Editing Caesarean section (section)

===Child===
Non-medically indicated (elective) childbirth before 39 weeks gestation "carry significant risks for the baby with no known benefit to the mother." Newborn mortality at 37 weeks may be up to 3 times the number at 40 weeks and is elevated compared to 38 weeks gestation. These early-term births were associated with more death during infancy, compared to those occurring at 39 to 41 weeks (full-term).<ref name="urlwww.patientsafetycouncil.org">{{cite web |url=http://www.patientsafetycouncil.org/uploads/MOD_39_Weeks_Toolkit.pdf |title=Elimination of Non-medically Indicated (Elective) Deliveries Before 39 Weeks Gestational Age |access-date=13 July 2012 |url-status=dead |archive-url=https://web.archive.org/web/20121120003529/http://www.patientsafetycouncil.org/uploads/MOD_39_Weeks_Toolkit.pdf |archive-date=20 November 2012  }}</ref> Researchers in one study and another review found many benefits to going full term, but no adverse effects in the health of the mothers or babies.<ref name="urlwww.patientsafetycouncil.org"/><ref name="urlTerm Pregnancy: A Period of Heterogeneous Risk for Infant Mortality">{{cite journal | vauthors = Reddy UM, Bettegowda VR, Dias T, Yamada-Kushnir T, Ko CW, Willinger M | title = Term pregnancy: a period of heterogeneous risk for infant mortality | journal = Obstetrics and Gynecology | volume = 117 | issue = 6 | pages = 1279–1287 | date = June 2011 | pmid = 21606738 | pmc = 5485902 | doi = 10.1097/AOG.0b013e3182179e28 }}</ref>

The [[American Congress of Obstetricians and Gynecologists]] and medical policymakers review research studies and find more incidence of suspected or proven [[sepsis]], RDS, hypoglycemia, need for respiratory support, need for NICU admission, and need for hospitalization > 4–5 days. In the case of caesarean sections, rates of respiratory death were 14 times higher in pre-labor at 37 compared with 40 weeks gestation, and 8.2 times higher for pre-labor caesarean at 38 weeks. In this review, no studies found decreased neonatal morbidity due to non-medically indicated (elective) delivery before 39 weeks.<ref name="urlwww.patientsafetycouncil.org"/>

