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Caesarean birth: what are the risks and benefits?

Woman on the operating table having a caesarean section.
Photo credit: iStock.com / AngelIce

If there are no complications with your pregnancy or labour, a vaginal birth is safer than a caesarean birth. This is true for your current pregnancy, and for any future pregnancies, because complications are more common with c-sections. A vaginal delivery is also better for your future fertility.

How safe is a c-section?

All operations carry some risk. A caesarean involves major surgery in your tummy and pelvic area, and complications and re-admissions into hospital afterwards do sometimes happen.

However, serious complications are rare for a first caesarean section, particularly if it's planned (elective), and you’re fit and healthy.

Sometimes, a caesarean birth is needed to save the life of a mum or baby, in which case it is without question the safest option. If your labour isn’t progressing, even after you’ve been induced, you may also need to consider a caesarean.

In some cases, your doctor may offer you the choice between being induced and having a caesarean. Having an induced labour can lead to more interventions, such as an assisted birth with ventouse or forceps, and these carry risks too. So you and your doctor will need to weigh these risks against the risks of having a caesarean.

There are times when the decision is not clear-cut. It will be up to you and your doctor to weigh up the risks and benefits of having a caesarean, and to decide what's best for you. This may happen well before you’re due to give birth, or while you’re in labour, so knowing the facts may help you to prepare.

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What are the risks of having a caesarean?

Pain

You will need pain relief for a while after the operation, and it will take longer to recover than if you'd had a straightforward vaginal birth. You'll probably feel pain in your wound for the first few days. About one in ten people continue having some discomfort in their tummy and wound for a few months after the operation.

A caesarean may affect your day-to-day activities for some time.

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Bleeding

You will usually lose more blood overall with a caesarean than with a vaginal birth. Most of the bleeding will be during the surgery so will be managed by your doctor. One of the main risks of caesarean birth, though, is bleeding more than expected during the procedure. Very heavy bleeding is uncommon, but it may mean that you need to have a blood transfusion. This may sound scary, but you’re in the right place to be treated quickly.

Infection

About one in 12 people get an infection after having a c-section, so before you go into surgery, you'll be offered a single dose of antibiotics, to reduce your risk.

The three main types of infections are:

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  • Infection in your wound. Symptoms include redness and discharge, worsening pain in the wound and separation of the wound. The wound may also be hot or you may have a temperature. Infection is more likely to happen if you have diabetes or are overweight or obese.
  • Infection of the lining of your womb (uterus) called endometritis. Symptoms include heavy bleeding, irregular bleeding, pain in your tummy, smelly discharge and fever after the birth.
  • Urinary tract infection as a result of having a thin tube (catheter) inserted to empty your bladder. Symptoms include pain low down in your tummy or groin, a high temperature, chills and confusion. The catheter is usually inserted during the operation and may be left in for at least 12 hours or until you are mobile.

 

Blood clot

As with any surgery, a c-section raises your chance of developing a blood clot, and this can be serious, depending on where the clot lodges. If the clot lodges in your lungs (pulmonary embolism), it can even be life-threatening. Signs include a cough or shortness of breath, or pain and swelling in your calf. Call your doctor if you notice any of these signs after your caesarean.

Your medical team will give you preventive treatments, such as blood-thinning drugs and elastic support stockings, to improve the blood flow in your legs. You'll be encouraged to move around as soon as possible after your caesarean. This will help your circulation and reduce the risk of a clot forming. After you’ve been discharged, it’s important to carry on with any blood-thinning medication at home.

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Adhesions

A caesarean carries a risk of developing adhesions as you heal. Adhesions are bands of scar tissue that can make organs in your tummy stick to each other, or to the inside wall of your tummy.

It's hard to say exactly how many people are affected by adhesions after a c-section, as most of the time they don't cause any symptoms and don’t need treatment. It’s estimated that at least one in four people who have had a caesarean will have adhesions. However, the rate of adhesions increases the more caesareans that you have.

Adhesions can occasionally be painful, because they limit the movement of your internal organs. They can sometimes lead to blockages in your gut and problems with fertility if they press on or block neighbouring organs. Problems are not common though and treatments are available.

Effects of anaesthetic

Most caesareans are carried out with an epidural or a spinal to numb your tummy, as it's safer than having a general anaesthetic. But having any anaesthetic involves a small risk. After an epidural or spinal, you may have:

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  • A severe headache. You may also be sensitive to light. Severe headaches affect between one in 100 and one in 500 people having a c-section and are more likely if you've had more than one type of regional anaesthetic leading up to the birth.
  • Nerve damage. Though this rarely happens, and usually only lasts for a few days or weeks. Permanent nerve damage is very rare.

Should I be worried about serious complications after a caesarean?

