Over 30% of all births in the USA occur by cesarean section. Expecting mothers and their families are concerned about the risks of surgical delivery for the mother and the baby.
The most commonly cited complications of a C-section in the mother are surgical site infections and problems associated with anesthesia. The risks are higher for the mother if she undergoes an unscheduled C- section and if C-section is done in the second stage of labor versus the first stage.
Risks of a C-section for the mother:
Complications during or after the anesthesia
Some of the complications associated with anesthesia for a C-sections are:
- hypotension (low blood pressure)
- drug reaction resulting in pruritus (itching)
- urinary retention and constipation
- nausea and vomiting
- intrapartum fever
- postpartum shivering
- headaches and back pains
- pneumocephalus (inadvertent injection of air into subarachnoid space resulting in severe headache and neurological symptoms)
- spinal epidural hematoma
- respiratory depression
- errors such as inappropriate dose or route of the medications given
Postpartum endometritis is a term used to describe infection of the lining of the womb. It may occur up to several weeks after the birth of the baby. The disease is much more common among women after C-section delivery than women who delivered vaginally.
Symptoms of endometritis include:
- increased body temperature
- abdominal pain
- heavy or irregular vaginal bleeding
- foul-smelling vaginal discharge
- painful urination
Postpartum endometritis can be treated with antibiotics; usually, they have to be administered by the IV route.
Wound complications such as hematoma (collection of the blood), infections, dehiscence (splitting of the wound edges) have been described in women after C-section with a frequency being below 2%. Rates of wound complications after emergent C-sections may be higher than with scheduled C-sections.
The following factors increase risks of early wound infections in women after a C-section:
- infection of the amniotic membranes and fluid (chorioamnionitis)
- drug and alcohol abuse
- blood transfusions
- anticoagulation treatment (anti-clotting treatment)
- presence of the hematoma post-surgery
2%-4% of all women undergoing a C-section receive blood transfusion due to severe blood loss and anemia.
Factors that can contribute to blood loss:
- The uterus does not contract after removal of the baby (atony)
- Abnormal placentas (previa, accreta)
- Significant injury to the uterus
- Damage to the large blood vessels
- Damage to the abdominal organs
Injury to organs located in the abdomen
During a C-section, especially if it is an emergency C-section, injury to abdominal organs can occur. Those injuries include damage to the bowel loops, urinary bladder, urethra, and ligaments. The reported rate of these injuries is below 0.5% of all primary C sections (Source article).
Strokes and Heart attacks
Rates of acute myocardial disease (heart attack) and ischemic brain disease (stroke) during the first six weeks after a C-section are much higher when compared to a population of women who delivered their babies vaginally. Most likely surgical delivery results in more cases of deep vein thrombosis and dislodged thrombi lead to the inadequate blood supply to the brain and heart, causing strokes and heart attacks.
Death of the mother
Approximately 13 women will have died in the USA for each 100 000 Cesarean sections conducted. Mortality rates in low and middle-income level countries are much higher and may be as high as 750 deaths per 100 000 C-sections performed.
Maternal mortality in the US is usually caused by obstetrical factors, maternal medical conditions, and rarely anesthesia complications. It is still debatable if rates of maternal death for women with C-section and with vaginal delivery are any different once we take all confounding factors under consideration (Source article).
Mothers may have problems with constipation after C-section. Illness may affect up to 20% of patients and occurs due to narcotic or paralytic drugs used during anesthesia and due to a physiologic response of abdominal organs irritated during surgery.
Formation of adhesions after C-section
Adhesions form after the cesarean section as they do after any other abdominal surgery. Patients may be asymptomatic, or adhesions can contribute to bowel obstruction, infertility, or difficulties during subsequent abdominal operations resulting in injury to the organs. Even 45% of women during the second C-section and 75% of women during the third C-section may have adhesions present.
Each subsequent abdominal surgery on a woman with adhesions will take longer since the surgeon will have to proceed very carefully due to complicated anatomy.
Abnormal placentas in the future pregnancies
Cesarean section contributes to the increased incidence of the abnormal placenta in the future (placenta previa, placenta accreta). Both types of placentas may be associated with massive bleeding, severe complications, and the need for removal of the uterus during the subsequent vaginal delivery or cesarean section.
