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Method of Delivery and Developmental Outcome At Five Years of Age
Abstract
A controlled follow-up study examined the impact of delivery method on developmental outcome of the child. The modes of delivery investigated were low forceps delivery (188 infants), midcavity forceps delivery (51 infants), forceps rotation with forceps delivery (57 infants), manual rotation with forceps delivery (67 infants), elective caesarean section (101 infants) and spontaneous delivery (control, 207 infants). Breech presentation (100 infants) was separately compared with the vertex presentation groups. Sample selection controlled for complications during pregnancy and low birthweight and was restricted to married English-speaking mothers. The children were assessed at the age of five years on verbal and non-verbal subtests of a standardized intelligence scale, tests of gross motor coordination, and auditory and visual tests. A full paediatric examination was also performed. Breech presentation children performed less well on tests of balance and fine motor coordination and on visual acuity and stereopsis testing than children who presented in the vertex position. No deleterious effect of delivery method was found. In the absence of other complicating events (like a poor antenatal history, prematurity, and a disorganized home environment) delivery complication constitutes an early risk factor which the growing child is able to overcome.
... 7,8 Opposite studies have found improved cognitive function among children born by CS, 9 or no association. [10][11][12] This study aimed to investigate the association between delivery by CS (elective and acute) and school performance in adolescence and intelligence in early adulthood. of registered variables and registration practice, causing some variables to change over time. ...
... The results are inconsistent as to why the possible association remains unresolved. 11,9,7,26,8 Among Swedish school-aged children, Curran et al found slightly ...
... 9 Again, the results are hard to compare, as we did not have access to data concerning anesthesia. Eide et al found no significant association between mode of delivery and low scores at the Norwegian military intelligence test 25 and McBride et al, 11 Smithers et al, 12 Khadem and Khadivzadeh, 26 and Hong-tian et al 27 found no association, in contrast to our results. ...
Introduction
It is suggested that birth by elective cesarean section (CS) reduces the risk of birth‐related infant mortality and injury. Other studies suggest an increased risk of somatic immune‐related diseases among children born by CS such as asthma, type 1 diabetes, and inflammatory bowel disease. The WHO Statement on Cesarean Section Rates 2015 described an increase in CS globally. The statement concluded that the effects of CS on social and psychological outcomes remain unclear and that more research is needed to fully understand the effects of CS, including effects on cognition and intelligence in the child. Therefore, we aimed to investigate the association between delivery by CS (elective and acute) and school performance and intelligence in youth.
Material and methods
This cohort study included all Danish live‐born children in 1978–2000. We retrieved data regarding pregnancies, births, parents, school grades, and intelligence of the children from Danish registers and performed multiple imputations to avoid discarding data. The final cohort after exclusion comprised 1 408 230 children. Associations between CS and school graduation, grades, conscription attendance, and conscription intelligence scores were analyzed using univariate and multivariate logistic and linear regressions.
Results
Adjusted odds ratio with 95% CI of graduating from lower (LSE) and upper (USE) secondary education and of attending conscription were significantly lower in the CS group: LSE graduation: 0.87 (0.84–0.89), USE graduation: 0.93 (0.92–0.94), attending conscription: 0.95 (0.93–0.98). The CS group had significantly lower grade point averages (GPA) in LSE with adjusted differences in mean total GPA of −0.090 (−0.10 to −0.007), and mean core subject GPA of −0.098 (−0.11 to −0.08), in USE with total GPA difference of −0.091 (−0.11 to −0.075) and lower mean intelligence scores of −0.36 (−0.46 to −0.27) in adjusted linear models. A sub‐analysis revealed lower chances of graduating LSE and USE when born by acute rather than elective CS.
Conclusions
Chances of LSE and USE graduation and of attending conscription were significantly lower for children born by CS. However, even significant differences in mean GPAs and intelligence scores were very small, so performances when graduating school and attending conscription were comparable regardless of delivery mode.
... In some studies, no differences in IQ, motor skills, and physical development [10], maternal reports of developmental milestones [11], or increased rates of adverse neurodevelopmental diagnoses at age 4 years [12], were reported based on mode of delivery. However, in others, particularly studies comparing CD to vaginal delivery, lower developmental scores [13], lower performance on standardized testing [14], higher levels of inattention and social problems [15], diagnoses for autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) [16], and lower motor function scores [17], have been reported. ...
Objectives
Previous studies have reported that mode of delivery, particularly cesarean delivery (CD), is associated with neurodevelopmental outcomes in children. This study evaluates behavioral and neuropsychological test scores in children based on mode of delivery.
Methods
Children enrolled in the Raine Study from Western Australia, born between 1989 and 1992 by instrumental vaginal delivery (IVD), elective CD, and non-elective CD, were compared to those with spontaneous vaginal delivery (SVD). The primary outcome was the Child Behavior Checklist (CBCL) administered at age 10. Secondary outcomes included evaluations of language, motor function, cognition, and autistic traits. Multivariable linear regression was used to evaluate score differences by mode of delivery adjusted for sociodemographic and clinical characteristics, and Poisson regression was used to evaluate for increased risk of clinical deficit.
