title: Postnatal adaptation after Caesarean section or vaginal delivery, studied with the static-charge-sensitive bed.
abstract: OBJECTIVE
  To compare postnatal adaptation between Caesarean and vaginal deliveries, by studying sleep states, oxygenation, heart rate and body movements. Another aim was to follow the adaptation of healthy, term, vaginally born babies.
  
  
  METHODS
  Ten vaginally born and 12 neonates born by elective Caesarean section were recorded with a movement sensor (SCSB, static-charge-sensitive bed), electrocardiogram and oximeter. The recordings started 1.5 h after birth and lasted for 12 h. For the vaginal group, another 12 h recording was performed during the third night postpartum.
  
  
  RESULTS
  Delivery mode did not affect sleep state distribution. The vaginal group had more oxyhaemoglobin desaturation episodes <95% than the Caesarean section group (mean +/- SD: 59 +/- 10% vs 42 +/- 22% of epochs, p = 0.03), especially in active sleep, but baseline saturation was similar (96 +/- 1% vs 95 +/- 3%, p = 0.93). The vaginal group had fewer movements during sleep than the Caesarean section group (movements of 5-10 s: 5 +/- 1 h(-1) vs 10 +/- 3 h(-1), p = 0.0001). During the first 3 d, the amount of sleeping and active sleep increased, whereas wakefulness and quiet sleep decreased. Baseline oxyhaemoglobin saturation and the number of movements of over 5 s increased.
  
  
  CONCLUSIONS
  Delivery mode did not affect sleep state distribution but, unexpectedly, the vaginal group had more oxyhaemoglobin desaturation events and fewer body movements than the Caesarean section group. These differences during the first postnatal day remain unexplained, but they may reflect stress and pain during labour. After a few days, changes in sleep organization, and increases in oxyhaemoglobin saturation and frequency of body movements were noted in the vaginal group, which may represent recovery and adaptation to extrauterine life.
authors.affiliation: Department of Anesthesiology, Turku University Hospital, Finland. nikkola@netti.fi
authors.forename: E M
authors.initials: EM
authors.lastname: Nikkol
authors.forename: T T
authors.initials: TT
authors.lastname: Kirjavainen
authors.forename: U U
authors.initials: UU
authors.lastname: Ekblad
authors.forename: P O
authors.initials: PO
authors.lastname: Kero
authors.forename: M A O
authors.initials: MA
authors.lastname: Salonen
mesh_terms: D000064:Acclimatization; D001513:Beds; D001795:Blood Pressure Determination; D002585:Cesarean Section / Q000379:methods; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000379:methods*; D017558:Elective Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008991:Monitoring, Physiologic / Q000295:instrumentation*; D010101:Oxygen Consumption; D011336:Probability; D012890:Sleep / Q000502:physiology*; D012894:Sleep Stages / Q000502:physiology; D018709:Statistics, Nonparametric