Impact of "natural" cesarean delivery on peripartum blood loss: a randomized controlled trial

Am J Obstet Gynecol MFM. 2022 Jul;4(4):100642 doi: 10.1016/j.ajogmf.2022.100642.

Early skin-to-skin contact after vaginal delivery increases milk production and may increase oxytocin release, leading to a reduction in the rate of postpartum hemorrhage.


This study aimed to examine the effect of "natural" cesarean deliveries on perioperative maternal blood loss.


This was a randomized controlled trial conducted at a single university-affiliated medical center, between August 2016 and February 2018. Term singleton pregnancies scheduled for a planned cesarean delivery under spinal anesthesia were included. Women were randomized at a ratio of 1:1 to natural cesarean delivery (study group) or traditional cesarean delivery (control group) during the routine preoperative assessment. Women in the study group watched fetal extraction, had early skin-to-skin contact, and breastfed until the end of surgery. Neonates in the control group were presented to the mother for a few minutes. Blood samples were drawn from all women, during fascia closure, to determine oxytocin levels using an enzyme-linked immunosorbent assay kit. The laboratory component was performed after recruitment completion and was accomplished in February 2019. The primary outcome was postpartum hemoglobin levels. To detect a difference of 0.5 g/dL between the groups with α=0.05 and β=80%, 214 women were needed.


Of 214 randomized women, 23 were excluded. There was no difference in demographic and obstetrical variables between the groups. Postpartum hemoglobin levels were 10.1±1.1 and 10.3±1.3 g/dL in the study and control groups, respectively (P=.19). There was no difference in the rates of postpartum hemorrhage and blood transfusion. Maternal pain scores, satisfaction, and exclusive breastfeeding were comparable. Maternal oxytocin blood levels were 389.5±183.7 and 408.5±233.6 pg/mL in the study and control groups, respectively (P=.96). The incidence of neonatal hypothermia was comparable between the groups (P=.13).


Natural cesarean delivery did not affect perioperative hemoglobin level or maternal oxytocin blood concentration.

KEYWORDS: blood loss; breastfeeding; natural cesarean delivery; oxytocin level; skin-to-skin contact
MESH HEADINGS: Cesarean Section; Female; Hemoglobins; Humans; Infant, Newborn; Oxytocin; Peripartum Period; Postpartum Hemorrhage; Pregnancy
Study Details
Study Design: Randomised Controlled Trial
Language: eng
Credits: Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine