Aim: To determine the association between the mode of
delivery and selected neonatal and maternal morbidities and outcomes in NSW,
during 1998-2008. Methods: This study is a retrospective review of NSW Midwives
Data Collection (MDC) of 981,178 deliveries during 1998-2008. Maternal
condition and neonatal outcomes were compared for different modes of
delivery. Results: The annual rate of caesarean section has steadily
increased from 19% to 31.1% with a mean of 25.9% during the study period. The
risk of neonatal death was higher for forceps-assisted delivery compared to
vacuum-assisted delivery (adjusted odds ratio 0.85%, 95% CI 0.52 - 1.37),
caesarean section (adjusted odds ratio 1.14%, 95% CI 1.01 - 1.3) and normal
vaginal delivery. Operative vaginal delivery and caesarean section had
significantly increased risk for maternal mortality compared to normal
vaginal delivery. Conclusions: There is an association between maternal and
neonatal outcome and mode of delivery. Mothers and babies with normal vaginal
delivery achieved better outcomes in this community. Caesarean section and
operative vaginal delivery are associated with significant maternal and
neonatal risk. Breech vaginal delivery carries a significant neonatal risk.
More future prospective analyses, such as multicentre controlled studies,
should be designed to determine whether and how much the adverse pregnancy
outcomes were caused by unnecessary surgical and operative vaginal delivery.
Cite this paper
Shamsa, A. , Bai, J. , Raviraj, P. and Gyaneshwar, R. (2013) Mode of delivery and its associated maternal and neonatal outcomes. Open Journal of Obstetrics and Gynecology, 3, 307-312. doi: 10.4236/ojog.2013.33057.
 Villar, J., Carroli, G. and Zavaleta, N. (2007) Maternal and neonatal individual risks and benefits associated with caesarean delivery: Multicentre prospective study. BMJ, 335, 1025.
 Centre for Epidemiology and Research. NSW Department of Health (2010) New South Wales mothers and babies 2007. NSW Public Health Bulletin, 21.
 Centre for Epidemiology and Research. NSW Department of Health (2002) New South Wales mothers and babies 2002. NSW Public Health Bulletin, 14.
 National Institutes of Health (2006) State-of-the-Science Conference Statement on Caesarean Delivery on Maternal Request, 23, 27-29.
 Lumbiganon, P., Laopaiboon, M., Gülmezoglu, A.M., Souza, J.P., et al. (2010) Method of delivery and pregnancy outcomes in Asia: The WHO global survey on maternal and perinatal health 2007-08. The Lancet, 375, 490-500.
 Belfort, M. (2000) Operative vaginal delivery. ACOG Practice Bulletin, 17.
 Al-suhel, R., Gill, S., Robson, S. and Shadbolt, B. (2009) Kjelland’s forceps in the new millennium. Maternal and neonatal outcomes of attempted rotational forceps delivery. Australian and New Zealand Journal of Obstetrics and Gynaecology, 49, 510-514.
 Vacca, A. (2002) Vacuum-assisted delivery. Best Practice & Research Clinical Obstetrics & Gynaecology, 16, 17-30.
 Ebulue, V., Vadalkar, J., Cely, S., Dopwell, F. and Yoong, W. (2008) Fear of failure: Are we doing too many trials of instrumental delivery in theatre? Acta Obstetricia et Gynecologica Scandinavica, 87, 1234-1238.
 Al-Kadri, H., Sabr, Y., Al-Saif, S., Abulaimoun, B., Ba’Aqeel, H. and Saleh, A. (2003) Failed individual and sequential instrumental vaginal delivery: Contributing risk factors and maternal-neonatal complications. Acta Obstetricia et Gynecologica Scandinavica, 82, 642-628.
 Mola, G.D., Amoa, A.B. and Edilyong, J. (2002) Factor associated with success or failure in trials if vacuum extraction. Australian and New Zealand Journal of Obstetrics and Gynaecology, 42, 35-39.
 Yeomans, E.R. (2010) Operative vaginal delivery. Obstetrics & Gynecology, 115, 645-653.
 Centre for Epidemiology and Research. NSW Department of Health (2000) New South Wales mothers and babies 1998. NSW Public Health Bulletin, 1.
 Robson, M.S. (2001) Classification of caesarean sections. Fetal and Maternal Medicine Review, 12, 23-39.
 Fischer, A., LaCoursiere, D.Y., Barnard, P., Bloebaum, L. and Varner, M. (2005) Differences between hospitals in cesarean rates for term primigravidas with cephalic presentation. Obstetrics & Gynecology, 105, 816-821.
 Dulitzki, M., Soriano, D., Schiff, E., Chetrit, A., Mashiach, S. and Seidman, D.S. (1998) Effect of very advanced maternal age on pregnancy outcome and rate of cesarean delivery. Obstetrics & Gynecology, 92, 935-939.
 Bofill, J.A., Rust, O.A., Schorr, S.J., Brown, R.C., Martin, R.W., Martin Jr., J.N. and Morrison, J.C. (1996) A randomized prospective trial of the obstetric forceps versus the M-cup vacuum extractor. American Journal of Obstetrics & Gynecology, 175, 1325-1330.
 Clark, S.L., Belfort, M.A., Hankins, G.D., Meyers, J.A. and Houser, F.M. (2007) Variation in the rates of operative delivery in the United States. American Journal of Obstetrics & Gynecology, 196, e1-e5.
 Prapas, N., Kalogiannidis, I., Masoura, S., Diamanti, E., Makedos, A., Drossou, D. and Makedos, G. (2009) Operative vaginal delivery in singleton term pregnancies: Short-term maternal and neonatal outcomes. Hippokratia, 13, 41-45.
 Rossen, J., Okland, I., Nilsen, O.B. and Eggebo, T.M. (2010) Is there an increase of postpartum hemorrhage, and is severe hemorrhage associated with more frequent use of obstetric interventions? Acta Obstetricia et Gynecologica Scandinavica, 89, 1248-1255.
 Jacobsen, A.F., Drolsum, A., Klow, N.E., Dahl, G.F., Qvigstad, E. and Sandset, P.M. (2004) Deep vein thrombosis after elective cesarean section. Thrombosis Research, 113, 283-288.
 Allen, V.M., O’Connell, C.M. and Baskett, T.F. (2006) Maternal morbidity associated with cesarean delivery without labor compared with induction of labor at term. Obstetrics & Gynecology, 108, 286-294.
 van Dillen, J., Zwart, J.J., Schutte, J., Bloemenkamp, K.W. and van Roosmalen, J. (2010) Severe acute maternal morbidity and mode of delivery in the Netherlands. Acta Obstetricia et Gynecologica Scandinavica, 89, 1460-1465.
 Contag, S.A., Clifton, R.G., Bloom, S.L., et al. (2010) Neonatal outcomes and operative vaginal delivery versus cesarean delivery. American Journal of Perinatology, 27, 493-499.
 Hofmeyr, G.J. and Hannah, M. (2003) Planned caesarean section for term breech delivery. Cochrane Database of Systematic Reviews, 2, Article ID: CD000166.