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Nachrichten, Termine, Experten
Nachrichten, Termine, Experten
The obstetrics team at MHH advises pregnant women on questions regarding the “right” delivery method. Being well informed enables them to make a better decision.
In Germany, almost one in three children is currently born by cesarean section. That is almost twice as many as in 1993. There are various reasons for this increase. However, in many cases, a surgical delivery is not medically necessary. “The decision for or against a cesarean section always depends on the individual case,” explains Dr. Lars Brodowski from the Department of Obstetrics and Gynecology at Hannover Medical School (MHH). “It is important that pregnant women receive support and comprehensive advice so that they can make the right decision for themselves.” At the MHH Women's Clinic, for example, there are consultation hours for pregnant women and consultation hours for multiple births and breech presentations.
Caesarean section rate has risen sharply
According to the Federal Statistical Office, the caesarean section rate in Germany was 32.6 percent in 2023. In 1993, it was only 16.9 percent. How did this increase come about? “Medical advances have made cesarean sections safer, so they're generally seen as a more common option,” says PD Dr. Brodowski. Plus, the profile of pregnant women has changed. Lots of women are having kids later in life, which comes with a higher risk of complications. Being overweight, chronic illnesses, or previous operations can also contribute to a higher cesarean section rate. “Safety” is often the decisive argument, although in many cases a spontaneous birth would be possible—or at least should be considered.
Spontaneous birth has many advantages
A spontaneous birth, also known as a vaginal birth, is usually healthier for both mother and child than a cesarean section. “Recovery after a spontaneous birth is usually faster and less complicated,” notes PD Dr. Brodowski. In addition, the risk of infection, bleeding, and postoperative complications is lower. Spontaneous birth is also more favorable for subsequent pregnancies. This is because caesarean sections can, in rare cases, lead to malpositioning and dangerous placental ingrowth in subsequent pregnancies, as well as tears in the uterine wall. Spontaneous birth also has advantages for the child. As it is pushed through the birth canal, the lungs and airways are cleared and hormones are released that stimulate the cardiovascular system. Through contact with the maternal vaginal flora, the baby comes into contact with microorganisms that strengthen the immune system. Babies born spontaneously have a lower risk of developing allergies, respiratory diseases, diabetes, and rheumatic diseases later in life. They are also less likely to become obese.
Decision on a case-by-case basis
There are situations in which a cesarean section is absolutely necessary. “This applies, for example, in the case of a transverse position of the child, a prolapsed umbilical cord, and placenta praevia, i.e., an abnormal position of the placenta,” explains PD Dr. Brodowski. Certain diseases of the mother and the unborn child may also necessitate delivery by surgery. On the other hand, there are also conditions affecting the pregnant woman that allow for spontaneous delivery. These include certain diseases of the heart, respiratory organs, metabolism, and nervous system. Even in cases of malformations and diseases in the child, vaginal delivery is possible in many cases. Likewise, a breech presentation of the child or a twin birth does not have to be an obstacle to vaginal delivery.
Comprehensive information and care
Pregnant women can find out whether a spontaneous birth is possible in their individual case during consultation hours at the MHH Women's Clinic. The team, consisting of experienced midwives and doctors, takes plenty of time to accompany expectant mothers through the final weeks of pregnancy. For women whose babies are lying bottom-down in the uterus and women who are expecting multiples, there is a special “consultation hour for multiples and breech presentations.” During these consultation hours, the parents-to-be receive comprehensive information based on the latest scientific findings – always with their personal situation in mind. “We make women experts in their own pregnancies so that they can then decide for themselves whether they want to give birth spontaneously or by C-section,” says PD Dr. Brodowski. “In the end, everything should have gone the way they wanted it to.”
Vaginal birth despite high-risk pregnancy
The World Health Organization (WHO) estimates that only about ten percent of all cesarean sections are medically necessary. The cesarean section rate at the MHH Women's Clinic was around 30 percent in 2024. Considering that the Level 1 supramaximal care facility mainly treats high-risk pregnancies, such as women with severe pre-existing conditions and women with extremely premature births, this is a very low figure. The obstetrics team is particularly proud of the fact that in 2024, more than 40 percent of more than 100 twin births and more than 100 breech births were performed vaginally. In order to achieve these results, the team regularly completes interdisciplinary case training. In addition, the specialists at the MHH have access to a safety net comprising gynecology, neonatology, pediatric surgery, anesthesia, and other specialist areas.
Further information is available on the website https://www.mhh.de/geburtshilfe#c54771.
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For further information, please contact PD Dr. Lars Brodowski, brodowski.lars@mh-hannover.de.
Which type of birth is right for me? This is not always an easy decision for pregnant women.
Copyright: Karin Kaiser/MHH.
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Which type of birth is right for me? This is not always an easy decision for pregnant women.
Copyright: Karin Kaiser/MHH.
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