The 5 Real Risks of a C-Section
Last week, I counseled a second-time mother on her upcoming scheduled cesarean section.
After a very difficult previous delivery that involved a fourth-degree tear (ouch!) and a baby that was larger than average, she and her doctor had decided that the best course of action for her to take was planning a c-section at 39 weeks.
Understandably, she was nervous about her first c-section and asked me many questions. I tried my hardest to calm her fears, but in reality, I completely understood. As an OB nurse, I've been in on countless c-sections, being the first person after the doctor to hold a baby fresh from his mother's womb, so in a way, the surgery seems pretty routine to me–but that doesn't mean I'm not aware of the risks that can accompany the procedure.
So, just what are the real risks involved with a c-section?
Scar tissue/uterine weakening. One of the biggest risks for a c-section is not necessarily within the surgery itself, but what comes after the surgery, especially for mothers who want to have more children. Because a c-section literally cuts through the uterine muscle, it weakens the muscle fibers. As the incision heals, scar tissue replaces the healthy tissue, making the uterus much more susceptible to splitting open, through what is called a uterine rupture. According to an article by the National Institute of Child Health and Human Development, the risk of uterine rupture increased by a factor of 5 for each repeated indicated c-section. Or, in other words, the more c-sections, the higher the risk of uterine rupture. Which makes sense.
Trouble breastfeeding. Unlike a vaginal delivery, where a mother can literally be breastfeeding her infant seconds after giving mother, a mother in a c-section often has a much longer recovery time. After the surgery itself, which can take upwards of 30 minutes to complete after the baby is delivered, a mother usually has a one to two hour recovery time where she is carefully monitored by a nurse. She may have received additional drugs that make her drowsy during the surgery and it is often very difficult and painful for her to hold her baby right away and/or initiate breastfeeding. One study by the Neonatal Medicine, Department of Medicine in London found that early initiation of breastfeeding was, predictably, much lower for mothers who had received c-sections.
Respiratory problems for baby. The risks for the baby in a c-section are often two-fold, because many c-sections are usually “emergency” surgeries — wherein the baby has displayed some type of distress during labor or there is a dangerous condition with the mother — c-section babies are naturally more prone to have negative outcomes at birth, since that's what usually caused the c-section in the first place. Further complicating matters is that c-section babies are notorious among healthcare staff for having trouble breathing. Unlike a journey through the birth canal, when a baby will have all of the secretions of birth “squeezed” out on her way out, a baby delivered through c-section may swallow mucus or have a more difficult time clearing secretions, which can lead to respiratory problems. The American Association of Pregnancy reports that many studies have found an increased incidence of newborns needing breathing assistance after a c-section.
Hemorrhage. Obviously, the risk of blood loss is elevated with any type of surgery and the American Pregnancy Association reports that 1 in 6 women receiving a c-section will require a blood transfusion. One of the most common fears with a c-section is that the bleeding might actually lead a woman to require an emergency hysterectomy — especially a worry for women who would like to have more children. However, according to the American College of Obstetricians and Gynecologists, the risk of an emergency hysterectomy for a mother with a planned c-section versus a mother having a vaginal birth is about the same; however, for mothers on their second or more c-section, the risks become much higher.
Infection. Again, it might seem obvious, but infection following a c-section is definitely a risk that is much higher than with a vaginal birth. Opening the body up in an “unnatural” way, human error, and the use of surgical instruments all make a mother with a c-section more susceptible to an infection. Again, the ACOG states that maternal infection is increased in c-sections and can range from infections at the incision site to internal infections of the uterus.