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I think we might add reduced rates of breastfeeding (awaiting confirmation in large pragmatic RCTs). Existing observation studies suggest that CS reduces breastfeeding rates, but further large trials are needed. [The term breech trial data indicate a negative impact.] Best wishes, Sue McFadden A, Renfrew MJ, Dykes F, Burt S. <http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=16999765&ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum> Assessing learning needs for breastfeeding: setting the scene. Matern Child Nutr. 2006 Oct;2(4):196-203 Rowe-Murray H., Fisher J. 2002 Baby Friendly Hospital Practices: Cesarean Section is a persistent barrier to early initiation of breastfeeding. Birth;29: 124-31 Sorkio S, Cuthbertson D, Bärlund S, Reunanen A, Nucci AM, Berseth CL, Koski K, Ormisson A, Savilahti E, Uusitalo U, Ludvigsson J, Becker DJ, Dupré J, Krischer JP, Knip M, Akerblom HK, Virtanen SM; TRIGR Study Group Breastfeeding patterns of mothers with type 1 diabetes: results from an infant feeding trial. Diabetes Metab Res Rev. 2010 Mar;26(3):206-11 Wiklund I, Norman M, Uvnäs-Moberg K, Ransjö-Arvidson AB, Andolf E. <http://www.ncbi.nlm.nih.gov/pubmed/17980469?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum> Epidural analgesia: Breast-feeding success and related factors. Midwifery. 2009 Apr;25(2):e31-8. Epub 2007 Nov 5.PMID: 17980469 [PubMed - indexed for MEDLINE] doi:10.1016/j.midw.2007.07.005 <http://dx.doi.org/10.1016/j.midw.2007.07.005> Jordan, S., Emery, S., Watkins, A., Evans, J., Storey, M., Morgan, G. (2009) Associations of drugs routinely given in labour with breastfeeding at 48 hours: analysis of the Cardiff Births Survey. BJOG 2009; 116(12) 1622-30 Jordan S., Emery S., Bradshaw C., Watkins A., Friswell W. 2005 The Impact of Intrapartum Analgesia on Infant Feeding. BJOG: An International Journal of Obstetrics and Gynecology. 112, 927-34 Sue Jordan Sue Jordan Darllenydd Reader Coleg y Gwyddorau Dynol a Iechyd College of Human and Health Sciences Prifysgol Abertawe Swansea University Abertawe SA2 8PP Swansea SA2 8PP 01792 518541 01792 518541 From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] On Behalf Of Soo Downe Sent: 30 October 2011 22:59 To: [log in to unmask] Subject: Re: c-section for all women who request it by NICE? And here is another one: Arch Dis Child doi:10.1136/archdischild-2011-300607 · Original articles Hospitalisation for bronchiolitis in infants is more common after elective caesarean delivery 1. Hannah C Moore <http://adc.bmj.com/search?author1=Hannah+C+Moore&sortspec=date&submit=Submit> 1 <http://adc.bmj.com/content/early/2011/10/28/archdischild-2011-300607.abstract?papetoc#aff-1> , 2. Nicholas de Klerk <http://adc.bmj.com/search?author1=Nicholas+de+Klerk&sortspec=date&submit=Submit> 1 <http://adc.bmj.com/content/early/2011/10/28/archdischild-2011-300607.abstract?papetoc#aff-1> , 3. Patrick Holt <http://adc.bmj.com/search?author1=Patrick+Holt&sortspec=date&submit=Submit> 1 <http://adc.bmj.com/content/early/2011/10/28/archdischild-2011-300607.abstract?papetoc#aff-1> , 4. Peter C Richmond <http://adc.bmj.com/search?author1=Peter+C+Richmond&sortspec=date&submit=Submit> 2 <http://adc.bmj.com/content/early/2011/10/28/archdischild-2011-300607.abstract?papetoc#aff-2> ,3 <http://adc.bmj.com/content/early/2011/10/28/archdischild-2011-300607.abstract?papetoc#aff-3> , 5. Deborah Lehmann <http://adc.bmj.com/search?author1=Deborah+Lehmann&sortspec=date&submit=Submit> 1 <http://adc.bmj.com/content/early/2011/10/28/archdischild-2011-300607.abstract?papetoc#aff-1> + <http://adc.bmj.com/content/early/2011/10/28/archdischild-2011-300607.abstract?papetoc> Author Affiliations 1. 1Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, Australia 2. 2School of Paediatrics and Child Health, University of Western Australia, Perth, Australia 3. 