Are Premature Babies Safer Born By Cesarean or Normal Birth?

Premature baby in NICU

Premature baby on oxygen in NICU incubator

Everyone knows that premature babies are smaller and more fragile than full term babies. What does this mean about how the type of birth preemies have effects them?

A study published in the American Journal of Obstetrics and Gynecology in August, 2012 shows that it may depend on the baby’s position. In the study of over 4300 births before 32 weeks, babies that were head-down (vertex) were just as healthy if they were born vaginally (normal birth) as those who were born by cesarean surgery. Considering the other benefits that we know babies get from normal birth, it is likely that most preemies will be better off if they are born vaginally. This also helps avoid the risks that cesarean surgery holds for mom.

The story for breech (butt-down) babies was different. The study showed a large increase in mortality (death :(  ) of premature babies born by breech vaginal birth, especially among those born before 28 weeks. What we do not know is whether or not this increase is linked to the reason that labor began early. It is possible that there may be no increase in mortality in breech preemies if the cause of premature birth is premature rupture of membranes of preterm labor, but there is a danger if baby is unhealthy. Perhaps the study authors have that information and can offer additional analysis.

Remember that this study is about preterm babies born before 32 weeks, also called “very preterm.” Full term frank breech (butt-down) babies can usually have a safe, normal birth with a birth attendant skilled in vaginal breech birth. The trick is finding a practitioner who still has those skills.

What does this mean for pregnant moms?

Of course, everyone wants to have their baby full-term if possible. But spend a few minutes discussing what would happen if something went wrong and baby were to be born early. Here are some questions to ask your doctor or midwife in your second trimester in case something were to happen and baby came very prematurely.

  • How will we know what position my baby is in before birth?
  • Can I have my baby vaginally if he or she is head-down?
  • Can I use kangaroo care if I have a preemie?
  • Will there be support for pumping and feeding breastmilk to my baby, or using a supplemental nursing system?

Hopefully, we can reduce the number of preterm births and help more babies be healthy and full term. In the meantime, be informed and involved, and make sure you have a doctor or midwife you trust. :)


Nicholas Bakalar. Vaginal Delivery Safe for Most Preterm Babies. New York Times, October 1, 2012

Reddy UM, Zhang J, Sun L, et al. Neonatal mortality by attempted route of delivery in early preterm birth. Am J Obstet Gynecol 2012;207:117.e1-8.

Amy Tuteur, MD. Is breech vaginal delivery safe? Science-Based Medecine, Jan. 14, 2010. Accessed Oct 2, 2012.

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