How C-Sections Work

The Risks of a C-section

Doctors perform a C-section in Kabul, Afghanistan, in October 2007. One out of nine Afghan women die during pregnancy or soon after.
Doctors perform a C-section in Kabul, Afghanistan, in October 2007. One out of nine Afghan women die during pregnancy or soon after.
Paula Bronstein/Getty Images

C-sections are relatively safe, but they are major surgery. So, by definition, they are riskier than vaginal deliveries. All surgeries involve the risk of infection, complications from anesthesia, internal injuries, postoperative adhesions and hemorrhaging. Today, maternal deaths in the United States range anywhere from 6 to 22 per every 100,000 births, with the higher rates usually involving emergency C-sections [source: WebMD]. However, these numbers can be a bit misleading. Many women have C-sections because of medical conditions, and complications from that condition -- not from the surgery -- are more often the cause of the death. About 25 to 50 percent of C-section deaths are directly attributable to the actual operation [source: WebMD].

After a C-section, the uterine tissues become infected in nearly 40 percent of women. This complication, postpartum endomyometritis, is 20 times more likely after a C-section than after a vaginal delivery. Incision infection occurs in anywhere between 2.5 and 15 percent of women. Urinary tract infections are a common risk, affecting as many as 16 percent of C-section patients. These infections, usually a result of the urinary catheter, can be treated with antibiotics. Decreased or absent bowel function can also occur, which is usually caused by pre- and postsurgery narcotics. Another serious risk is blood clotting. These clots are found in 1 out of every 400 pregnancies, regardless of delivery. However, the risk is as much as five times greater after a C-section [source: Emedicine].

C-sections can also put the mother at risk during subsequent births. Complications include preterm birth, breech presentation and low birth weight, with the major risk being a ruptured uterus. This rupture can involve a small tear (with minimal complications) or a large one that results in the fetus and placenta pouring into the abdominal cavity. This happens when the incision scar expands and tears during pregnancy or labor, and it can cause the mother to need a blood transfusion and possibly a hysterectomy -- and the baby could die from lack of oxygen. It's certainly a serious complication, but the actual risk can be as low as 1 percent when the previous C-section was a low transverse incision. It increases to 4 to 10 percent with a classic C-section [source: Emedicine]. So, doctors often advise women not to opt for vaginal delivery after having had a C-section.

The risks increase with each C-section -- one of the most common is placenta accreta. This happens when the placenta, which provides nourishment to the fetus during pregnancy, is attached too deeply to the uterine wall. The risk gets higher with each C-section because scar tissue can build up in the uterus. Another risk that increases with recurring C-sections is the need for emergency hysterectomies at delivery. The chance of hysterectomy increases five times with the fourth C-section and is nearly 20 times greater in women with six or more C-sections [source: Emedicine]. Placenta previa can also occur with multiple C-sections. This occurs when the placenta develops low in the uterus, blocking the cervix and possibly causing a need for another C-section.

Mom is not the only one who faces risks with C-sections. Babies born by C-section can suffer from neonatal respiratory distress -- breathing problems in the first few days of life that usually call for treatment with oxygen therapy. This occurs in 12 to 35 per 1,000 C-section babies -- compared to 5.3 per 1,000 vaginal births [source: Canadian Medical Association Journal]. When a baby is born vaginally, pressure on the lungs pushes out excess fluid. That doesn't happen in a C-section, so these babies sometimes have trouble breathing.

Doctors use the Apgar scale to quickly assess a baby's health immediately after birth -- they rate the baby's skin color, heart rate, reflexes, muscle tone and respiration on a scale of one to 10. Babies who are delivered by C-section often have low scores, usually because of the breathing problems mentioned above, along with the sedation medication given to the mother (and therefore baby), which can make the child lethargic. These sedatives can also make it hard to breast-feed at first. Finally, a rare but serious risk is injury to the fetus from the surgical incisions.

Even with these risks, sometimes doctors and patients plan C-sections. But many C-sections are unplanned -- performed in emergency situations. We'll find out more about unplanned C-sections next.