Caesarean delivery has immediate known benefits and risks for those women who need help in childbirth.
The risks associated with cesarean delivery can be divided into those that are short term, those that are longer term, and those that present risks to future pregnancies. There are also risks to the newborn that need to be considered.
Maternal Death. The risk of maternal death during childbirth is greater with cesarean delivery compared with vaginal delivery, although very low.
Thromboembolism. One of the leading causes of maternal mortality related to cesarean delivery is deep vein thrombosis resulting in pulmonary embolism.
Hemorrhage. Blood loss during a cesarean delivery may be greater than during a vaginal delivery.
Infection. Infection is one of the most common complications of cesarean delivery. In the absence of prophylactic antibiotics, the rates of postpartum endomyometritis can be as high as 35% to 40%.
Incidental Surgical Injuries. Bladder injuries are the most common injuries to surrounding structures occurring at the time of cesarean delivery.
Less common surgical injuries involve the bowel or ureters. Risk factors for any of these injuries are prior pelvic surgery (including prior cesarean deliveries), emergency cesarean delivery, and cesarean-hysterectomy. Early recognition and prompt management of these injuries are key to preventing the development of further complications, such as sepsis, renal failure, and fistula formation.
Extended Hospitalization. A woman who has had a cesarean delivery typically remains hospitalized longer than one who has had a vaginal delivery and has increased risk for readmission. Patients who delivered abdominally are usually discharged on the 3rd or 4th postpartum day compared with the 1st or 2nd postpartum day for those who deliver vaginally. The average length of hospitalization may even be longer given some of the complications (eg, postpartum infections) that are more common in women who deliver by cesarean section.
Emergency Hysterectomy. The risk of the need for hysterectomy after or during a cesarean delivery is greater than after a vaginal delivery.
Pain. Women who undergo cesarean delivery more commonly experience pain after delivery compared with those having vaginal deliveries.
Poor Birth Experience. women who delivered healthy babies by cesarean section (both planned and unplanned) were more likely to report dissatisfaction with their birth experience compared with those who delivered vaginally.
Women who deliver by cesarean have less early contact with their newborns than those who deliver vaginally, and typically have to wait a significantly longer time before their first contact with their baby.
Readmission to the Hospital. the rate of postpartum readmission to the hospital was significantly greater for those who delivered by cesarean delivery than for those who delivered vaginally and this increased risk persisted even after controlling for obstetric and intrapartum complications
Pain. Women who undergo cesarean deliveries are more likely to report pain to be a problem in the first 2 months after delivery.
Adhesion Formation. Adhesion formation resulting from cesarean delivery is common and significantly contributes to the risk of complications at future deliveries (see below). Adhesions arising from cesarean deliveries can also on rare occasions contribute to other complications, such as small bowel obstruction.
These adhesions may also be contributing to the reported increased risk of ectopic pregnancy among women with prior cesarean deliveries.
Infertility/Subfertility. An observational study of nearly 4000 women reported that women who had undergone cesarean delivery were more likely to be unable to conceive a pregnancy for more than 1 year
Neonatal Death. Although cesarean deliveries are typically performed for the benefit of the fetus, there are also risks for the newborn. In fact, babies both born by planned as well as unplanned cesarean deliveries had a nearly 4-fold risk of dying before discharge compared with those delivered vaginally (8 deaths per 10,000 births for each planned or unplanned cesarean deliveries and 2 per 10,000 for those delivered vaginally).
Respiratory Difficulties. Most well described are the respiratory difficulties encountered in newborns delivered at term. These respiratory difficulties, known as transient tachypnea of the newborn (TTN), probably result from a failure of the mechanisms to resorb fetal lung fluid that are typically triggered during vaginal birth
Asthma. Several studies have reported an association between cesarean delivery and the later development of asthma. One of these studies examined more than 40,000 children delivered by cesarean and found that those delivered either by planned or unplanned cesarean were approximately 30% more likely than those delivered vaginally to have been admitted to the hospital for asthma during childhood. This increased risk of asthma may persist into adulthood. In a study of more than 9700 Danish women, the authors found that those who were delivered by cesarean were also approximately 30% more likely to report that they ever had asthma.
Iatrogenic Prematurity. Also encountered more commonly with planned cesarean deliveries than those performed after the onset of labor is iatrogenic prematurity. This occurs occasionally even for babies thought to be full term.
Trauma. Babies delivered by cesarean are also at risk of trauma, most commonly as the result of surgical cuts, particularly during emergency deliveries.
Failure to Breastfeed. babies delivered by cesarean were less likely to be breastfed compared with those who were delivered vaginally, and this effect seemed to be stronger for those delivered by unplanned cesareans. mothers who underwent planned or unplanned cesarean deliveries were nearly twice as likely to have breastfeeding difficulties compared with those who delivered vaginally.