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Risks of Cesarean

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.

Risks of Cesarean for Mothers

Risks of Cesarean for Babies

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.

Read about the how the pelvis is designed for birth and about cephalo-pelvic disproportion. Research shows that this can never be accurately determined until a trial of labor.1

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.

Risks of Cesarean for the Mother

Many of the following risks are also possible with other types of abdominal surgery.

Major infection1

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

Incisional endometriosis9,10

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.

Maternal mortality12

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

  • A sense of loss: birth didn‘t turn out like expected, loss of the experience of participating in the birth experience, not being there when the baby enters the world
  • Interrupted relationship with baby: feelings of detachment from her baby
  • Altered identity: sense of failure, feminine identity altered; lowered confidence in her body
  • Intimations of mortality: surgery gives “rise to fears about mortality”
  • Feelings of violation: from surgery where the body boundaries are violated, feeling “mutilated” or “butchered”
  • Anger at caregivers: particularly regarding “what was perceived to be an unnecessary cesarean, lack of involvement in medical decisions, feeling unsupported by hospital staff before, during and after the cesarean”
  • Dissociation: feeling that the surgery was taking place on someone else or from a distance
  • Humiliation: being scolded
  • Helplessness: not being able to take care of herself or her baby
  • Post-traumatic Stress Disorder symptoms: anxiety, trouble sleeping, panic attacks

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Risks of Cesarean and Complications for the Baby

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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More Pages Related to Risks of Cesarean

Reasons for Cesarean Section

Planning a Cesarean Section

Recovery after Cesarean Birth

Risks and Benefits of VBAC vs Risks of Cesarean

Video Report on High Cesarean Rate

Cesarean Birth Videos

Back to Cesarean Section

References for Risks of Cesarean for Mothers

  • 1. Henderson EJ & Love EJ. Incidence of hospital-acquired infections associated with cesarean section. J Hosp Infect 1995; 29: 245-255.
  • 2. Van Ham MA, van Dongen PW & Mulder J. Maternal consequences of caesarean section. A retrospective study of intra-operative and postoperative maternal complications of caesarean section during a 10-year period. Eur J Obstet Gynecol Reprod Biol 1997; 74: 1-6.
  • 3. Naef RW III, Washburne JF, Martin RW et al. Hemorrhage associated with cesarean delivery: When is transfusion needed? J Perinatol 1995; 15: 32-35.
  • 4. Eisenkop SM, Richman R, Platt LD & Paul RH. Urinary tract injury during cesarean section. Obstet Gynecol 1982; 60: 591-596.
  • 5. Davis JD. Management of injuries to the urinary and gastrointestinal tract during cesarean section. Obstet Gynecol Clin North Am 1999; 26: 469-480.
  • 6. Engelsen, Ingeborg Bøe, Albrechtsen, Susanne & Iversen, Ole Erik. Peripartum hysterectomy-incidence and maternal morbidity. Acta Obstetricia et Gynecologica Scandinavica 2001 80 (5), 409-412.
  • 7. Stanco LM, Schrimmer DB, Paul RH, Mishel DR Jr. Emergency peripartum hysteretomy. A five year review. J Reprod Med 2000:45(9):96-8
  • Bakshi, S Meyer BA. Indications for and outcomes of emergency peripartum hysterectomy. A five-year review. J Reprod Med 2000; 45(9):733-7
  • 9. Wolf Y, Haddad R, Werbin N, Skornick Y, Kaplan O. Endometriosis in abdominal scars: A diagnostic pitfall. Am Surg 1996; 62(12):1042-4.
  • 10. Wolf GC, Singh KB. Cesarean scar endometriosis: A review. Obstet Gynecol Surv 1989; 44(2):89-95.
  • 11. Lydon-Rochelle M, Holt VL, Martin DP, Easterling TR. Association between method of delivery and maternal rehospitalization. J Amer Med Assoc 2000; 283(18):2411-2416.
  • 12. Bewley S, Maternal mortality and mode of delivery. Lancet 1999; 354:776
  • 13. ICAN Online Cesarean Fact Sheet,, retrieved 02 September 2010
  • 14. Ryding, Elsa Lena, Wijma, Klaas & Wijma, Barbro. Experiences of Emergency Cesarean Section: A Phenomenological Study of 53 Women. Birth 1998; 25 (4), 246-251.
  • 15. Lydon-Rochelle M et al..First birth cesarean and placental abruption or previa at second birth. Obstet Gynecol 2000;97 (5 Pt 1):765-9.
  • 16. Zaideh, SM et al. Placenta praevia and accreta: Analysis of a two-year experience. Gynecol Obstet Invest 1998; 46(2):96-8.
  • 17. Ananth, CV et al. The association of placenta previa with history of cesarean delivery and abortion: A meta-analysis. Am J Obstet Gynecol 1997; 177(5):1071-78.
  • 18. Miller DA, Chollet JA & Goodwin TM. Clinical risk factors for placenta previa-placenta accreta. Am J Obstet Gynecol 1997; 177: 210-214.
  • 19.Hemminki, E and Merilainen, J. Long-term effects of cesarean sections: Ectopic pregnancies and placental problems. Am J Obstet Gynecol 1996; 174(5):1569-74.
  • 20. Hall MH, Campbell DM, Fraser C & Lemon J. Mode of delivery and future fertility. Brit J Obstet Gynecol 1989; 96: 1297-1303.
  • 21. Declerq 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.
  • 22. 32. Lydon-Rochelle MT, Holt VL, Martin DP. Delivery method and self-reported postpartum general health status among primiparous women. Paediatr Perinat Epidemiol 2001 Jul;15(3):241-2.
  • 23. Reported by Udy, P. Emotional Impact of Cesareans, Midwifery Today Issue 89, Spring 2009

