A cesarean birth happens through an incision in the abdominal wall and uterus rather than through the vagina. There has been a gradual increase in cesarean births over the past 30 years. In November of 2005, the Centers for Disease Control and Prevention(CDC) reported the national cesarean birth rate was the highest ever at 29.1%, which is over a quarter of all deliveries. This means that over 1 in 4 women will experience a cesarean delivery.
With any major surgical procedure, there are risks involved. It is important to know and understand your risks before a cesarean procedure, so that you may feel equipped to talk with your health care provider and make informed decisions.
Risks and Complications for the Mom:
Take into account that most of the following risks are associated with any type of abdominal surgery.
- Infection: Infection can occur at the incision site, in the uterus and in other pelvic organs such as the bladder.
- Hemorrhage or increased blood loss: There is more blood loss in a cesarean delivery than with a vaginal delivery. This can lead to anemia or a blood transfusion (1 to 6 women per 100 require a blood transfusion1).
- Injury to organs: Possible injury to organs such as the bowel or bladder (2 per 1002).
- Adhesions: Scar tissue may form inside the pelvic region causing blockage and pain. This can also lead to future pregnancy complication such as placenta previa or placental abruption3.
- Extended hospital stay: After a cesarean, the normal time in the hospital is 3-5 days after giving birth if there are no complications.
- Extended recovery time: The amount of time needed for recovery after a cesarean can extend from weeks to months, having an impact on bonding time with your baby (1 in 14 report incisional pain six months or more after surgery4).
- Reactions to medications: There can be a negative reaction to the anesthesia given during a cesarean or reaction to pain medication given after the procedure.
- Risk of additional surgeries: Such as hysterectomy, bladder repair or another cesarean.
- Maternal mortality: The maternal mortality rate for a cesarean is greater than with a vaginal birth.
- Emotional reactions: Women who have a cesarean report feeling negatively about their birth experience and may have trouble with initial bonding with their baby5.
Risks and Complications for the Baby:
- Premature birth: If gestational age was not calculated correctly, a baby delivered by cesarean could be delivered too early and be low birth weight6.
- Breathing problems: When delivered by cesarean, a baby is more likely to have breathing and respiratory difficulties. Some studies show an increased need for assistance with breathing and immediate care after a cesarean than with a vaginal delivery7.
- Low APGAR scores: Low APGAR scores can be the result of anesthesia, fetal distress before the delivery or lack of stimulation during delivery (vaginal birth provides natural stimulation to the baby while in the birth canal). Babies born by cesarean are 50% more likely to have lower APGAR scores than those born vaginally8.
- Fetal injury: Very rarely, the baby may be nicked or cut during the incision (1 to 2 babies per 100 will be cut during the surgery9).
If your health care provider has suggested a cesarean and you are in a non-emergency situation, take the time to really discuss your options regarding the procedure.
- Ask questions so that you can understand why a cesarean procedure has been recommended
- Ask for any alternatives that my be an option in your particular situation
- Have your health care provider compare all the possible risks and complications for you and your baby when having a cesarean and not having a cesarean
- Get information regarding the normal procedures after a cesarean (i.e., when can you hold your baby, can the newborn evaluation be done while the baby is on your chest, how soon can you try to breastfeed, are you given medication that would make you drowsy after the delivery)
What else you should know about Cesarean Birth:
- Cesarean Procedure
- Reasons for a Cesarean
- Avoiding a Cesarean
- Making the Most of a Cesarean
- Care Following a Cesarean
1 & 2Shearer El. Cesarean section: medical benefits and costs. Soc Sci Med 1993;37(10): 1223-31.
3Lydon-Rochelle M et al..First birth cesarean and placental abruption or previa at second birth. Obstet Gynecol 2000;97 (5 Pt 1):765-9.
4 & 5Declerq ER , Sakala C, Corry MP. Listening to Mothers: Report of the First National U.S .Survey of Women’s Childbearing Experiences. New York: Maternity Center Association, Oct 2002.
6ACOG. Evaluation of Cesarean Delivery. Washington, DC: ACOG, 2000.
7 & 8Annibale DJ et al. Comparative neonatal morbidity of abdominal and vaginal deliveries after uncomplicated pregnancies. Arch Pediatr Adolesc Med 1995;149(8):862-7.
9Van Ham MA, van Dongen PW, Mulder J. Maternal consequences of cesarean section. A retrospective study of intraoperative and postoperative maternal complications of cesarean during a 10-year period. Eur J Obstet Gynecol Reprod Biol 1997; 74 (1): 1-6.