How safe is caesarean birth compared with vaginal birth?
A vaginal birth is safer than a caesarean birth. This is the case not just for your current pregnancy, but also for any more pregnancies you may have. A vaginal birth is also better for your future fertility. Although a caesarean section is a common procedure, all operations carry risk. A caesarean involves major surgery in your tummy and pelvic area.
Sometimes, a caesarean section is needed to save the life of a mum or baby. In these cases, caesarean birth is without question the safest option. But there are also times when the decision is not so clear-cut. It’ll be up to you and your doctor to weigh up the risks and benefits of having a caesarean to decide what’s best for you.
Your general health and your lifestyle will influence this decision. You have a higher risk of complications after a caesarean if you:
- Are overweight or obese
- Have had previous surgery on your tummy
- Already have a medical condition
If your labour has been induced, and is still not progressing, you may have to decide whether or not to have a caesarean. An induced labour can lead to more and more interventions by the medical team.
Some interventions, for example, an assisted birth with ventouse or forceps, carry their own risks. So you and your doctor will need to weigh these risks against those of a caesarean.
What are the main risks of having a caesarean?
1. Pain : The main disadvantage of caesarean birth is pain after the operation. You’re likely to have pain in the wound and discomfort in your belly for at least a few weeks after the operation. You will be given drugs to help you cope with the pain, but it will affect your day-to-day activities for some time.
2. Infection : Before you go into surgery you’ll be offered a single dose of antibiotic to reduce your risk of infection. However, about eight per cent of women still go on to get an infection after a caesarean birth.
There are three main infections to be aware of:
- Infection in your wound. Signs of wound infection include redness, discharge, or worsening pain in the wound.
- Infection of the lining of your uterus (womb). This is called metritis. It is more likely to happen if your waters broke a while before labour started or if you had lots of vaginal examinations before your caesarean. Heavy, smelly bleeding and fever can be signs of this infection.
- Urinary tract infection. You’ll have to have a thin tube, or catheter, inserted during the operation to empty your bladder and this can be a route for infection.
3. Blood clot : Any surgery raises your chances of developing a blood clot. This can be serious, depending on where the clot lodges. If the clot lodges in your lungs it can even be life-threatening. Signs of a problem include a cough or shortness of breath or pain or swelling in your calf. Call your doctor if you have any of these signs after your caesarean.
Your medical team will give you blood-thinning drugs, and elastic support stockings to improve the blood flow in your legs. You’ll also be encouraged to get up on your feet as soon as possible after your caesarean. This will help your circulation and reduce your risk of a clot forming.
4. Adhesions : A caesarean, like any other operation in the tummy or pelvic area, carries a risk of adhesions as you heal. Adhesions are bands of scar tissue which can make organs in your abdomen stick to each other or to the inside of your tummy wall. About half of women who have had a caesarean have adhesions, and this rises to 83 per cent after three caesareans.
Adhesions can be painful because they limit the movement of your internal organs. Occasionally, adhesions can lead to problems with fertility, as they can press on or block fallopian tubes.
5. Anaesthetic : Most caesareans are done without a general anaesthetic, which puts you to sleep. Instead, an epidural or a spinal will numb your belly. An epidural or spinal is safer for you and your baby than a general anaesthetic. However, having any anaesthetic involves a small risk. With epidurals and spinals a few women have:
- A severe headache. This affects about one per cent of women.
- Nerve damage. This rarely happens and, if it does, it usually only lasts for a few days or weeks.
What other complications do I need to know about caesareans?
Serious complications are rare, affecting less than one in 100 caesareans. They include:
- Injury to the bladder, to the tubes connecting the kidneys to the bladder (ureters) or to the bowel.
- Very occasionally, to protect a woman’s health, doctors may have to perform an operation to remove the uterus (hysterectomy).
- The need for further surgery at a later date
If you’ve had a serious complication during the caesarean, you may need a blood transfusion. Some of the rarer complications of a caesarean can be life-threatening. However, the risk of a caesarean proving fatal is extremely small, only one in 12,000.
What are the risks to my baby after a caesarean?
Your baby is likely to be perfectly well, both during and after the caesarean. Some babies do have breathing problems after they’re born. Breathing problems after a caesarean are not usually serious, but sometimes babies need to have special care to help them recover.
About 35 in every 1,000 babies have breathing problems after a caesarean. This compares with five in 1,000 babies born vaginally. Breathing problems are more common for:
- premature babies born by caesarean
- babies born by a caesarean carried out before labour started
Sometimes, babies get a little nick, from the doctor’s scalpel. About two per cent of babies get a minor cut during caesarean birth.
Will having a caesarean affect future pregnancies?
Possibly. Once you’ve had one caesarean, you’re much more likely to have another caesarean in future pregnancies. Having had a caesarean slightly increases your risk of having a low-lying placenta (placenta praevia) in future pregnancies.
There is a very small risk of the scar on your uterus opening up again in future pregnancies or births, but this rarely happens. Doctors call this uterine rupture. Uterine rupture is so rare that less than 0.4 per cent of women who have had caesareans experience it.
What do I need to know about after I’ve had a caesarean?
You may have heard scare stories about postnatal depression and that it is difficult to breastfeed after a caesarean. Try not to let these worry you. Although early postnatal depression is more common in women who’ve had a caesarean than women who’ve had a vaginal birth, by two months, the rates are about the same.
If you want to breastfeed your baby, it is important to get help from the outset. Women who’ve had a caesarean are less likely to start breastfeeding than women who’ve had a vaginal birth. However, once you’ve started, your chances of success are the same as for a woman who’s given birth vaginally.
Ask your nurse or a breastfeeding counsellor to help you and your baby get started as soon as possible.
Are there any advantages of caesarean birth?
The advantage of a planned caesarean is that you will know when your baby will be born. Also, although you’ll have a very sore tummy, you won’t have some of the discomforts that can result from a vaginal birth. These can include:
- Pain from bruising and stitches in the area between your vagina and back passage (perineum).
- Urine leaks, while the area round your vagina recovers.
Caesarean birth may help protect against the slight risk of your uterus slipping into your vagina in later years (prolapse). But other factors such as the number of births, having big babies, having assisted deliveries and obesity also contribute to this condition. Pregnancy itself can weaken your pelvic floor. This can lead to problems such as incontinence in later life. So you still need to do your pelvic floor exercises!