About one in ten people need to spend some time in a high-dependency unit after a caesarean, because of complications. Being in a high dependency unit means that hospital staff can give you more one-to-one care than you may have on a normal ward. Your baby can stay with you in a high dependency unit.

Thankfully, most serious complications are rare, although they do become more common if you’ve had three or more caesareans. These include:

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  • Injury to your bowel or bladder. This happens in about one in 1,000 women who have caesareans.
  • Injury to the tubes connecting the kidneys to the bladder (ureters). This is rare, and happens to about three in 10,000 women.


The risk of needing further treatment after a caesarean is also small, but may include:

  • Being admitted to intensive care after a caesarean. This happens to about one in every 100 women.
  • Having an emergency operation to remove the womb (hysterectomy). This happens to about seven to eight in 1,000 women.

What are the risks to my baby after a caesarean?

Your baby is likely to be perfectly well, both during and after the caesarean. The most common problem is that some babies may have some temporary breathing difficulties. This is not usually serious, but some babies may need to have special care to help them to recover, usually only for a short time.

Breathing problems are more likely if your baby is born by caesarean before 39 weeks of pregnancy. After this time, the risks are much lower.

About one in 50 babies are accidentally nicked with the doctor's scalpel, but this usually heals without causing any harm.

Babies born by caesarean are more likely to need a stay in the neonatal care unit than babies born vaginally.

In the long term, being born by caesarean may slightly increase the risk of your baby developing asthma in childhood. There is some evidence to suggest that it may also slightly increase their risk of becoming overweight during childhood, but more research is needed to understand this link.

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Will having a caesarean affect future pregnancies?

Possibly. Once you've had one caesarean, you're more likely to have another caesarean in future pregnancies. However, most people who have previously had a caesarean will be able to have a vaginal birth in their next pregnancy. This is called a vaginal birth after caesarean (VBAC), and your midwife will discuss this with you during your next pregnancy.

Having had a caesarean increases your risk of having a low-lying placenta (placenta praevia) in future pregnancies. Having a low-lying placenta increases your risk of the placenta embedding too deeply (placenta accreta), particularly if you've had two or more caesareans before. This complication can result in losing a lot of blood at the birth, a greater need for blood transfusion and possibly hysterectomy.

There is a small risk of the scar on your womb opening up again in future pregnancies or births (uterine rupture), though this is uncommon. About one in 200 women who have had a previous caesarean experience this when trying for a VBAC. Rest assured that your midwife will be monitoring the progress and duration of your labour to ensure that the chances of this happening are small.

Sadly, and for reasons we don’t yet understand, the chance of stillbirth in a future pregnancy is also slightly increased if you've had a caesarean, although it is still very uncommon.

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What should I know about recovery after a caesarean?

You're likely to recover well from your caesarean if you're fit, healthy and not overweight. If your BMI was 30 or more before pregnancy you may be more at risk of complications, such as bleeding and infection. This can make recovery more difficult and result in a longer hospital stay. About three to five in every 100 women are also readmitted to hospital for these reasons.

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You may have heard scare stories about postnatal depression after a caesarean. Try not to let these worry you. Experts now say that having a caesarean makes postnatal depression no more likely than if you’ve had a vaginal birth.

If you want to breastfeed your baby, ask for help from a midwife or breastfeeding counsellor from the start. You may need more support than someone who's had a vaginal birth, such as physical help in getting your baby into the right position. However, once you've started, your chances of success are the same as for someone who's given birth vaginally.

What are the advantages of caesarean birth?

If you’ve been advised by your doctor to have a caesarean, then you’ll know that it’s likely to be the safest way for your baby to be born and for you to give birth.

Having a planned caesarean also means you know when your baby will be born. If you have older children you can arrange childcare in advance of the big day.

You won't have the pain of contractions to contend with, and you won’t have to worry about tearing to the area between your vagina and back passage (perineum).

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You may still experience some of the discomforts that can result from a vaginal birth, but a planned caesarean may make the following less likely:

  • Pain from bruising or stitches to your vagina and perineum.
  • Heavy bleeding in the first few days after the birth
  • Leaking wee when you cough or laugh (stress incontinence), although this still affects about one in 25 people three months after caesarean.


Pregnancy can weaken your pelvic floor. So it's important to do your pelvic floor exercises during pregnancy as well as afterwards, however you gave birth. When your doctor has given you the all clear, you can try this postnatal workout for your core and pelvic floor.

Find out more about what a caesarean involves.

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BabyCentre's editorial team is committed to providing the most helpful and trustworthy pregnancy and parenting information in the world. When creating and updating content, we rely on credible sources: respected health organisations, professional groups of doctors and other experts, and published studies in peer-reviewed journals. We believe you should always know the source of the information you're seeing. Learn more about our editorial and medical review policies.

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Chess Thomas

Chess Thomas is a freelance health writer and former research editor at BabyCentre.

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