and Cesarean Births

The percentage of cesarean deliveries in the United States has increased to a rate of 32.1%, double what the World Health Organization recommends as an ideal rate for maternal and fetal benefits. The majority of cesarean sections are performed on women who have never had the procedure before and this increases the risk for subsequent cesarean deliveries. Half of the indications for primary cesarean delivery were found to be non-reassuring fetal heart tracings and arrest of labor, both of which are subject to obstetric provider judgment and comfort level. Among these there is also an increasing incidence of elective primary cesarean deliveries. In order to mitigate the number of unnecessary cesarean sections, the morbidity and mortality of the surgery is necessary to consider for both patient and provider. In comparison to vaginal deliveries, cesarean deliveries carry an increased risk of overall maternal morbidity, including but not limited to thromboembolic events, abdominal adhesions, placental abnormalities in future pregnancies, hysterectomy, and longer hospital stay. Fetal risks include an overall increase in fetal mortality, decreased likelihood of breastfeeding, and emerging evidence of inappropriate immune system development. Conversely, vaginal deliveries carry an increased risk of hemorrhage requiring transfusion, perineal lacerations, and temporary urinary incontinence. These consequences, among others not identified in this article, are important for obstetric providers and patients to consider when electing between a cesarean or vaginal delivery.