Experts discuss neurodevelopmental outcomes after assisted delivery

In this Contemporary Pediatrics interview, Giulia M. Muraca, MPH, PhD, and Maya Rajasingham, BSc, discuss findings from a population-based analysis examining whether neurodevelopmental outcomes in children differ according to the mode of delivery when spontaneous vaginal birth is not possible. The researchers focused on a specific and clinically relevant subgroup: individuals who enter labor intending a spontaneous vaginal birth, reach full dilation, but ultimately require an intervention to complete delivery.

Muraca explains that while most births occur spontaneously, a substantial minority—about one-quarter of first-time births in Canada—require assistance. In these situations, clinicians must choose among several options, including second-stage cesarean delivery or assisted vaginal delivery using forceps, vacuum, or a combination of both. The study was designed to compare these intervention strategies directly, rather than broadly contrasting cesarean and vaginal births, which has been the focus of much prior research.

The analysis evaluated long-term neurodevelopmental outcomes in children, specifically attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, and intellectual disability. According to Rajasingham, the overall results were reassuring. Rates of ADHD, autism, and intellectual disability were largely similar across the different delivery modes examined.

Although the researchers identified modest increases in ADHD risk among children delivered with combined forceps and vacuum assistance, and slightly greater rates of intellectual disability following vacuum-assisted births, these differences were small in magnitude. As a result, the findings suggest that these interventions are generally safe with respect to neurodevelopmental outcomes.

Muraca emphasizes that the study addresses a critical gap in the literature. Assisted deliveries and second-stage cesareans are relatively common, yet there has been limited high-quality evidence examining their long-term effects on child neurodevelopment. Previous studies have often compared cesarean deliveries to all vaginal births, without accounting for important clinical differences among delivery scenarios.

This approach has contributed to perceptions that cesarean delivery itself increases the risk of neurodevelopmental disorders. By using more appropriate comparison groups, the study challenges that assumption and suggests that mode of delivery alone may not be the primary driver of these outcomes.

The findings provide clearer guidance for clinicians and families making time-sensitive decisions during labor when intervention is required. Looking ahead, Muraca notes that future research could expand to other neurodevelopmental and neurologic outcomes, such as cerebral palsy and epilepsy, and examine additional factors during pregnancy and labor that may play a more substantial role in shaping long-term child development.

No relevant disclosures.

Reference

Rajasingham M, Lisonkova S, Razaz N, Muraca GM. Long-term neurodevelopmental outcomes after forceps, vacuum, and second-stage cesarean delivery. JAMA Netw Open. 2026;9(1):e2556637. doi:10.1001/jamanetworkopen.2025.56637