3Princess Margaret Hospital for Children, Perth, Australia 1. Correspondence toHannah C Moore, Telethon Institute for Child Health Research, University of Western Australia, PO Box 855, West Perth, WA 6872, Australia; [log in to unmask] <mailto:[log in to unmask]> · Received 2 July 2011 · Accepted 4 October 2011 · Published Online First 28 October 2011 Abstract Background The authors previously reported an increased risk of hospitalisation for acute lower respiratory infection up to age 2 years in children delivered by elective caesarean section. In view of increasing rates of elective caesarean delivery, this association warranted further investigation. Objective To examine associations between the number of hospital admissions for bronchiolitis and pneumonia and elective caesarean delivery. Design Retrospective population-based data linkage cohort study of 212 068 non-Aboriginal singleton births of 37-42 weeks gestation. Methods Negative binomial regression was used to examine associations between mode of delivery and hospitalisations for both bronchiolitis and pneumonia in children aged <12 months and 12-23 months. Models were adjusted for obstetric and known risk factors. Results 16% of children were delivered by elective caesarean section (n=33 421). In adjusted analysis, compared with spontaneous vaginal delivery, these children had increased risk of admissions for bronchiolitis at age <12 months (incidence rate ratio (IRR) 1.11; 95% CI 1.01 to 1.23) and 12-23 months (IRR 1.20; 95% CI 0.94 to 1.53) independent of other fetal and maternal factors. There was no association between elective caesarean delivery and number of pneumonia admissions aged <12 months (IRR 1.03; 95% CI 0.80 to 1.33) and 12-23 months (IRR 1.09; 95% CI 0.88 to 1.34). Conclusion Delivery by elective caesarean was independently associated with infant admissions for bronchiolitis but not pneumonia. Elective caesareans or delivery without labour may result in impaired immunity in the newborn leading to increased risk of early viral lower respiratory infections. ________________________________ From: A forum for discussion on midwifery and reproductive health research. [[log in to unmask]] on behalf of Soo Downe [[log in to unmask]] Sent: Sunday, October 30, 2011 10:50 PM To: [log in to unmask] Subject: Re: c-section for all women who request it by NICE? Just in case you cant download the information I have just sent: Increased with CS * Abdominal pain * Bladder injury * Ureteric injury * Need for further surgery * Hysterectomy * Intensive therapy/high dependency unit admission * Thromboembolic disease * Length of hospital stay * Readmission to hospital * Maternal death * Antepartum stillbirth in future pregnancies * Placenta praevia * Uterine rupture * Not having more children * Neonatal respiratory morbidity No difference after CS * Haemorrhage * Infection * Genital tract injury * Faecal incontinence * Back pain * Dyspareunia * Postnatal depression * Neonatal mortality (except breech) * Intracranial haemorrhage * Brachial plexus Reduced with CS * Perineal pain * Urinary incontinence * Uterovaginal prolapse All the best Soo ________________________________ From: A forum for discussion on midwifery and reproductive health research. [[log in to unmask]] on behalf of Soo Downe [[log in to unmask]] Sent: Sunday, October 30, 2011 10:40 PM To: [log in to unmask] Subject: Re: c-section for all women who request it by NICE? Hmm - CS is now safe? Maybe it depends on what outcomes you look at: These are the risks cited in the current NICE CS guidelines: NICE 2004 Cesarean section: Quick reference guide. Available at: http://www.nice.org.uk/nicemedia/live/10940/29333/29333.pdfdopwnloaded on 6th Oct 2011 <http://www.nice.org.uk/nicemedia/live/10940/29333/29333.pdfdopwnloaded%20on%206th%20Oct%202011> Longer term, CS has also been linked to type one