Table 3. Summary of maternal outcomes and certainty of evidence.
| Outcomes | Clinical evidence | Favours planned VD | Favours planned CS | Certainty of evidence* |
|---|---|---|---|---|
| Hospital stay | Maternal length of stay was significantly longer in women who delivered by planned CS compared to those who had a VD [20, 22] | Moderate | ||
| Recovery | Women with a CS were more likely to have bodily pain that interfered with their usual activities at 8 weeks and 6 months after delivery than women who had a VD [20] | Low | ||
| Haemorrhage and hysterectomy | The risk of hysterectomy due to postpartum haemorrhage was two times higher in women having a planned CS versus those with a planned VD [19, 20] | Moderate | ||
| Risks associated with surgery | A planned CS was associated with a fivefold increased risk of cardiac arrest, compared to planned VD [20] | Low | ||
| Abdominal/pelvic pain during birth and in immediate postpartum | CS was significantly associated with less pain in the abdomen during labour and delivery and 3 days after [20] | Low | ||
| Abdominal/pelvic pain in late postpartum | Women who had a planned CS were more likely to report pain in the abdomen at three months after delivery [20–22] and persistant wound pain for 12 or more months [23] | Low | ||
| Perineal pain | Perineal pain level during birth, 3 days and three months after delivery was significantly lower in women who had a planned CS versus those who had a planned VD [20–22, 24] | Low | ||
| Breastfeeding initiation | Women who had an elective CS had, on average, a 17% lower chance of successfully starting to breastfeed than women who delivered vaginally [20–22, 25] | Moderate | ||
| Short-term urinary incontinence | The risk of urinary incontinence was significantly higher in women who delivered vaginally than in those who had an elective CS at 3 months and 1 year after delivery [20–22, 24, 26]** | Low | ||
| Long-term urinary incontinence | The risk of urinary incontinence was not significantly different after 2 years | Low | ||
| Complication during future pregnancy | A previous CS (no specification on the type) significantly increased the risk of uterine rupture, placenta praevia, placenta accreta, placenta abruption, miscarriage, and ectopic pregnancy in subsequent pregnancies [20, 22, 24] | Moderate |
VD = vaginal delivery; CS = caesarean section
*Certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) scale