Knowing the possible benefits and risks of having a c-section can help you decide how you would like to give birth. Opting for a caesarean birth can depend on a variety of factors – such as whether you are having a planned or emergency c-section, your general health and your baby’s wellbeing. Throughout this article, I aim to discuss the benefits and risks of caesarean birth to ease any concerns, and to provide expert & research-led insights towards your birth options. You can also find my article ‘Benefits and risks of vaginal birth’ within my portfolio of free content on bloss, to ensure you are fully informed on each birth option. Let’s get started.
What are the benefits and possibilities of a caesarean birth and why might I be offered a caesarean birth?
Common reasons to be offered a caesarean include:
- IUGR (a baby who has stopped growing)
- Twins, particularly if neither baby is head down or engaged, or if there are concerns with growth or wellbeing of the baby
- Any baby with abnormal monitoring or scans
- Placenta previa
- Breech baby (particularly if baby is not in a frank breech position)
- Vasa previa
- Other fetal or maternal health conditions on an individualised basis
In addition you can also request a caesarean birth. You will be counselled regarding the risks and benefits, particularly to the long term health and wellbeing implications, particularly for any future pregnancies you may be planning.
What are the benefits of a planned caesarean birth?
- Can be the safest way for a baby to enter the world with certain medical or pregnancy complexities.
- No perineal tearing or vaginal tearing
- Not feeling discomfort in labour
- Postpartum bleeding is shorter in length
- Lower chance of pelvic organ prolapse compared to vaginal birth (5.6% compared to 6% vaginal birth. NIHR, 2018)
- Lower chance of incontinence (does not remove the need to do pelvic floor exercises, the pregnancy weakens the pelvic floor regardless of which way a baby is born). The chance with a planned caesarean birth is 13% compared to 21% with spontaneous vaginal birth and 36% with a forceps birth.
- Can be mentally positive and empowering for women. A caesarean can provide control particularly for women who have experienced previous birth trauma.
- Can choose a date and time (however if the unit is incredibly busy the planned caesarean lists can sometimes be delayed)
What are the possibilities with a caesarean birth?
- 1 in 4 women will have another caesarean in future pregnancies
- 1 in 10 women will have a wound infection. Antibiotics are always given in theatre to reduce this risk, instruments are always sterile and good wound care postnatally can help prevent infection. In addition having a BMI over 30 has a higher chance of infection compared to women with a BMI under 30.
- 1 in 10 women will go into labour before the planned caesarean date (increasing the risks of a caesarean to the mother as labour has already began). Planned caesareans without labour before 39 weeks increases the chances of a baby going to the neonatal unit with breathing problems, which is why planned caesarean births are not usually booked until 39 weeks unless there are other medical or pregnancy complications.
- 9 in 100 women will have persistent abdominal pain in the first few months after surgery.
- 5 in 100 women will have a postpartum haemorrhage (higher in an unplanned caesarean at around 20-22%, variable depending on when the caesarean birth was done, length of labour, whether oxytocin was used, medical and obstetric and pregnancy history).
- 5 in 100 women will be readmitted to hospital (with pain, infection or other complications)
- 1 in 200 chance of uterine rupture in future pregnancies (lower if a woman has more than 18 months between the previous caesarean birth and the start of the next pregnancy)
- 7-8 in 1000 women will have an emergency hysterectomy, (more likely in unplanned caesareans or women who have had multiple caesarean births)
- 9 in 1000 women will be admitted to ICU. This is usually due to the risk factors above.
- 4-16 in 1000 women will develop blood clots (those women at high risk will be advised to wear TED stockings and self administer blood thinning injections for ten days, alongside mobilising and hydration which significantly lowers the risks. Not smoking also lowers the risk further).
- 10-15% of women will develop a paralytic ileus (where the bowel stops working) which in serious but rare cases leads to severe pain, NG tube feeding, hospitalisation and antibiotics to prevent bowel damage or perforation. There is no data for absolute risk at the severe end of the scale.
- 5 in 1000 women will require further surgery. This is often linked to the other complications complications reasons and Readmission. Examples include surgery for bleeding or wound infection.
- 1 in 1000 women will have bladder damage (more common with 3 or more caesarean births due to scar tissue and adhesions)
- 1 in 359 women will have a placenta previa (where the placenta covers the cervix and can cause miscarriage, stillbirth and be life threatening for the woman, usually requiring long term hospital admission in pregnancy) in a future pregnancy – this risk becomes higher with every caesarean birth a woman has.
- Small increased miscarriage risk in future pregnancies and possibly increased ectopic pregnancy risk (NIHR, 2018. O’Neill, 2014). Interestingly, one study found a reduction in miscarriage risk in women who had a maternally requested first caesarean birth. There needs to be more data and research in this area to give absolute risks, and particularly for more than one caesarean birth. NIHR report around a 1:69 chance of miscarriage, but further data is needed to confirm.
