Risks involved in cesarean section and vaginal birth

The rate of cesarean section now exceeds 20% and continues to increase. This effect is enhanced by the almost negligible surgery-dependent risks. Maternal mortality in Central Europe has evidenced a sharp decline to approximately 10-20 deaths per 100,000 live births. Cesarean mortality due solely to surgical and/or anesthesiological intervention has also decreased considerably in the past 20 years. Nevertheless, vaginal birth entails a lower risk per se for the mother. Thus, the letality rate for vaginal birth is lower by a factor of 5-10 excluding pregnancy-dependent risks. Primary cesarean section exhibits a 1.7-fold lower risk of letality in comparison to secondary cesarean section. The main ca uses of death continue to be hemorrhages and thromboembolism. The mortality rate due to cesarean section continues to remain higher than that for vaginal birth. The rate of severe blood loss is significantly higher. The risk of deep Vein thrombosis is about ten times greater than for vaginal birth with concomitantly increased risk for a pulmonary embolism as well as post-thrombotic syndrome. Perioperative prophylactic treatment with antibiotics was able to reduce the morbidity rate due to infection by more than 50%, but endometritis and wound infection continues to occur 10-15 times more frequently than during vaginal birth. In summary, maternal risk during pregnancy and birth - be it vaginal or cesarean - has been further reduced considerably. Nevertheless, cesarean section constitutes a surgical intervention entailing significantly higher rates of morbidity and mortality in comparison to vaginal birth.