The number of cesarean sections is essential as well since each subsequent C-section increases that risk even further. The risk of placenta previa is 2.8 times higher for the woman after 3 C-sections when compared to the woman who only had 1 C-section. The risk of placenta accreta with the second C-section is 0.3%, with the third C-section 0.6%, and with the 4th C-section is 2.1% (Source article).
Uterine rupture in the future pregnancies
Women who want to try natural vaginal birth in the future are at higher risk of having a ruptured uterus when compared to women who desire a repeat C-section. This knowledge is a primary reason for the US having a high rate of repeat C-section. The risk will depend on the type of incision, its location, and other factors; therefore, if you are interested in having vaginal delivery after a previous C-section, you need to discuss your risks with the obstetrician.
Complications related to scar formation
Abnormalities pertaining to scar formation:
- numbness and pain in the surrounding area
- incisional endometriosis (painful mass changing size during menstruations)
- incisional hernia
- ectopic pregnancy within the scar tissue
A difficult decision regarding a future delivery mode
Having a C-section in the past puts you at an increased risk of having abnormal placentas and uterine rupture in the future, especially if you try a vaginal delivery. Due to those findings deciding the mode of delivery for your future babies will be much more complicated. The discussion that will be focused on all risks and benefits for the mother and her baby is a must.
Risks of a C-section for the baby:
Higher incidence of breathing problems in newborns after birth
Hormonal changes in the mother and baby occurring during the natural labor process lead to fetal lungs being ready for life outside the womb. The incidence of breathing problems such as TTN or RDS (Transient tachypnea of the newborn, Respiratory Distress Syndrome) is 3 times higher for babies born by C-section versus ones who were born by vaginal delivery (Source article).
Most babies with TTN and RDS will need to be admitted to NICU, will require respiratory support and supplementary oxygen, and will not be able to eat by mouth right after birth. Many babies with respiratory problems will have to stay in the hospital longer than typical 2-3 days. Healthy full-term newborn babies usually go home in 1-3 days after birth.
Less favorable developmental outcomes in babies
Some studies, although not of excellent quality, point to the possibility that babies born by C-section have a 1.2 – 1.3 times higher risk of developing autism spectrum disorders and attention deficit hyperactivity disorders (ADHD). Probably, more studies will need to be done in the future before we can conclude that with certainty (Source article)
Newborns are less likely to be breastfed
We know that the best type of milk for the newborn baby is mother’s breast milk (my article). Unfortunately, due to surgical anesthesia and the time needed for the mother to recover from surgery, it may take a long time until the mother and baby can be together. The time gap between birth and the first breastfeeding attempt has crucial importance on breastfeeding rates. Statistics provide proof that women who had a C-section are less likely to breastfeed their babies than women who had a natural vaginal birth.
Negative effects on the gut microbiome in the baby
Our bodies are covered (colonized) with thousands of bacteria. They are on our skin, in the mouth and gut. Those bacteria serve essential roles for us: defend us from “bad” bacteria and help us build our immune system. For the newborn baby, the first encounter with “good bacteria” is in the birth canal, with the mother’s genital flora and soon after with mother’s skin flora. Newborn babies born by C-section are deprived of the opportunity of being exposed to maternal genital flora. Delay in bonding with the mother and delay until the first breastfeeding may also affect their microbiome.
How the changed microflora in newborn babies affects their lives is not well known yet. However, doctors speculate that it may lead to a higher incidence of obesity and allergies in those children.
Possibly increased risk of preterm birth in the future pregnancy
Researchers analyzed over 180 thousand of paired deliveries and looked if premature birth was less or more likely if previous delivery was by cesarean section (Source article).
They concluded that having previous cesarean delivery in your obstetric history increases the risk of having a premature baby at less than 32 weeks of gestational age by 100% (doubles it), and risk of having a premature baby at less than 37 weeks of gestational age by 50% (1.5 times higher).
You may also be interested in my article: When do I need a C-section to deliver my baby?
This article is only for general information purposes. It should not be viewed as any kind of medical advice. There is a chance that information here may be inaccurate. You should always discuss all health-related matters with your doctor before making any decisions that may affect your health or health of your family members.