For otherwise healthy [[twin]] pregnancies where both twins are head down a trial of [[vaginal delivery]] is recommended at between 37 and 38 weeks.<ref name="NICE2011">{{cite report | title = Caesarean Section: NICE Clinical Guidelines, No. 132 | year = 2011 | pmid = 23285498 | url = https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0050826/ | url-status = live | publisher = National Institute of Health and Clinical Excellence | series = National Institute for Health and Clinical Excellence: Guidance | archive-url = https://web.archive.org/web/20160102022125/http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0050826/ | archive-date = 2 January 2016 }}</ref><ref name=Bis2013/> Vaginal delivery, in this case, does not worsen the outcome for either infant as compared with caesarean section.<ref name=Bis2013>{{cite journal | vauthors = Biswas A, Su LL, Mattar C | title = Caesarean section for preterm birth and, breech presentation and twin pregnancies | journal = Best Practice & Research. Clinical Obstetrics & Gynaecology | volume = 27 | issue = 2 | pages = 209–219 | date = April 2013 | pmid = 23062593 | doi = 10.1016/j.bpobgyn.2012.09.002 }}</ref> There is some controversy on the best method of delivery where the first twin is head first and the second is not, but most obstetricians will recommend normal delivery unless there are other reasons to avoid vaginal birth.<ref name=Bis2013/> When the first twin is not head down, a caesarean section is often recommended.<ref name=Bis2013/> Regardless of whether the twins are delivered by section or vaginally, the medical literature recommends delivery of dichorionic twins at 38 weeks, and monochorionic twins (identical twins sharing a placenta) by 37 weeks due to the increased risk of stillbirth in monochorionic twins who remain in utero after 37 weeks.<ref>{{cite journal | vauthors = Lee YM | title = Delivery of twins | journal = Seminars in Perinatology | volume = 36 | issue = 3 | pages = 195–200 | date = June 2012 | pmid = 22713501 | doi = 10.1053/j.semperi.2012.02.004 }}</ref><ref>{{cite journal | vauthors = Hack KE, Derks JB, Elias SG, Franx A, Roos EJ, Voerman SK, Bode CL, Koopman-Esseboom C, Visser GH | title = Increased perinatal mortality and morbidity in monochorionic versus dichorionic twin pregnancies: clinical implications of a large Dutch cohort study | journal = BJOG | volume = 115 | issue = 1 | pages = 58–67 | date = January 2008 | pmid = 17999692 | doi = 10.1111/j.1471-0528.2007.01556.x | s2cid = 20983040 | doi-access =  }}</ref> The consensus is that [[Late preterm infant|late preterm delivery]] of monochorionic twins is justified because the risk of stillbirth for post-37-week delivery is significantly higher than the risks posed by delivering monochorionic twins near term (i.e., 36–37 weeks).<ref>{{cite journal | vauthors = Danon D, Sekar R, Hack KE, Fisk NM | title = Increased stillbirth in uncomplicated monochorionic twin pregnancies: a systematic review and meta-analysis | journal = Obstetrics and Gynecology | volume = 121 | issue = 6 | pages = 1318–1326 | date = June 2013 | pmid = 23812469 | doi = 10.1097/AOG.0b013e318292766b | s2cid = 5152813 }}</ref>
The consensus concerning monoamniotic twins (identical twins sharing an amniotic sac), the highest risk type of twins, is that they should be delivered by caesarean section at or shortly after 32 weeks since the risks of intrauterine death of one or both twins are higher after this gestation than the risk of complications of prematurity.<ref>{{cite journal | vauthors = Pasquini L, Wimalasundera RC, Fichera A, Barigye O, Chappell L, Fisk NM | title = High perinatal survival in monoamniotic twins managed by prophylactic sulindac, intensive ultrasound surveillance, and Cesarean delivery at 32 weeks' gestation | journal = Ultrasound in Obstetrics & Gynecology | volume = 28 | issue = 5 | pages = 681–687 | date = October 2006 | pmid = 17001748 | doi = 10.1002/uog.3811 | s2cid = 26098748 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Murata M, Ishii K, Kamitomo M, Murakoshi T, Takahashi Y, Sekino M, Kiyoshi K, Sago H, Yamamoto R, Kawaguchi H, Mitsuda N | title = Perinatal outcome and clinical features of monochorionic monoamniotic twin gestation | journal = The Journal of Obstetrics and Gynaecology Research | volume = 39 | issue = 5 | pages = 922–925 | date = May 2013 | pmid = 23510453 | doi = 10.1111/jog.12014 | s2cid = 40347063 }}</ref><ref>{{cite journal | vauthors = Baxi LV, Walsh CA | title = Monoamniotic twins in contemporary practice: a single-center study of perinatal outcomes | journal = The Journal of Maternal-Fetal & Neonatal Medicine | volume = 23 | issue = 6 | pages = 506–510 | date = June 2010 | pmid = 19718582 | doi = 10.3109/14767050903214590 | s2cid = 37447326 }}</ref>

In a research study widely publicized, singleton children born earlier than 39 weeks may have developmental problems, including slower learning in reading and math.<ref name="urlAcademic Achievement Varies With Gestational Age Among Children Born at Term">{{cite journal |url=http://pediatrics.aappublications.org/content/early/2012/06/27/peds.2011-2157d.abstract?sid=b95d99e5-556e-45d3-8326-e77459528363 |title=Academic Achievement Varies With Gestational Age Among Children Born at Term |journal=Pediatrics |date=June 2012 |access-date=12 July 2012 |url-status=live |archive-url=https://web.archive.org/web/20150904045302/http://pediatrics.aappublications.org/content/early/2012/06/27/peds.2011-2157d.abstract?sid=b95d99e5-556e-45d3-8326-e77459528363 |archive-date=4 September 2015  }}</ref>

