Category Archives: Post Partum Depression

Cesarean Risks: Overview

We all know the primary risk of VBAC – uterine rupture.  And when your typical VBACing mom meets with an OB, she must sign a “VBAC consent form” acknowledging that she understands this risk.  However, I find it ironic that women signing up for a repeat cesarean are not required by their OB to sign a “Repeat Cesarean Section consent form” as a matter of course during prenatal exams since there are risks associated with cesarean section.   But since this does not happen, and most OBs breeze over the risks if they even bother to mention them, expectant moms are lead to believe that VBACs are risky and cesareans are not.

What most moms signing up for cesareans don’t know, is that this decision not only introduces risks that can impact them or their baby immediately, but this decision also impacts their future fertility as well as future cesarean deliveries and babies.  And some of these complications increase with each surgery.  As they say, “Clearly, all the risks of primary cesarean delivery are only increased for repeat cesareans, and increase even more with third, fourth, and higher-order cesarean deliveries.”

This is a great article detailing the risks of cesareans, but I’ll just list the risks below.  If you wish to read more in detail, you can go here: Risks Associated With Cesarean Delivery

Short-term Risks of Cesarean Delivery

  • Maternal Death (yeap, that is the first one they list)
  • Thromboembolism – which is define as “blockage of a blood vessel by a clot that can travel in the bloodstream to the heart, lungs or brain and cause serious damage.”  If the clot goes to your brain, that’s a stroke.  It goes to your heart, that is a heart attack.  If the clot goes to your lungs, that’s a pulmonary embolism.  None of these things are good.
  • Hemorrhage – “The risk of hemorrhage requiring blood transfusion increases substantially with increasing number of prior cesarean deliveries.”
  • Infection – “most common complications of cesarean delivery” affecting 85% of women who labored prior and 4-5% of women with intact membranes.  “Wound infections may occur in 2.5% to 16% of cesareans.”
  • Incidental Surgical Injuries – typically the bladder, bowel or ureters which, if not corrected soon, can cause other complications such as sepsis (major, serious infection), renal (kidney) failure, or fistula formation. 
  • Extended hospitalization– some people view their stay at the hospital as a vacation, me, I like my vacations pain free and with better food, but to each their own!
  • Emergency Hysterectomy – This unfortunately happened to this woman.  “. . . those who did have a hysterectomy were 13 times more likely to have been delivered by cesarean section.”
  • Pain – This little word is so powerful.  Pain is such an easy thing to overlook or to say, yeah, that’s obvious, but when you are trying to care for a newborn, or a newborn and an older child, the risk of pain is huge.  And pain for some women can go on for months.  It took me 18 months for my scar to not be oddly numb, yet sensitive. From the article, emphasis mine:
    • “A study of 242 primiparous women reported that all those who underwent cesarean deliveries (both planned and unplanned) required narcotic pain medications compared with 11% of those who delivered vaginally.Having to relieve pain with narcotic pain medications can have a significant impact on initial bonding between the mother and the newborn and on breastfeeding success rates, as well as maternal functioning postpartum; in addition, the risk for postpartum depression may be greater.”
  • Poor Birth Experience – “more likely to report dissatisfaction with their birth experience compared with those who delivered vaginally . . . less early contact with their newborns . . . significantly longer time before their first contact with their baby . . . more likely to cite a poorer score for their initial contact with their baby.”

Long-term Risks of Cesarean Delivery

  • Readmission to the Hospital – ” . . . postpartum readmission to the hospital was significantly greater for those who delivered by cesarean delivery.”
  • Pain – ” . . . more likely to report pain to be a problem in the first 2 months after delivery.”  A survey of 1500 women who had cesareans in the past 24 months said, “incisional pain was a major problem 25% of the time, and a major or minor problem 83% of the time” and at 6 months postpartum, 7% of CS moms reported incisional pain compared with 2% of vaginal birth moms who reported perineal pain.
  • Adhesion Formation – “. . . is common and significantly contributes to the risk of complications at future deliveries . . . reported increased risk of ectopic pregnancy among women with prior cesarean deliveries.”
  • Infertility/Subfertility – “. . . more likely to be unable to conceive a pregnancy for more than 1 year”

Risks for the Newborn of Cesarean Delivery

  • Neonatal death (they listed this first)
  • Respiratory difficulties – “. . . probably result from a failure of the mechanisms to resorb fetal lung fluid that are typically triggered during vaginal birth . . .3 times more common after elective cesarean delivery than after vaginal delivery”
  • Asthma – “. . . 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”
  • Iatrogenic Prematurity – This means that the baby was premature because the cesarean occurred before the baby was ready to be born.  This typically happens with scheduled cesareans.
  • Trauma – Meaning the baby is accidentally cut by the surgeon
  • Failure to breastfeed

Risks of Cesarean Delivery to Future Pregnancies

  • Uterine Rupture – For more stats on this go here.
    • A population-based study of more than 255,000 women in Switzerland found that the incidence of uterine rupture for a woman with no previous cesarean delivery was 0.007%. That incidence rose to 0.192% for a woman with a prior cesarean delivery who planned a repeat cesarean delivery, and rose even higher to 0.397% for women who planned a trial of labor after a prior cesarean delivery. 
  • Abnormal Placentation – This means that your placenta either implants over the opening of the cervix (placenta previa) which means you have to have another cesarean or that your placenta grows through the uterine wall (placenta accreata) which can mean the placenta needs to be manually or surgically removed and puts you at a greater risk of post-partum hemorrhage.
    • . . . women with at least 1 prior cesarean delivery had approximately 3 times the risk of having a placenta previa at the time of delivery compared with women with no prior cesarean deliveries, and this risk increased substantially with increasing numbers of prior cesarean deliveries — reaching nearly 45 times the risk for women with 4 or more prior cesarean deliveries.
  • Hysterectomy – “As the number of prior cesarean deliveries rises, the risk of cesarean hysterectomy increases dramatically.”

As I’ve said before:

VBACs have risks.

Cesareans have risks.

Please understand all the information before making a decision.

Learn more here: Elective Cesarean Surgery Versus Planned Vaginal Birth: What Are the Consequences?