{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T07:40:41Z","timestamp":1793173241799,"version":"4.5.0"},"reference-count":41,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,1,25]],"date-time":"2024-01-25T00:00:00Z","timestamp":1706140800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare the carbon footprint of caesarean and vaginal birth.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Life cycle assessment (LCA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Tertiary maternity units and home births in the UK and the Netherlands.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Population<\/jats:title>\n                    <jats:p>Birthing women.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cradle\u2010to\u2010grave LCA using openLCA software to model the carbon footprint of different modes of delivery in the UK and the Netherlands.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measures<\/jats:title>\n                    <jats:p>\n                      \u2018Carbon footprint\u2019 (in kgCO\n                      <jats:sub>2<\/jats:sub>\n                      equivalents [kgCO\n                      <jats:sub>2<\/jats:sub>\n                      e]).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Excluding analgesia, the carbon footprint of a caesarean birth in the UK was 31.21\u2009kgCO\n                      <jats:sub>2<\/jats:sub>\n                      e, compared with 12.47\u2009kgCO\n                      <jats:sub>2<\/jats:sub>\n                      e for vaginal birth in hospital and 7.63\u2009kgCO\n                      <jats:sub>2<\/jats:sub>\n                      e at home. In the Netherlands the carbon footprint of a caesarean was higher (32.96\u2009kgCO\n                      <jats:sub>2<\/jats:sub>\n                      e), but lower for vaginal birth in hospital and home (10.74 and 6.27\u2009kgCO\n                      <jats:sub>2<\/jats:sub>\n                      e, respectively). Emissions associated with analgesia for vaginal birth ranged from 0.08\u2009kgCO\n                      <jats:sub>2<\/jats:sub>\n                      e (with opioid analgesia) to 237.33\u2009kgCO\n                      <jats:sub>2<\/jats:sub>\n                      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\u2009kgCO\n                      <jats:sub>2<\/jats:sub>\n                      e).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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\u2010fold. 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1471-0528.17771","type":"journal-article","created":{"date-parts":[[2024,1,25]],"date-time":"2024-01-25T22:35:26Z","timestamp":1706222126000},"page":"568-578","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["The carbon footprint of different modes of birth in the\n                    <scp>UK<\/scp>\n                    and the Netherlands: An exploratory study using life cycle assessment"],"prefix":"10.1111","volume":"131","author":[{"given":"Nienke A.","family":"Spil","sequence":"first","affiliation":[{"name":"Division of Developmental Biology and Medicine, Maternal and Fetal Health Research Centre, School of Medical Sciences, Faculty of Biology, Medicine and Health University of Manchester  Manchester UK"},{"name":"University of Groningen  Groningen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8531-4778","authenticated-orcid":false,"given":"Kim E.","family":"van Nieuwenhuizen","sequence":"additional","affiliation":[{"name":"Department of Gynaecology Leiden University Medical Centre  Leiden The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2994-3240","authenticated-orcid":false,"given":"Rachel","family":"Rowe","sequence":"additional","affiliation":[{"name":"National Perinatal Epidemiology Unit, Nuffield Department of Population Health University of Oxford  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9764-6876","authenticated-orcid":false,"given":"Jim G.","family":"Thornton","sequence":"additional","affiliation":[{"name":"University of Nottingham  Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Murphy","sequence":"additional","affiliation":[{"name":"Saint Mary's Hospital Manchester University NHS Foundation Trust  Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evelyn","family":"Verheijen","sequence":"additional","affiliation":[{"name":"Department of Gynaecology Saxenburgh Medisch Centrum  Hardenberg The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8438-398X","authenticated-orcid":false,"given":"Clifford L.","family":"Shelton","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Wythenshawe Hospital Manchester University NHS Foundation Trust  Manchester UK"},{"name":"Lancaster Medical School Lancaster University  Lancaster UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4303-7845","authenticated-orcid":false,"given":"Alexander E. 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