- Increased stillbirth chance in future pregnancies. This is difficult give complete overall risks due to different studies, limited research and the lack of randomised trials, so here is some of the evidence: Smith and (2003) found the absolute risk from their large study was 1.1 per 1000 women with a previous caesarean birth having an unexplained stillbirth in a future pregnancy compared to 0.5 per 1000 women who had a previous vaginal birth from 34 weeks. Stillbirth risks vary by study, and because there are other known factors (like smoking, medication/drug use, placental abruption, pre eclampsia, uncontrolled diabetes, gestation) without a randomised trial only correlation looking at population groups can be found rather than cause and effect. The risks of placenta previa and uterine rupture can also lead to a stillbirth if they aren’t recognised and responded to quickly which is another factor when exploring increased stillbirth chance after a previous caesarean birth. Bjellemo et al (2020) found the chance of pre term birth, stillbirth, cerebral palsy, small for gestational age baby, pre eclampsia, postpartum heamorrhage and placental concerns after one previous caesarean birth compared to previous vaginal birth. There were limitations of this study but it was a large study. Taylor, 2005 found the same chances increasing after one previous caesarean birth compared to vaginal birth as a first birth mode.
- Increased placenta accreta in future pregnancies (where the placenta vessels embed through the uterus and into the abdominal cavity or other organs). There is no absolute risk, but there is an small observed upward trend on the MBRRACE UK of placenta accreta data as caesarean births increase, placenta accreta is rising too. These can be more common with diagnosed placenta previa.
- Increased chance of endometriosis (some studies report around 1-2% increase compared to vaginal births).
- Increased chance of difficulty in trying to conceive (Kjurlff, 2020) the difficulties in research available is that it is limited, and difficult to know if fewer women decide to have future children after one caesarean birth (as family dynamics vary), whether implantation is as easy with previous uterine surgery, whether there were reasons in the first place with having a caesarean birth which impacts fertility or whether birth trauma also inhibits women in having more babies. There is no absolute risk in this area due to limited research currently. Secondary infertility can happen to anyone, however in the limited evidence available currently it appears that a caesarean birth may be linked to conception difficulties. More research is needed in this area, with much larger scale population studies. Recognition of secondary infertility also needs to be explored further too.
- Longer recovery time compared to spontaneous vaginal birth
- Unable to drive until 6 weeks postpartum or signed off by GP
- 4-5% chance (4-5:100) of a baby being admitted to the neonatal unit with breathing difficulties. This is called respiratory distress or transient tachyapnea of the newborn (RDS, TTN). This is due to not entering labour, the lungs not being squeezed through the pelvis (which is why there are some studies exploring gentle caesarean births or some pre labour preparation to see if this has an impact – outcomes to be awaited). This often results in a 2-7 day stay in the neonatal unit for the additional breathing support.
- Increased chance of asthma (3.3% compared to 3% vaginal birth – studies vary hugely in these statistics) for babies (NIHR, 2018. RCOG). Breastmilk can lower this chance, along with other factors like where a person lives (air pollution), family history even having pets is linked to lowering these risks. There is an increased chance of eczema and allergies too in babies following caesarean birth. What is difficult to know is whether this is the caesarean birth itself being sterile and not swallowing vaginal fluid which lines the baby’s gut to protect future health, or whether this could be linked to the antibiotic use.
- Increased chance of obesity (12.5% vs 9% in vaginal birth again studies varying largely). The theory behind eczema, allergies, asthma, obesity is to do with the good friendly bacteria which is swallowed during labour and coming through the vagina in lining the skin microbiome. Babies born vaginally at home have the highest bacterial species on stool samples for up to 6 months postnatally, followed by vaginal births, then unplanned in labour caesarean and then planned caesarean births. Microbiome research is relatively new around 20 years old and ever advancing. All of these factors are all also reduced by giving breastmilk. Research is currently exploring whether vaginal swabbing and seeding or probiotics may lower these chances for babies born by a caesarean birth, but the evidence in these areas is incredibly limited. Probiotics for mums after antibiotic use can help replenish their gut microbiome. In addition there is small amounts of evidence for babies with diagnosed cows milk protein allergy after birth, but further research is required to confirm, and then explore whether these could be used as a preventative measure.
Finally a caesarean birth can be empowering. It can be positive. You always have choices and options, and I shall put together another article for your choices in a caesarean birth. Check out my highlights and Instagram page for caesarean birth videos, positive caesarean birth stories and updated evidence based information. And remember you are incredible for growing and birthing a baby.
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