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References for Risks of Cesarean for Babies

  • 24. Morrison JJ, Rennie JM, Milton PJ. Neonatal respiratory morbidity and mode of delivery at term: Influence of timing of elective caesarean section. Br J Obstet Gynaecol 1995; 102:101-6.
  • 25. Hales KA, Morgan MA, Thurnau GR. Influence of labor and route of delivery on the frequency of respiratory morbidity in term neonates. Int J Gynaecol Obstet 1993; 43(1):35-40.
  • 26. Levine EM, Ghai V, Barton JJ, Strom CM. Mode of delivery and risk of respiratory diseases in newborns. Obstet Gynecol 2001;97(3):439-42.
  • 27. Parilla BV, Dooley SL, Jansen RD, and Socol ML. Iatrogenic respiratory distress syndrome following elective repeat cesarean delivery. Obstet Gynecol 1993; 81(3):392-5.
  • 28. CC Buhimschi, MD and I.A Buhimschi, MD, Advantages of Vaginal Delivery, Clinical Obstetrics and Gynecology, Volume 49, Number 1, 167-183
  • 29. Annibale DJ et al. Comparative neonatal morbidity of abdominal and vaginal deliveries after uncomplicated pregnancies. Arch Pediatr Adolesc Med 1995;149(8):862-7.
  • 30. Levine EM, Ghai V, Barton JJ, Strom CM. Mode of delivery and risk of respiratory diseases in newborns. Obstet Gynecol 2001; 97:439–42.
  • 31. Smith J, Hernandez C, Wax J 1997. Fetal laceration injury at cesarean delivery. Obstet Gynecol 90:344-6.
  • 32. Brown, Mark A., Rad, Parmis Y. & Halonen, Marilyn J. (2003) Method of birth alters interferon-gamma and interleukin-12 production by cord blood mononuclear cells. Pediatric Allergy and Immunology 14 (2), 106-111.
  • 33. Soet, Johanna E., Brack, Gregory A. & DiIorio, Colle en. Prevalence and Predictors of Women’s Experience of Psychological Trauma During Childbirth. Birth 2003; 30 (1), 36-46.
  • 34. Dahlberg, Karin, Berg, Marie & Lundgren, Ingela. Commentary: Studying Maternal Experiences of Childbirth. Birth 1999; 26 (4), 215-217.
  • 35. Rowe-Murray, Heather J. & Fisher, Jane R.W. Baby Friendly Hospital Practices: Cesarean Section is a Persistent Barrier to Early Initiation of Breastfeeding. Birth 2002; 29 (2), 124-131.
  • 36. MacDorman, M.F., Declerq, E., Menacker, F., & Mally, M.h. (2008).Neotnatal mortalisty for primary cesarean adn vaginal births to low-risk women: Application of an "intention-to-treat" model. Birth, 35(1), 3-8.

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