Other risks include:
* [[Wet lung]] (Transient Tachypnea of the Newborn): Failure to pass through the birth canal does not expose the baby to cortisol and epinephrine which typically would reverse the potassium/sodium pumps in the baby's lung. This causes fluid to remain in the lung.<ref>{{cite book | vauthors = Jha K, Nassar GN, Makker K | chapter = Transient Tachypnea of the Newborn |date=2022 | chapter-url= http://www.ncbi.nlm.nih.gov/books/NBK537354/ | title =StatPearls |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=30726039 |access-date=2022-06-22 }}</ref>
* Potential for early delivery and complications: Preterm delivery may be inadvertently carried out if the due date calculation is inaccurate. One study found an increased complication risk if a repeat elective caesarean section is performed even a few days before the recommended 39 weeks.<ref>{{cite web | url = https://www.npr.org/templates/story/story.php?storyId=99132594 | title = Study: Early Repeat C-Sections Puts Babies At Risk | archive-url = https://web.archive.org/web/20160131115102/http://www.npr.org/templates/story/story.php?storyId=99132594 | archive-date = 31 January 2016 | work = NPR.org | date = 8 January 2009 | access-date = 26 July 2011 }}</ref>
* Higher infant mortality risk: In caesarean sections performed with no indicated medical risk (singleton at full term in a head-down position with no other obstetric or medical complications), the risk of death in the first 28 days of life has been cited as 1.77 per 1,000 live births among women who had caesarean sections, compared to 0.62 per 1,000 for women who delivered vaginally.<ref>{{cite web |url=http://www.medicineonline.com/news/12/6008/High-infant-mortality-seen-with-elective-c-section.html |title=High infant mortality rate seen with elective c-section |work=Reuters Health—September 2006 |publisher=Medicineonline.com |date=14 September 2006 |access-date=26 July 2011 |url-status=dead |archive-url=https://web.archive.org/web/20110718123744/http://www.medicineonline.com/news/12/6008/High-infant-mortality-seen-with-elective-c-section.html |archive-date=18 July 2011  }}</ref>

Birth by caesarean section also seems to be associated with worse health outcomes later in life, including overweight or obesity, problems in the immune system, and poor digestive system.<ref>{{cite journal | vauthors = Mueller NT, Zhang M, Hoyo C, Østbye T, Benjamin-Neelon SE | title = Does cesarean delivery impact infant weight gain and adiposity over the first year of life? | journal = International Journal of Obesity | volume = 43 | issue = 8 | pages = 1549–1555 | date = August 2019 | pmid = 30349009 | pmc = 6476694 | doi = 10.1038/s41366-018-0239-2 }}</ref><ref>C. Yuan et al. (2016), "Association Between Cesarean Birth and Risk of Obesity in Offspring in Childhood, Adolescence, and Early Adulthood", ''[[JAMA Pediatrics]]''.</ref> However, caesarean deliveries are found to not affect a newborn's risk of developing food allergies.<ref>{{cite journal | vauthors = Currell A, Koplin JJ, Lowe AJ, Perrett KP, Ponsonby AL, Tang ML, Dharmage SC, Peters RL | title = Mode of Birth Is Not Associated With Food Allergy Risk in Infants | language = English | journal = The Journal of Allergy and Clinical Immunology. In Practice | volume = 10 | issue = 8 | pages = 2135–2143.e3 | date = August 2022 | pmid = 35597762 | doi = 10.1016/j.jaip.2022.03.031 | s2cid = 248903112 }}</ref> This finding contradicts a previous study that claims babies born via caesarean section have lower levels of ''[[Bacteroides]]'' that is linked to peanut allergy in infants.<ref>{{Cite web |date=2021-04-30 |title=Why C-Section Babies May Be at Higher Risk for a Food Allergy |url=https://consumer.healthday.com/4-29-why-c-section-babies-may-be-at-higher-risk-for-a-food-allergy-2652675840.html |access-date=2022-05-25 |website=Consumer Health News {{!}} HealthDay |language=en}}</ref>