According to the abstract and news reports, researchers in Iran have found that planned cesarean sections are associated with the lowest rate of long-term maternal and paternal sexual dysfunction in the year following childbirth. Normally, I do not blog about new research studies unless I have had a chance to read the study carefully. However, The Journal of Sexual Health embargoes its issues for a full year from the major medical school library from which I have access to medical journals. Thank goodness only a few medical journals do this. I have so many questions about this study. From where were the women and their husbands recruited? For the women who had spontaneous vaginal deliveries, was pushing spontaneous or coached? Researchers from the University of Texas Southwestern Medical School have found that “coached pushing” results in damage to the pelvic floor. I can understand that the first episode of sexual intercourse was most painful for those women who had operative vaginal deliveries. But I would like to see more information (and numbers) about sexual function after the first intercourse. Earlier studies have found temporary effects on the pelvic floor after vaginal delivery as compared to cesarean surgery, but there is controversy as to whether those effects were caused by the vaginal delivery alone or were caused by common interventions such as coached pushing, episiotomy, and/or instrumental delivery. Many new parents report changes in the frequency of intercourse and sexual desire as they juggle the demands of parenthood with all the other things going on in their lives. I can’t even begin to list all the factors that might impact the father’s sexual function. I will wait on drawing any conclusions about mode of delivery and sexual satisfaction until we have a lot more evidence.

I had heard about this study and was excited to finally see it published. Noted researcher Ellen Hodnett and colleagues did a pilot study looking at the effects of the labor room environment on the amount of time women spend laboring outside a bed and on women’s and caregiver’s perceptions of an alternative set-up for the labor room. In two Toronto hospitals, researchers set-up an “ambient” labor room. The standard hospital bed was removed from the room. Instead a double-sized mattress with a colorful sheet and lots of large pillows were placed in the corner of the room. The room also featured a birth ball and a chair which required an upright or forward-leaning position. Lights were dimmed and DVDs featuring movies of ocean beaches and waterfalls played on one wall. A variety of music that could be played via speakers or earphones was available. Fetal monitoring was accomplished by intermittent auscultation. Purposely, it was difficult to instigate routine medical interventions such as continuous EFM, augmentation, or epidural analgesia. After agreeing to participate in the study, low-risk women in spontaneous labor were randomized to either a standard labor room or to the ambient labor room. The standard hospital bed could be returned to the ambient labor room at any time at the request of the laboring woman or the health care provider. Nearly all the women who were invited to participate in the study agreed to do so. There were 31 women in each group (remember, this was a pilot study.) Far more women in the ambient group (19 versus 4 in the standard group) reported spending less than 50% of the time in a bed. Interestingly, the ambient room group was more likely to report that a nurse spent all or nearly all of labor with them. Only 12 women in the ambient group required augmentation versus 21 women in the standard group. The women overwhelmingly liked the ambient group; caregivers’ attitudes were mixed, sometimes hostile. The researchers concluded that the ambient labor room should be evaluated in an adequately powered RCT. You can read the abstract of this fascinating study at PubMed (ID# 19489810) or you can read the full study in the June 2009 issue of the journal, Birth. Note: Lamaze members can subscribe to the journal, Birth, at a substantial discount. See member benefits on the Lamaze International website.

It’s still hard for me to believe that in 2006 the National Institutes of Health State-of-the-Science Conference on Cesarean Delivery on Maternal Request concluded that we need “more research” in order to compare the outcomes from vaginal birth to the outcomes from cesarean delivery. Since that time, however, there have been numerous studies documenting the increased risks to both mothers and babies with cesarean delivery. One more study has been published this month in Obstetrics and Gynecology. The objective of this study was to look at the outcomes of newborns born by elective repeat cesarean delivery compared with VBAC in women with one previous cesarean delivery and to evaluate the cost differences between elective repeat cesarean and VBAC. The authors found that in comparison with VBAC, newborns born after elective repeat cesarean delivery have SIGNIFICANTLY higher rates of respiratory morbidity and NICU-admission and longer length of hospital stay. The costs of elective repeat cesarean were significantly greater than VBAC. Failed VBAC accounted for the highest total costs (delivery and NICU.) Not surprisingly, failed VBAC was associated with labor induction and chorioamnionitis. The authors also found that the greatest number of amniocenteses for fetal lung maturity were performed for those newborns who had elective repeat cesarean delivery without labor. However, these newborns had high rates of respiratory morbidity and NICU admission, indicating that surfactant deficiency may NOT be the sole cause of respiratory distress seen after elective cesarean delivery. Indeed, other researchers have speculated that hormonal changes that occur in the days prior to labor are critical in enhancing lung maturity and preparing the fetal lungs for air breathing. In addition, catecholamines released during labor likely play an important role in both clearance of fetal lung fluid and glycemic control after birth. More evidence supporting the wisdom of allowing labor to begin on its own and promoting the increased availability of VBAC.