Strategies to Prevent Infection During Childbirth: Vaginal vs Cesarean Delivery

Mother holding her newborn after labor in a hospital.

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During the childbirth process, whether through vaginal delivery or cesarean delivery, preventing infections is paramount to ensuring the health and safety of both the mother and the newborn. While vaginal delivery presents its own set of challenges, cesarean deliveries, being surgical procedures, carry a heightened risk of postpartum infections.

Health care workers employ a variety of strategies to mitigate these risks and maintain sterile conditions throughout the delivery process. Here are the specific strategies used to prevent infections during both vaginal and cesarean deliveries, high­lighting the importance of adherence to hygiene protocols, sterile techniques, and proactive measures to safeguard maternal and neonatal health.

Vaginal Delivery

The likelihood of acquiring a postpartum infection during vaginal delivery varies depending on several factors, such as the presence of risk factors, the specific circumstances of labor, and the health care setting. Generally, the incidence of postpartum infections following vaginal delivery ranges from 1% to 5% in developed countries, according to various studies.¹

Vaginal delivery should begin and end with stringent hand hygiene practices to minimize the transmission of pathogens. Sterile conditions must also be maintained during the procedure, ensuring proper sterilization of all equipment used during delivery. All medical devices should be handled with aseptic techniques, including hand hygiene and glove usage. Once these devices are no longer needed, the appropri­ate health care personnel should remove them quickly to reduce the risk of infection.

Immediate postpartum care, including prompt removal of placental tissue and proper perineal care, is essential. Addition­ally, maintaining a clean birthing environ­ment through regular cleaning and sanita­tion minimizes cross-contamination risk.

A clean birthing environment includes regularly sanitizing and clearing the deliv­ery room of clutter, properly disinfecting surfaces and equipment between uses, and maintaining adequate ventilation and temperature control to help maintain a comfortable and hygienic environment. Infection preventionists (IPs) should also ensure that health care workers adhere to hand hygiene and wear appropriate personal protective equipment.

Cesarean Delivery

Compared with vaginal delivery, cesarean delivery comes with a higher risk of post­partum infection. This surgical procedure, while crucial, introduces a heightened risk of infection compared with vaginal deliv­ery, amplifying the likelihood by a notable margin ranging from 5 to 20 times higher.² The incision during a cesarean delivery creates a direct pathway for pathogens to enter the body, increasing the likelihood of infection at the surgical site.

Additionally, prolonged exposure to the hospital environment during the surgery elevates the chances of exposure to pathogens. The disruption of the nat­ural barriers provided by the cervix and birth canal, which typically help protect against infection during vaginal delivery, further contributes to the heightened risk. Moreover, cesarean deliveries are commonly performed in situations where there may already be underlying maternal health issues, such as diabetes or obesity, which can compromise the body’s ability to fight off infections.

As a cesarean delivery is conducted under sterile conditions, it is imperative to uphold sterility meticulously throughout the procedure to prevent infections in the mother and newborn effectively. Before the procedure, hair around the surgical site may be shaved, and the skin will be cleaned with an antiseptic solution.³ A sur­gical drape will be draped on the patient.

Health care workers play a pivotal role in preventing infections during childbirth through a multifaceted approach. This includes stringent adherence to hygiene protocols such as thorough handwashing and sterilized equipment during cesarean delivery. It is also essential that aseptic techniques are used during catheteriza­tion and intravenous line insertion.

Single-dose antibiotic prophylaxis will be administered intravenously during cesarean delivery and in high-risk patients of vaginal delivery to prevent infections such as neonatal sepsis, wound infection, endometriosis, and urinary tract infection.²

Infection prevention measures are critical in reducing the risk of infections during cesarean delivery. IPs should adhere rigorously to sterile techniques, including proper hand hygiene, sterile draping, and sterile instruments and equipment. IPs should also monitor the timely removal of catheters and invasive devices, administration of antibiotic pro­phylaxis, and preoperative screenings.

REFERENCES

1. Wong AW, Rosh AJ. Postpartum infections. Medscape. March 27, 2024. Accessed April 25, 2024. https://emedicine.medscape.com/article/796892-overview?form=fpf
2. Kluytmans JAJW, Veenemans J. Chapter 40: infection control obstetrics. In: Guide to Infection Control in the Hospital. International Society for Infectious Diseases; 2018. Accessed April 25, 2024. https://isid.org/wp-content/uploads/2018/02/ISID_InfectionGuide_Chapter40.pdf
3. Cesarean section. Johns Hopkins Medicine. Accessed April 25, 2024. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/cesarean-section