Authors
1 Department of Obstetrics and Gynecology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Department of Epidemiology, Faculty of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3 Faculty of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Abstract
Objectives: This study aimed to compare maternal and neonatal side effects of natural vaginal delivery (NVD) under neuro-axial analgesia with usual NVD and C-section.
Methods: In this single center prospective cohort study, deliveries carried out in a 7 months’ period were evaluated after getting informed consent. The study is approved by the ethics committee of Shahid Beheshti University of Medical Sciences. Mothers were categorized into 3 groups of C-section, NVD with an analgesia, intervention, and usual NVD. Afterwards, maternal and neonatal side effects after delivery were assessed using physical examinations, laboratory results, and interviews.
Results: Overall, 121 mothers were equally assigned to 3 groups. No significant differences were found in the first and fifth-minute APGAR scores of the neonates born in these 3 groups. Moreover, none of the neonates’ fifth-minute APGAR scores were less than 7. In addition, hypoxia (umbilical artery pH < 7.2) was observed more in the neonates delivered by NVDs with analgesia interventions compared to the other 2 groups. In comparison with the mothers in the other 2 groups, headache and pruritus were more prevalent among the mothers who had NVDs under neuro-axial analgesia.
Conclusions: Given the advantages of natural vaginal deliveries for mothers and their fetuses and considering the side effects of C-sections without medical indications, propagating painless NVDs could be a proper solution for increasing the prevalence rate of NVDs in the society. Conducting further studies on larger samples is recommended.
Keywords
- American College of Obstetricians and Gynecologists . Pain relief during labor and delivery. ACOG Education Pamphlet AP0862004.
- Avery GB, MacDonald MG, Seshia MMK, Mullett MD. Avery's Neonatology: Pathophysiology and Management of the Newborn. Philadelphia: Lippincott Williams & Wilkins; 2005.
- Khani S, Shaaban KB. Can the cesarean rate be reduced in Mazandaran? [In Persian]. J Mazandaran Univ Med Sci. 2005;14(45):43-51.
- Garmaroudi G, Eftekhar H, Batebi AA. Cesarean section and related factors in Tehran, Iran [In Pesian]. Payesh. 2002;1(2):45-9.
- Cunnig F, Macdonald P, Leveno K, Gant N, Gilstrap L. Williams's obstetrics. New York: McGraw-Hill; 2005. Cesarean section and cesarean hysterectomy.
- Esmailpour N, Asgharnia M. Early neonatal injuries in normal vaginal and cesarean deliveries [In Persian]. J Guilan Univ Med Sci. 2005;14(54):76-84.
- Levine EM, Ghai V, Barton JJ, Strom CM. Mode of delivery and risk of respiratory diseases in newborns. Obstet Gynecol. 2001;97(3):439-42. https://doi.org/10.1016/S0029-7844(00)01150-9 [DOI:10.1097/00006250-200103000-00023]
- MacDorman MF, Declercq E, Menacker F, Malloy MH. Neonatal mortality for primary cesarean and vaginal births to low-risk women: application of an "intention-to-treat" model. Birth. 2008;35(1):3-8. [DOI:10.1111/j.1523-536X.2007.00205.x] [PMID]
- Anim-Somuah M, Smyth R, Howell C. Epidural versus non-epidural or no analgesia in labour. Cochrane Database Syst Rev. 2005(4):CD000331. [DOI:10.1002/14651858.CD000331.pub2] [PMID]
- Malone FD, Geary M, Chelmow D, Stronge J, Boylan P, D'Alton ME. Prolonged labor in nulliparas: lessons from the active management of labor. Obstet Gynecol. 1996;88(2):211-5. [DOI:10.1016/0029-7844(96)00185-8]
- Kumar M, Chandra S, Ijaz Z, Senthilselvan A. Epidural analgesia in labour and neonatal respiratory distress: a case-control study. Arch Dis Child Fetal Neonatal Ed. 2014;99(2):F116-9. [DOI:10.1136/archdischild-2013-304933] [PMID]
- Shahshahan Z, Faraji ZN, Ghasemi M. The evaluation of frequency of hypotention in normal vaginal delivery with epidural anesthesia in Beheshti and Jorjani hospitals of Isfahan 2003 [In Persian]. Iran J Obstet Gyneocol Infertil. 2008;11(2):49-53.
- Rafiei MR, Behnamfar F, Abdekhoda M, Mosavi GA. Evaluation of the effect of epidural anesthesia with marcaine and fentanyl on labor course and neonatal apgar scores [In Persian]. Koomesh. 2006;7(1):35-40.
- Dozier AM, Howard CR, Brownell EA, Wissler RN, Glantz JC, Ternullo SR, et al. Labor epidural anesthesia, obstetric factors and breastfeeding cessation. Matern Child Health J. 2013;17(4):689-98. [DOI:10.1007/s10995-012-1045-4] [PMID]
)
