Is a paediatrician needed at all Caesarean sections?

J Paediatr Child Health. 1998 Jun;34(3):241-4. doi: 10.1046/j.1440-1754.1998.00207.x.


Objective: The need for a skilled neonatal resuscitator in the form of a paediatrician or paediatric registrar to attend a vaginal delivery or Caesarean section (CS) is not clearly defined. This study was undertaken in order to ascertain the level of resuscitation a neonate might require dependent on the delivery mode and type of anaesthesia used.

Methodology: We analysed the Tasmanian Obstetric Audit from 1980 to 1989 for the need for intubation and Apgar scores at 1 min of term singleton deliveries by the mode of delivery.

Results: The number of singleton term deliveries was 64739. When the data were analysed annually there was a trend for a reduction in the need for intubation in CS deliveries during the first 5 years, although this was not paralleled by an improvement in Apgar scores. Thus the intubation rate data are also presented for the last 5 years of the study. The intubation rate, Apgar score at 1 min of < 4, and Apgar score at 1 min of > or = 4 < 7 for repeat CS under epidural anaesthesia were 0.55% (0.26% for 1985-89) 0.83% and 3.58%, respectively, with relative risks when compared with spontaneous normal vaginal delivery of 1.8 (1.2 for 1985-89), 0.7 and 0.5, respectively. The relative risk of these outcomes was higher than for normal vaginal delivery for all other modes of delivery including repeat CS under general anaesthesia.

Conclusion: It is concluded that a paediatrician or paediatric registrar is not required to routinely attend repeat CS under epidural anaesthesia, but should be present for repeat CS under general anaesthesia.

MeSH terms

  • Anesthesia, Obstetrical
  • Apgar Score
  • Cesarean Section*
  • Female
  • Health Services Needs and Demand
  • Humans
  • Infant, Newborn
  • Male
  • Medical Audit
  • Patient Care Team*
  • Pediatrics*
  • Pregnancy
  • Prospective Studies
  • Resuscitation
  • Risk Factors
  • Tasmania