The carbon footprint of different modes of birth in the UK and the Netherlands: An exploratory study using life cycle assessment

Abstract

Objective: To compare the carbon footprint of caesarean and vaginal birth.

Design: Life cycle assessment (LCA).

Setting: Tertiary maternity units and home births in the UK and the Netherlands.

Population: Birthing women.

Methods: A cradle-to-grave LCA using openLCA software to model the carbon footprint of different modes of delivery in the UK and the Netherlands.

Main outcome measures: 'Carbon footprint' (in kgCO₂ equivalents [kgCO₂ e]).

Results: Excluding analgesia, the carbon footprint of a caesarean birth in the UK was 31.21 kgCO₂ e, compared with 12.47 kgCO₂ e for vaginal birth in hospital and 7.63 kgCO₂ e at home. In the Netherlands the carbon footprint of a caesarean was higher (32.96 kgCO₂ e), but lower for vaginal birth in hospital and home (10.74 and 6.27 kgCO₂ e, respectively). Emissions associated with analgesia for vaginal birth ranged from 0.08 kgCO₂ e (with opioid analgesia) to 237.33 kgCO₂ e (nitrous oxide with oxygen). Differences in analgesia use resulted in a lower average carbon footprint for vaginal birth in the Netherlands than the UK (11.64 versus 193.26 kgCO₂ e).

Conclusion: The carbon footprint of a caesarean is higher than for a vaginal birth if analgesia is excluded, but this is very sensitive to the analgesia used; use of nitrous oxide with oxygen multiplies the carbon footprint of vaginal birth 25-fold. Alternative methods of pain relief or nitrous oxide destruction systems would lead to a substantial improvement in carbon footprint. Although clinical need and maternal choice are paramount, protocols should consider the environmental impact of different choices.

Keywords: caesarean section; life cycle assessment; net zero; operating room; sustainability; vaginal birth.