Results
Of 2,855 children, 1770 (62.0 %) were delivered via SVD, 480 (16.8 %) via IVD, 346 (12.1 %) via elective CD, and 259 (9.1 %) via non-elective CD. Non-elective CD was associated with higher (worse) CBCL Internalizing (+2.09; 95 % CI 0.49, 3.96; p=0.01) scores, and elective CD was associated with lower (worse) McCarron Assessment of Neuromuscular Development (MAND) (−3.48; 95 % CI −5.61, −1.35; p=0.001) scores. Differences were not seen in other outcomes, and increased risk of clinical deficit was not observed with either the CBCL Internalizing or MAND scores.
Conclusions
Differences in behavior and motor function were observed in children delivered by CD, but given that score differences were not associated with increased incidence of clinical deficit, clinical significance may be limited.
... However, for older children, these differences became more pronounced, especially in the 26-to-48-months range where the greatest differences between the types of delivery were noted; the best results were found for children born via eutocic delivery in terms of both global and fine motor skills. These results are in line with those obtained by Rodrigues and Silva [32], who found that those born via cesarean section (dystocic delivery) have worse locomotion, manipulation, visual, speech and language skills and personal autonomy compared to those born through a eutocic delivery; McBride et al. [33] also concluded that children born via a dystocic delivery had worse balance performance, fine motor coordination, and visual acuity compared to those born via a eutocic delivery. There are few investigations on this variable, especially in these age groups, but even so, it is essential to mention that according to recent studies, the type of delivery is an option in 80% of cases, where the mother usually opts for a dystocic delivery (cesarean, induced, forceps, etc.); this is usually done to avoid pain and sacrifice, but according to medicine, can bring serious complications for the mother and the baby. ...
This study aimed to verify whether the presence of siblings and the type of delivery had an influence on the motor skills development of children in the first 48 months of life. We developed a quantitative study with a sample of 405 children of both genders, divided according to the studied variables: children with siblings, children without siblings, children born via eutocic delivery, and children born via dystocic delivery. The instrument used in the study was the Peabody Developmental Motor Scales-2. Overall, the results indicated that children who had siblings had, on average, better outcomes regarding all motor skills (global and fine). Furthermore, those born via eutocic delivery, on average, had better outcomes regarding all motor skills (global and fine) when compared to children born via dystocic delivery. Thus, the presence of siblings in the family context and the type of delivery positively influenced motor development, especially after 24 months of age, showing that the presence of siblings providing cooperative activities through play and challenges improved cognitive, social, emotional, and physical development. Furthermore, a eutocic delivery, in addition to providing a better recovery from labor and the immediate affective bond between mother and child, also led to better results in terms of global and fine motor skills.
Objective:
To investigate the association between planned mode of birth after previous caesarean section and the child's risk of having a record of special educational needs (SENs).
Background: Caesarean section is associated with different development outcomes in children. In this way, the type of delivery can influence the health of the child. Objectives: To investigate the existence of differences in skill development up to the age of 2 between children who were born by vaginal delivery and those born by elective cesarean section. Methodology: Observational and cross-sectional study with a sample composed of 400 dyads, using a quantitative methodology based on a multivariate analysis with Generalized Linear Models in IBM SPSS Statistics, version 18.0. Results: Children born by cesarean delivery scored lower in the locomotor skill domain, but still within the normal parameters for their age. They also scored lower in the manipulative, visual, speech and language, and self-care skill domains than those born by vaginal delivery. No differences were found between groups in the cognitive, hearing and language, and interactive-social skills. Conclusion: Significant differences were found in the development of some skills at 2 years of age between children born by elective cesarean section and those born by normal delivery.
The short- and long-term effects of obstetric anaesthetic techniques on behaviour and development of the neonate, infant and child have been of long-standing interest. It is clear that these techniques may at least transiently affect some aspects of newborn behaviour [1–7]. However, the impact of obstetric analgesia and anaesthesia on long-term outcomes in the absence of concurrent events such as foetal asphyxia is not known. Studies evaluating the association between perinatal and environmental characteristics and childhood behavioural outcomes have suggested that operative or instrumented deliveries per se are not linked to childhood behavioural disorders or abnormalities in cognitive, verbal or reading functioning [8–12], but these studies do not specifically evaluate the impact of anaesthesia and analgesia.
… the Forceps…As it is not sharper than the Hand, it may be introduced with all imaginable Safety,…I can, from my own Experience, affirm it to be a most excellent Instrument, and so far from Hurting or Destroying, that it frequently saves the Mother's Life, and That of the Child, as will appear in the Course of this Treatise. Edmund Chapman (1680?–1756) Treatise on the Improvement of Midwifery Third Edition, London 1759, John Brindley: pp. xxvii–iii. ROLE OF INSTRUMENTAL DELIVERY. Since its inception in the seventeenth century, instrumental delivery has been controversial [1–5]. Although most practitioners employ methods of assisted delivery on occasion, there are substantial international and local variations, and the acceptability of certain techniques has changed rapidly in recent decades [6,7]. Although both forceps and the vacuum extractor continue in everyday use, vacuum extraction continues to gain in popularity [8–10]. In the United States, the prevalence of operative vaginal delivery is estimated at 10% to 15% [11]. Despite changes in practice and in the popularity of forceps versus vacuum extractor over recent decades, the important questions about assisted delivery remain the same: when to conduct operative deliveries, which instrument is best for specific indications, and what the associated short- and long-term risks are. Previous generations of obstetricians were taught that the principal indications for instrumental delivery were two: prevention and rescue.
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