Adverse Neonatal Outcomes Following Planned Vaginal Birth Compared to Planned Caesarean Birth: A Population‐Based Study

AIM: To compare adverse outcomes in neonates born by planned vaginal birth to those born by planned caesarean section. METHOD: This retrospective cohort study analysed data from southern Sweden between 1995 and 2015, using the perinatal revision South Register. Only women with singleton, term (≥ 37 + 0 weeks) and cephalic presentation were included. Planned vaginal birth included all vaginal non-instrumental, instrumental, and emergency caesarean births. Logistic regression was used to study the relationship between neonates born via planned vaginal birth and planned caesarean section to adverse neonatal outcomes. RESULTS: Of 97,886 included, 91,834 (8.9%) underwent planned vaginal birth, and 6052 (91.1%) underwent planned caesareans. After adjustment, neonates with planned caesarean birth had lower odds for UApH < 7.05 [OR 0.64; 95% CI, 0.46-0.88, p = 0.006] but higher need for continuous positive airway pressure [OR 2.22; 95% CI, 1.74-2.85, p < 0.001]. No differences were seen for apgar score < 7 at 5 min, seizures, central nervous system disease or hypoxic ischemic encephalopathy. CONCLUSION: While planned caesarean birth may reduce the risk of neonatal acidemia, it is associated with a higher odds of respiratory support after birth. Overall, both planned birth modes demonstrated comparable risks for other serious neonatal outcomes, indicating that decisions should balance these specific differences alongside individual clinical circumstances.