Keeping it Simple - Caesarean section or vaginal birth?

Which is best for a baby with trisomy 18?

This is the Keeping it Simple summary - read the detailed version here.

This question comes up all the time on trisomy groups. It came up for us. Our initial plans were to have a caesarean section, but we eventually decided to opt for vaginal birth after a lot of discussion with different professionals and taking all our circumstances into account. What I would say is that there is no clear-cut answer as to which is the best option for a baby with trisomy 18.

However, there are things that should be taken into consideration:

• Labour and birth is a highly risky time for babies with T18. Depending on which study you read, around 40% of babies die during labour without monitoring and interventions.
• Consider your goals and your post birth treatment choices.These will impact on your decisions regarding mode of delivery.
• Even if you opt for a vaginal birth, due to the high rate of fetal distress in babies with trisomy 18, there is a good chance you will have an emergency caesarean section anyway.  

If your primary aim is for a live birth, DO NOT commit to a vaginal birth without appropriate monitoring and guarantees of intervention in the event of fetal distress. If you have doubt in your healthcare provider's ability or willingness to offer this, it may be safer for your baby to opt for elective caesarean section.

Planned caesarean section

Disadvantages

• A caesarean section may carry a higher risk of serious maternal morbidity (eg. a higher risk of significant haemorrhage and cardiac arrest), but the risks are still very low.
• A caesarean section may carry a slightly higher risk of breathing difficulties for the baby. This is unclear, but would be particularly significant for babies with trisomy 18, who have a higher incidence of breathing issues after birth.
• A caesarean section may make you less mobile and able to spend time with your baby; this may be particularly important if your time together is likely to be short.

Advantages

• If you have had more than one previous caesarean section, or have some specific medical or pregnancy issues, a caesarean section may reduce the risks to you.
• Some women may have pre-existing negative feelings towards vaginal birth, or have experienced trauma in a previous birth, and may therefore prefer caesarean sections.
• If your baby is in a less common position (eg. breech: bottom- or feet-first), or is one of multiples, then it may be safest for your baby to have a planned caesarean section.
• There is a good chance with a baby with trisomy 18 that you will end up with a caesarean section anyway. A planned caesarean means that you don't have the increased risk of an emergency section.

Vaginal Birth

Disadvantages

• Vaginal births carry a slightly higher risk of perineal pain three days after birth, and of vaginal damage.
• Vaginal births, if not appropriately monitored, or if intervention is delayed, may carry a higher risk of your baby becoming compromised or even dying in labour.
• A vaginal birth may be more risky if you have particular medical or pregnancy complications.
• There is a relatively high possibility that you will end up with an emergency caesarean section, which is more risky than a planned caesarean section.

Advantages

• Vaginal births may help promote lung maturity in newborns - particularly useful for babies with T18.
• A vaginal birth may mean you are more mobile and able to get to spend more time with your baby.
• A vaginal birth may reduce the risk of significant complications for you.

For a much more detailed look at how your and your baby's individual conditions may affect your choices, read the full version of this post.