As with any surgical procedure, there are serious risks of cesarean section that must be considered, so that you may make an informed decision. It is your body and your baby, so the decision remains YOUR DECISION.
To reduce the risk of cesarean, women should seek caregivers and hospitals with low cesarean rates and which support VBAC. Low risk women can also consider midwifery care, a birthing center or a home birth. Having a doula also reduces the likelihood of a cesarean.
A cesarean section involves major abdominal surgery through seven different layers of tissue and the displacement of the bladder.
If your health caregiver suggests a cesarean and you are not in an emergency situation, take the time to really investigate your options.
Make sure you understand why a cesarean section has been suggested and what are valid reasons for a cesarean.
Many women are told their baby is too big or that their pelvis is too small. This is a myth.
Often caregivers suggest that twins and multiples be born by cesarean, but research shows that they can be born vaginally too. A previous cesarean section is often given as a reason for a subsequent cesarean, but research has shown that a vaginal birth after cesarean (VBAC) is a safer option for 90% of women who have had previous cesareans.
It is your responsibility to find out if there are alternative options for your situation and then compare the risks and benefits of those options.
Finally, investigate the best birth venue for the option of your choice. For example, if a cesarean section is unavoidable, you should choose to have the surgery at a hospital that encourages skin-to-skin bonding and breastfeeding in theater, rather than one that routinely keeps the newborn in an incubator until the mother is out of the theater.
Also find out if they practice kangaroo mother care of preterm babies.
Find out the effects of pain medication that may be used and find out if there are alternatives that will not have negative side effects that affect you, your baby or your breastfeeding relationship.
Many of the following risks are also possible with other types of abdominal surgery.
There is a considerable risk of infection. This could occur at the incision wound, in the uterus and in other pelvic organs such as the bladder. Up to 30% of cesarean patients acquire a postpartum infection, resulting in prolonged hospital stays and increased maternal morbidity.
Blood loss and massive hemorrhage2
More blood is lost during in a cesarean delivery than with a vaginal delivery. As a result, a woman may suffer from anemia or require a blood transfusion3 (1 to 6 women per 100 require a blood transfusion.
Risk of injury to other organs such as the bladder or bowel1,4,5
There is a risk of surgical mistakes, nicks and lacerations that may damage other organs and cause complications.
Risk of additional surgery after cesarean
Research has shown that there is an increased risk of bladder repair and repeat cesarean.
Risk of hysterectomy6
Women undergoing cesarean have an increased risk of requiring a hysterectomy in the present pregnancy or in future pregnancies, often due to uncontrollable bleeding.7,8
Endometriosis is a condition in women in which endometrial-like cells appear and flourish in areas outside the uterine cavity. Endometrial cells are under the influence of female hormones and respond in a way that is similar to the cells found inside the uterus. Symptoms often worsen with the menstrual cycle. The main symptom is pelvic pain in various manifestations. Women who undergo cesareans are at risk for endometriosis at the site of the incision and may need major surgery to remove the abnormal cells.
Heart and lung complications11
Many women who undergo cesarean section have twice the risk of rehospitalization for cardipulmonary conditions.11
Risk of rehospitalization for complications related to surgery11
Cesarean patients have twice the risk of rehospitalization for conditions such as uterine infection, obstetrical surgical wound complications, thromboembolic conditions (blood clots), gallstones and appendicitis in the following year. Deep venous closts can travel to the lungs and brain causing pulmonary embolism or stroke, respectively.
There is a greater risk of maternal death for a cesarean birth than with a vaginal birth. According to the International Cesarean Awareness Network, (ICAN) the cesarean maternal mortality rate is at least 2-4 four times that of women who have vaginal births. Approximately 180 women die annually in the United States from elective repeat cesareans.13
Complications resulting from anesthesia and medication11
There is a risk of a negative reaction to the anesthesia administered in order to perform the surgery or a negative reaction to pain medication given after the procedure.
Complications arising from scar tissue formation
Potential chronic complications from scar tissue adhesions include pelvic pain, bowel problems, and pain during sexual intercourse.14
The formation of scar tissue may also lead to future pregnancy complications such as placenta previa (low lying placenta), placenta accreta (placenta too deeply attached) or placental abruption (placenta separates from uterus)15,16,17,18.
These placental conditions can potentially threaten the life of both the mother and baby in future pregnancies.
Scar tissue and chronic adhesions make future cesareans more difficult to perform, increasing the risk of injury to other organs.
The risk of secondary infertility, miscarriage and ectopic pregnancy and unexplained stillbirth in subsequent pregnancies is also increased after a cesarean section.
Rate of establishment and ongoing breastfeeding is reduced11
Since mothers and babies are not often placed skin-to-skin immediately their breastfeeding relationship is often at a disadvantage. Mothers who birthed by cesarean are less likely to room-in with their newborns and this affects attachment and bonding.
Extended hospital stay
After a cesarean, the usual hospital stay is 3-5 days, if there are no complications.
Extended recovery time
The total recovery time after a cesarean can extend from weeks to months, which affects many aspects of a woman's life. It can influence the bonding between mother and baby, particularly if there are complications. One in 14 women who had cesarean births report incisional pain six months or more after the operation.21
Negative emotional reactions21
Many women who have had a cesarean birth report feeling negatively about their birth experience and may have trouble with initial bonding with their baby. Reports show that their psychological well-being is compromised and that they experience an increased rate of emotional trauma.22
According to Christie Craigie Carter, from ICAN‘s Traumatic Birth Awareness Training program, many women report feeling the following:23
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Respiratory distress syndrome24-27
Babies born by cesarean have a high risk of respiratory distress syndrome (RDS), which can be fatal and a high risk of asthma.28
Cesarean babies tend to need more medical assistance due to breathing difficulties than babies born vaginally.
Babies born by cesarean may be removed from the womb prematurely, particularly if there was inaccuracy in determining the expected due date. A baby removed surgically could be at risk for prematurity and low birth weight and may experience respiratory problems as a result of under-developed lungs and may need to spend time in intensive care. Premature babies born by cesarean fare worse than premature babies that have a vaginal birth. They may also have difficulties with jaundice, dehydration, infection, feeding, blood sugar levels and maintaining body temperature. Later in life, preterm babies are also more prone to learning problems at school age.
Persisten pulmonary hypertension30
Pulmonary hypertension (PH or PHT) is an increase in blood pressure in the pulmonary artery, pulmonary vein, or pulmonary capillaries. Babies born by cesarean are five times more at risk of PPH.
Risk of laceration during surgery31
Researchers report that fetal laceration injury at cesarean delivery is not rare. The incidence increases when the baby is not positioned head-down.
Cytokines in cord blood altered32
Preliminary studies also have found cesarean delivery significantly alters the capability of cord blood mononuclear cells (CBMC) to produce cytokines. Cytokines are small proteins that are secreted by specific cells of the immune system and glial cells, which carry signals locally between cells, and thus have an effect on other cells.
Low APGAR scores 29
The effects of anesthesia, fetal distress before birth or the lack of stimulation while passing through the birth canal may account for lower APGAR scores for babies born by cesarean. Babies born surgically are 50% more likely to have lower APGAR scores babies birthed vaginally.
Delayed attachment and family bonding2,33,34,35
Cesareans may delay the early mother-newborn interaction, the initiation of breastfeeding, and the establishment of family bonds.
Death in the first 28 days after birth36
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