Monday, August 24, 2009

Cesarean Birth and SIDS

If you or someone you know is considering scheduling an elective c-section, you should know that:

"Studies have shown that infants born through elective cesarean section may be at greater risk for SIDS."

RT for Decision Makers in Respiratory Care: Cesarean Birth and SIDS

The above article cites several studies that have been done about cesarean section and SIDS, and there are some alarming findings. I'll list in a nutshell what I consider key information from the article:

What is an Elective Cesarean Section?

"A mother may undergo cesarean section electively or as the result of an emergency. In an elective cesarean section, no labor takes place. This option may be chosen for several reasons, such as to avoid the risk of labor-induced uterine rupture if a mother has undergone previous cesarean sections; as a personal lifestyle choice; or if mother has tocophobia (severe fear of labor). An emergency cesarean section, on the other hand, takes place after labor has begun. It is performed in cases of fetal distress; prolonged, unprogressive labor; breech birth; or if the mother’s life is in danger."

Why is there a higher risk of SIDS for babies born via elective c-section?

"Because of the suspected role of sleep apnea in SIDS, infants are considered at greater risk for SIDS if they have symptoms of (sleep) apnea. These respiratory alterations are more pronounced if the infant is delivered by an elective cesarean section" because of two main factors:
  • Gestational age at the time of birth. Elective cesarean sections are more likely to be done at 38 to 39 weeks gestation, whereas emergency cesareans are more often done at 40+ weeks gestation. The gestational age has an impact on the infant's respiratory health. Babies that are born before 40 weeks are more likely to have respiratory problems, which can cause sleep apnea, increasing the risk of SIDS.
  • Compression. In an elective cesarean there is no trial of labor, so the baby doesn't experience any contractions. In labor the contractions have been found to compress on the baby's body in such a way that it prepares the infant's lungs for breathing outside of the womb. Babies delivered by c-section with no labor contractions don't have this vital preparation. The article details a study done on baby rats in which they tested the impact of compression on respiratory health, and the findings are clear that compression is very important.
I'll share some of the facts from the rat study involving compression:
  • The group of rats that were given compression initially had 5 breaths/min and it increased to about 20 breaths/min during the hour in which this group of rats were observed.
  • One group of rats that were not given any compression (but had cooling) had a significantly reduced respiration rate immediately after birth (about 1–2 breaths/min) and had a smaller increase in the rate of respiration to about 3–4 breaths/min by 1 hour. The other group that had no compression (but had cord clamping) all died within an hour of observation.
  • In one group of rats that had no compression only 23% of the rats were breathing by 1 hour.
  • In the groups of rats that involved compression, 100% of the rats were breathing by 1 hour.
What can you do to lower these risks?
  • Avoid an elective cesarean section. Plan to birth your baby vaginally, if possible. If you do plan to have a c-section, you may want to consider doing a trial of labor by allowing your body to labor and experience contractions and give the baby important compression before the surgery is performed. According to the article, "even a short duration of labor seems to stabilize a neonate’s respiration after birth."
  • Schedule your cesarean section at 40 to 42 weeks gestation. This will give your baby more time for the lungs to develop properly before birth.
  • Send your infant to the NICU if your baby was delivered by elective cesarean. This would likely be a decision made by your care giver, but it could improve the baby's chances of survival because respiration patterns could be closely monitored and periods of apnea avoided through the efforts of NICU workers.
  • Use a home apnea monitor on the infant if your baby was delivered by elective cesarean. "Ideally, an apnea monitor could prevent an infant’s apnea from progressing to SIDS. The monitor sounds an alarm if it detects a prolonged episode of apnea, hypoxia, or bradycardia, at which point parents can arouse their infant or do cardiopulmonary resuscitation if necessary."
The article also states that more studies are needed on this subject, and I agree.


  1. I found this post because I was wondering if moms who have c-section may be more likely to bed-share due to post-surgical pain making it more difficult to lift an infant into and out of a crib in the night. The increased risk of bed-sharing would then make sleep-related deaths more likely to occur. The link didn't work, but I still found it interesting!

  2. I don't believe a mom who has had a cesarean is more likely to bedshare than a mom who had a vaginal birth. Regardless of the reason a mom chooses to bedshare, bedsharing does not increase the risk of SIDS if it's done correctly. Dr. Sears outlines guidelines for safe cosleeping and bedsharing. Babies die in cribs more than they do in a parent's bed.

    The risk of SIDS increases for babies born by cesarean because their lungs were not compressed through the process of labor and vaginal birth. There's a higher likelihood that there can be fluid in the lungs, which can lead to apnea or other complications after birth. There's also the factor of timing. Babies who are born as a result of spontaneous labor are "ripe" and ready for life on the outside. The lungs are mature and ready to breathe air, whereas a scheduled c-section or induction that ends in c-section is more likely to result in a baby that's not quite ready to breathe well.

    Back to bedsharing: When done correctly (parents don't smoke or drink, no extra pillows or blankets, baby sleeps on the side of the bed near the wall, etc.) a baby's chances of having apnea or other breathing issues are reduced. Being next to the mother helps regulate the baby's heartbeat and respiration, increasing its well-being and chances for survival. I think that's a stronger motivation for a c-section mom to bedshare than the discomfort of getting out of bed.