Children born by assisted vaginal delivery (AVD) are more likely to develop psychopathological problems than those born by caesarean delivery on maternal request (CDMR) or spontaneous vaginal delivery (SVD) suggests new research published today in BJOG: An International Journal of Obstetrics and Gynaecology.
The study involved 4190 preschool children from southeast China and looked at the different modes of delivery and their relation to childhood psychopathology.
Caesarean section rates are increasing and in southeast China, the rates have risen from 22% in 1994 to 56% in 2006. CDMR is a major contributor to this trend accounting for 3.6% of all caesarean births in 1994 and 36% in 2006 in southeast China. However, little research has been undertaken into the effects of CDMR.
Of the 4190 children who took part, 100 (2.4%) were delivered by CDMR, 3563 (85%) by SVD and 527 (12.6%) by AVD (210 forceps and 317 vacuum extraction).
The study examines whether CDMR or AVD has any impact on childhood psychopathology compared to SVD.
Using the 1991 Child Behaviour Checklist (CBCL) to assess the selected children’s psychopathological problems, parents were asked to complete the list which looks at emotional and behavioural problems.
The study shows that CBCL problem scores were lowest in children born by CDMR and highest in those born by AVD.
The association between mode of delivery and subsequent childhood psychopathology is possibly related to cortisol response. Immediately after birth, cord blood cortisol levels have been found to be lowest in babies born by elective caesarean followed by SVD whereas the highest levels were found in AVD. Previous studies have suggested that children born by AVD experienced the highest levels of stress during birth.
Professor Jianmeng Liu, Deputy Director of the Institute of Reproductive and Child Health, Peking University Health Science Centre, Beijing, one of the authors on the paper said:
“This is the first time research has looked at the effect of caesarean delivery on maternal request on childhood psychopathology. The caesarean section rate is increasing and this study was a large population based study.
“Cortisol levels have been linked to childhood psychopathology, however, more studies are still needed to look at this in more detail.”
Professor Philip Steer, BJOG editor-in-chief said:
“With the rising rates of elective caesarean section in China and in other countries, it is interesting to see from this research that there is a low impact on childhood psychopathology. Assisted vaginal delivery can be more traumatic for both the mother and child hence the rise in cortisol levels. More research is needed however to look at the specific link between assisted delivery such as forceps and psychopathology in children.”
Ends
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Notes
BJOG: An International Journal of Obstetrics and Gynaecology is owned by the Royal College of Obstetricians and Gynaecologists (RCOG) but is editorially independent and published monthly by Wiley-Blackwell. The journal features original, peer-reviewed, high-quality medical research in all areas of obstetrics and gynaecology worldwide. Please quote ‘BJOG' or ‘BJOG: An International Journal of Obstetrics and Gynaecology' when referring to the journal and include the website: www.bjog.org as a hidden link online.
Reference
Li H-T, Ye R, Achenbach T, Ren A, Pei L, Zheng X, Liu J-M. Caesarean delivery on maternal request and childhood psychopathology: a retrospective cohort study in China. BJOG 2010; DOI: 10.1111/j.1471-0528.2010.02762.x.
