Wednesday, January 21, 2009

Long-term benefits outweigh risks, says Malaysian doctor

You may have read my criticism of recent reports on the increased risk of asthma in children born by cesarean delivery, and how research in this area is still incomplete and inconsistent. Now the president of the Obstetrical and Gynaecological Society of Malaysia, Dr A. Baskaran, has criticized a media report by Datuk Dr Rajen M, titled 'C-Section babies risk becoming asthmatic'.

He says: "The article gives the impression that Caesarean section is detrimental to the health of the baby and should not be resorted to at all. Our greatest concern is that mothers may refuse to give consent when a Caesarean section is indicated in times of emergency after reading the article."

He continues: "In any operative delivery or, for that matter, in any operation, the benefits from the operation must be weighed against the short-term and long-term risks of the operation. Perhaps, one of the long-term risks to a baby born by Caesarean section may very well be a higher incidence of asthma but this must be balanced against the immediate and long-term risks to the baby when there is delay or no intervention by Caesarean section.

We do not want a baby to be forever mentally handicapped for fear of a higher risk of asthma.

The study quoted in the report, from the Dec 3 issue of the medical journal Thorax, showed that Dutch children born by Caesarean section were 80 per cent more likely to develop asthma by the time they are 8 years old. This study, together with another Norwegian study published in June last year in the Journal of Pediatrics, has shown an increased risk.

However, previous studies have shown conflicting evidence. More prospective, multi-central studies from many different countries need to be done before this risk is accepted into evidence-based practice. More importantly, other aspects such as failure to breast-feed a baby after a Caesarean section need to be considered.

Nevertheless, the increase in Caesarean section rates in the past couple of decades cannot be denied. It has always been an important and heavily debated topic of discussion in practically every obstetrics conference all over the world. The reason for this is complex and every attempt has been made by the fraternity to reduce this rate. But its judicious use has saved many a mother and baby."

My thoughts
I agree with a great deal of what Dr Baskaran says, but it would be interesting to learn more about his views on planned cesarean delivery with no medical indication. He does mention above that "every attempt has been made by the fraternity to reduce this [cesarean] rate" and it concerns me that women making legitimate decisions to choose one set of birth risks and benefits over another may be not be supported in Malaysia. I only hope that this is not the case.

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