Paixao ES, Bottomley C, Pescarini JM, et al. - In many countries, clinician and maternal preference, rather than medical indication, has resulted in increasing rates of cesarean delivery (CD). Researchers herein sought to ascertain the effects of unindicated CD on infant and child health outcomes.

• Over 17.8 million live births in Brazil from 2012 to 2018 were analyzed and classification of each birth was done into one of 10 Robson groups.

• Performing comparison between CD vs vaginal delivery and prelabor CD vs unscheduled CD, the relative child mortality rates in the first 5 years of life were determined.

• A 25% increased mortality rate in the first 5 years of life was recorded for live births to women in Robson group 1 to 4 (groups with low expected rates of CD) who had a CD relative to those born vaginally.

• No statistically significant association with mortality up to the age of 5 was observed of either prelabor CD (compared with unscheduled CD) or of repeated CD (compared with vaginal) (Robson group 5).

• Reduced risk of death was recorded for births with a noncephalic presentation, multiples (twins or triplets,) or preterm births (Robson groups 6 to 10) if delivered by CD rather than vaginally.

• Overall, unless there is a clear indication for the procedure, an increased risk of child mortality appeared in correlation with performing CD.