Cesarean births are quite common, occurring in about one-third of all deliveries in the United States. Various factors could necessitate a C-section birth. According to the American College of Obstetricians and Gynecologists (ACOG), these include a large baby, pregnancy with twins, failure of labor to progress, fetal distress, and maternal medical conditions like diabetes, high blood pressure, or placenta previa.
But while C-sections can help keep Mom and Baby safe, the decision to perform the operation isn’t taken lightly. "If there's any question, the doctor may even bring in another physician and obtain a second opinion beforehand," explains Joan Kent, M.D., a New York City Ob-Gyn. Why the hesitation? Partly because unpleasant or even dangerous side effects are possible—though they're very rare in most cases. Here’s what you need to know about the C-section complications that may arise during or after delivery.
C-Section Complications for Mom
To be sure, C-sections are safer now than in decades past. This is largely because improved surgical techniques and better antibiotics protect against postoperative infection, and because regional (local) rather than general anesthesia is usually used. Yet compared to women who deliver vaginally, those who deliver by C-section more likely to be re-hospitalized. The risk of maternal death is also higher. Here are potential C-section complications for moms.
Your uterine lining may become infected (endometritis) after a C-section surgery; in severe cases, this could require a hysterectomy The four- to six-inch C-section incision may also develop an infection, especially if you don’t properly care for the wound. Watch out for redness, drainage from the wound, fever, or excessive pain.
Being overweight and having a pre existing medical condition, such as diabetes, raises your risk for infection, says Mabel Wong, chief of the Ob-Gyn department at Kaiser Permanente in Hawaii. “Antibiotics are given routinely before C-section to decrease the risk,” she adds. Some doctors may also advise you to shower with antibacterial soap before the surgery.
Some women may experience uncontrolled bleeding (hemorrhage) as a C-section complication. Various factors may cause hemorrhage, including emergency situations, a vaginal tear, a cut organ, a large episiotomy, and more. A blood transfusion might be necessary, says Pamela Promecene, M.D., professor and obstetrician with McGovern Medical School at UTHealth/UT Physicians in Houston.
Bladder or Bowel Injury
Unfortunately, some C-section complications involve surgical accidents. In very rare cases, the woman may experience damage to her bowel or bladder during the procedure. Subsequent surgeries can usually fix the issue.
The risk of blood clots rises after a C-section, including deep vein thrombosis (DVT) in the legs or pelvic area. A dislodged blood clot may travel to your lungs, block blood flow to the heart, and cause a life-threatening pulmonary embolism.
If you had a previous C-section, your risk of complications rises with each additional pregnancy. For example, uterine scarring from a previous C-section leads to a much higher risk of placenta previa (when the placenta partially or entirely covers the cervix) and placenta accreta (when the placenta burrows into the uterine muscle rather than simply attaching to the lining), says David Colombo, M.D., Director of Maternal Fetal Medicine at Spectrum Health. Both conditions can trigger life-threatening hemorrhage in the mother, either during labor or after giving birth.
In roughly 1 percent of attempted vaginal births after cesareans (VBACs), the woman's uterine scar ruptures. In rare cases, the rupture results in severe blood loss in the mother and/or brain damage or death of the baby. This is one of the reasons some doctors hesitate to perform VBACs.
No accurate formula exists to predict whose uterus will rupture, but there are numerous established criteria for which women make the best VBAC candidates. For example, your success rate may be as high as 85 percent if you have had a previous vaginal birth, if your uterine scar (not the visible scar on your belly) is from a "low transverse" incision, if you're younger than 40 and not overweight, if your C-section was more than two years earlier, and if you arrive at the hospital during labor rather than being induced.
Reactions to Anesthesia
Some people have negative reactions to anesthesia. These side effects vary, but they may include vomiting, headaches, dizziness, blurred vision, weakness, and breathing difficulties.
C-Section Complications for Baby
Most C-section complications for babies are minor, resolving in days or weeks. Here are some possible negative outcomes.
If scheduled too early in the pregnancy, a C-section can make breathing difficult for your baby. That’s one of the reasons doctors recommend an elective C-section no earlier than 39 weeks—or one week before your due date. The labor process releases hormones that likely help the baby cope with lung fluid so she can breathe easier; during most emergency C-sections, labor has already begun. "Being pushed through the birth canal squeezes fluid from their lungs, so babies delivered vaginally tend to have fewer respiratory issues," explains Ob-Gyn Bonnie Wise, M.D., an associate professor at the Northwestern University Feinberg School of Medicine in Chicago.
C-sections also have the standard surgical risks. “Rarely, there can be accidental nicks to the baby’s skin,” says Dr. Wong. Most cuts will heal without any complications.
Women should schedule elective C-sections no sooner than 39 weeks. However, it’s possible to misjudge the due date, which might cause your baby to be delivered prematurely. Babies might also be born premature because of an emergency C-section before 39 weeks.
Low Apgar Scores
Apgar testing analyzes your infant’s well-being after birth. C-section babies might have lower Apgar scores—possibly because of the anesthesia or the reason behind the C-section (fetal distress, non-progressing labor, etc.)