When a cesarean section is done, the risks and benefits of the procedure need to be weighed. This includes looking at the added benefits and risks of doing a c-section or of birthing the child vaginally. Sometimes the benefits of the cesarean will outweigh the risks, and sometime the vaginal birth benefits will outweigh the risks of the cesarean.
Cesarean birth is major surgery, and, as with other surgical procedures, risks are involved. The estimated risk of a woman dying after a cesarean birth is less than one in 2,500 (the risk of death after a vaginal birth is less than one in 10,000). These are estimated risks for a large population of women. Individual medical conditions such as some heart problems may make the risk of vaginal birth higher than cesarean birth.
Other risks for the mother include the following:
- Infection. The uterus or nearby pelvic organs such as the bladder or kidneys can become infected.
- Increased blood loss. Blood loss on the average is about twice as much with cesarean birth as with vaginal birth. However, blood transfusions are rarely needed during a cesarean.
- Decreased bowel function. The bowel sometimes slows down for several days after surgery, resulting in distention, bloating and discomfort.
- Respiratory complications. General anesthesia can sometimes lead to pneumonia.
- Longer hospital stay and recovery time. Three to five days in the hospital is the common length of stay, whereas it is less than one to three days for a vaginal birth.
- Reactions to anesthesia. The mother's health could be endangered by unexpected responses (such as blood pressure that drops quickly) to anesthesia or other medications during the surgery.
- Risk of additional surgeries. For example, hysterectomy, bladder repair, etc.
- Risk of adhesions.
- Risk to future fertility and babies.
- Increased risk of placenta previa in future pregnancies.
- Risk that all future births may be surgical.
- Maternal death (very rare). (6 in 100,000 for a scheduled cesarean birth.)
In cesarean birth, the possible risks to the baby include the following:
- Premature birth. If the due date was not accurately calculated, the baby could be delivered too early.
- Breathing problems. Babies born by cesarean are more likely to develop breathing problems such as transient tachypnea (abnormally fast breathing during the first few days after birth).
- Low Apgar scores. Babies born by cesarean sometimes have low Apgar scores. The low score can be an effect of the anesthesia and cesarean birth, or the baby may have been in distress to begin with. Or perhaps the baby was not stimulated as he or she would have been by vaginal birth.
- Fetal injury. Although rare, the surgeon can accidentally nick the baby while making the uterine incision.
- Increased risk of asthma in babies born via cesarean section.
Sources:
American College of Obstetricians and Gynecologists (2000; reaffirmed 2003). Scheduled cesarean delivery and the prevention of vertical transmission of HIV infection. ACOG Committee Opinion No. 234. Washington, DC: American College of Obstetricians and Gynecologists.
Cunningham FG, et al. (2005). Cesarean delivery and peripartum hysterectomy. In Williams Obstetrics, 22nd ed., pp. 587–606. New York: McGraw-Hill.
Kolas T, et al. (2006). Planned cesarean versus planned vaginal delivery at term: Comparison of newborn infant outcomes. American Journal of Obstetrics and Gynecology, 195(6): 1538–43.
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Lydon-Rochelle M, et al. (2000). Association between method of delivery and maternal rehospitalization. JAMA, 283(18): 2411–2416.
Mercer et al, Labor Outcome With Repeated Trials of Labor Am J Obstet Gynecol 2008;VOL. 111, NO. 2, PART 1.
Porter TF, Scott JR (2003). Cesarean delivery. In JR Scott et al., eds., Danforth's Obstetrics and Gynecology, 9th ed., pp. 449–460. Philadelphia: Lippincott Williams and Wilkins.
Roduit C, Scholtens S, de Jongste JC, Wijga AH, Gerritsen J, Postma DS, Brunekreef B, Hoekstra MO, Aalberse R, Smit HA. Asthma at 8 years of age in children born by caesarean section. Thorax. 2009 Feb;64(2):107-13. Epub 2008 Dec 3.
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