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Maternal and neonatal outcomes following “natural” caesarean section

Background “Natural” caesarean section (NCS) is a technique in which the obstetrician replicates the mechanisms of normal parturition at the time of caesarean delivery.1 NCS has the potential to improve the birth experience for the mother and might also reduce the incidence of neonatal respiratory morbidity associated with caesarean delivery. There is no published quantitative data on the safety of NCS to validate the technique, only anecdotal evidence from current advocates. Aims To compare outcomes for women delivered by NCS to traditional techniques of caesarean delivery. Methods A case-control study of women delivered by planned caesarean section in Ninewells Hospital Dundee. Women were matched for age, parity, body mass index and gestational age at delivery. The obstetric case notes and local maternity database (Torex Protos Evolution) were used to determine obstetric and neonatal outcomes. Results 22 women had NCS and were matched to 44 controls. There were no differences in operative haemorrhage (Mean-Mean difference NCS-Control=-72ml, p=NS), or the rates of maternal sepsis (NCS=0/22, Control=0/44, p=NS). There were no differences in the rates of neonatal admissions to special care baby unit (NCS=3/22(14%), Control=7/44(16%), p=NS) and no differences in the rates of neonatal respiratory morbidity. There were also no differences in mean APGAR Scores (Mean-Mean difference NCS-Control=0.181, p=NS) and mean Umbilical Arterial Cord pH (Mean-Mean difference NCS-Control=0.02, p=NS). Conclusions NCS is not associated with increased risk of adverse maternal or neonatal outcomes and appears to be as safe as traditional caesarean delivery. Larger studies are required to confirm these findings.