diabetes in the neonate, athsma, excema, and, most recently, multiple sclerosis: Mult Scler. <http://www.ncbi.nlm.nih.gov/pubmed/21982872> 2011 Oct 7. [Epub ahead of print] Cesarean delivery may increase the risk of multiple sclerosis. Maghzi AH <http://www.ncbi.nlm.nih.gov/pubmed?term=%22Maghzi%20AH%22%5BAuthor%5D> , Etemadifar M <http://www.ncbi.nlm.nih.gov/pubmed?term=%22Etemadifar%20M%22%5BAuthor%5D> , Heshmat-Ghahdarijani K <http://www.ncbi.nlm.nih.gov/pubmed?term=%22Heshmat-Ghahdarijani%20K%22%5BAuthor%5D> , Nonahal S <http://www.ncbi.nlm.nih.gov/pubmed?term=%22Nonahal%20S%22%5BAuthor%5D> , Minagar A <http://www.ncbi.nlm.nih.gov/pubmed?term=%22Minagar%20A%22%5BAuthor%5D> , Moradi V <http://www.ncbi.nlm.nih.gov/pubmed?term=%22Moradi%20V%22%5BAuthor%5D> . Source IRCOMS, Iran/Neuroimmunology Unit, Centre for Neuroscience & Trauma, Blizard Inst. of Cell &Molecular Sci.,UK/Med. Schl, Isfahan Uni. of Med.Sci, Iran. Abstract Background: Prenatal and perinatal factors are believed to contribute to the risk of developing multiple sclerosis (MS). Objective: This study was designed to evaluate whether mode of delivery (vaginal versus cesarean section), as a perinatal factor, affects susceptibility to MS. Methods: MS patients were recruited from the MS registry of Isfahan Multiple Sclerosis Society (IMSS) and were compared with their healthy siblings. Data regarding mode of delivery, birth order, and gestation week of birth were obtained through a specially designed questionnaire. Preterm or post term deliveries were excluded. We used conditional logistic regression statistics and adjusted for gender and birth order. Results: This study included 1349 participants (449 MS patients and 900 controls). Subjects who were born by cesarean sectionhad significant risk of MS (odds ratio, OR = 2.51; 95% confidence interval, CI: 1.43-4.41; p = 0.001). There was significant MS risk for females who were born by cesarean section (OR = 2.69, 95% CI: 1.30-5.58; p = 0.008), but not for males (OR = 2.25, 95% CI: 0.90-5.63; p = 0.082). The mean age at onset was lower in MS patients born by cesarean section (24.58 ± 6.33) compared with that of patients born by vaginal delivery (27.59 ± 7.97; p = 0.041). There was no significant difference between the two groups for birth order (p = 0.417). Conclusion: Our results suggest that those born by vaginal delivery are at a lower risk of subsequent MS. These preliminary findings will need to be addressed in a much larger and preferably prospective study. PMID: 21982872 [PubMed - as supplied by publisher] ________________________________ From: A forum for discussion on midwifery and reproductive health research. [[log in to unmask]] on behalf of Pamela Harnden [[log in to unmask]] Sent: Sunday, October 30, 2011 10:25 PM To: [log in to unmask] Subject: Re: c-section for all women who request it by NICE? Dear Lucia, The impression in Australia is that it is true and that the risks are so small now because the obstetricians are so expert at it, the suggestion is that it is actually safer than birthing normally! Pam On Mon, Oct 31, 2011 at 9:18 AM, LUCIA ROCCA <[log in to unmask]> wrote: Dear All, I am sure this must be misinformation but I am a bit worried about the news from Sky news: http://news.sky.com/home/uk-news/article/16099301 about NICE publishing a new report saying that women must have the right to ask, at NHS expenses, a CS without medical indication. could please somebody reassure me ( while I am on holiday...) that I got it wrong? Thanks Lucia -- Lucia Rocca-Ihenacho Senior Midwife and Research Fellow Barts and the London NHS Trust 07989 230313 -- Pam Harnden Honorary Research Fellow & Research Assistant Melbourne University Health E Learning Consultancy Web: http://midwifepam.wikispaces.com <http://midwifepam.wikispaces.com/> Phone: +61 431 259 755 Skype: pamela.harnden Twitter: SmilingPamela