Caesarean section-benefits v/s complications

As the journey of pregnancy advances and your due date approaches, sometimes certain conditions may develop that necessitate the delivery of the baby by a Caesarean section. This could be a pre-planned situation or an emergency during labor which necessitated the caesarean section. A caesarean delivery, also knows as C-section, is a surgical technique that involves making a cut in the abdomen and uterus of the mother to deliver the baby.

A C-section is quite a safe surgery. However, like any other operation, it comes with its set of risks and complications.

Risks and complications associated with C-section

Various factors play a role in determining the level of risk with a C-section. The chances of complications increase if you have any of the following risk factors:

• Diabetes
• High blood pressure
• Liver dysfunction in pregnancy (Obstetric cholestasis)
• Being overweight
• Co-existing medical illness
• Complications during labor that led to the emergency C-section
• An epidural injection for pain relief
• Low hemoglobin or platelet count of the mother
• Having given birth to multiple children
• Having had a previous caesarean or other abdominal surgery
• Large baby size > 3.8 or 4 Kg

According to CDC, approximately 30% - 32% of women need a caesarean section for delivery of the baby and a C-section is probably the most commonly performed surgery nowadays. As a result, there has been extensive research on the surgical technique involved in it and there have been a number of advancements which have made it a very safe surgery for pregnant women. However, things can & sometimes do go wrong and like any other surgery, there may be some complications associated with a Caesarean.

Here are few of the complications that can arise from a C-section:

• Bleeding: During C-section, a mother loses twice as much blood as compared to vaginal birth. Usually, this is easily controlled with the help of medications given during surgery and extremely heavy bleeding is uncommon, but if it occurs, you may require a blood transfusion
• Wound infection: This is one of the common complications of C-section. It presents as swelling, tenderness, and pain at the site of the wound. Sometimes there may be discharge of fluid or pus from the stich line. You may also develop a fever. Wound infection is usually treated with antibiotics, and cleaning the wound /dressing.
• Infection of the uterine lining: Endometritis is the medical term for this condition. After birth, you may experience severe bleeding, irregular bleeding, foul discharge, or a fever. The risk for endometritis increases if your water broke before you went into labor, if you have had many internal vaginal examinations during your pregnancy/labor, if your immunity is lower due to any medical illness or anemia.
• Urinary tract infection: After you regain consciousness, you will notice a thin tube attached to your urethra, which will help empty your urinary bladder until you are able to move around and pass urine yourself. Occasionally, this can also be a route for developing a urinary tract infection.
• Blood clot: Although very rare, but the development of a blood clot in your legs (Deep vein thrombosis) is one of the most serious complications of a C-section. If left untreated, the clot can travel to your lungs/brain/heart or other vital organs and result in life-threatening consequences.
• Injury to adjacent organs: A C-section can sometimes cause damage to your urinary bladder or ureters (the tubes connecting your kidneys to the bladder). If this happens, you may require an additional surgery to correct it.
• Scar formation & adhesions: The healing of the tissues after any surgery takes place by fibrosis and scar formation. Sometimes this may lead to the intestines or the urinary bladder and other internal organs to get stuck with each other or with the uterus leading to formation of adhesions and a chronic pain in the abdomen.
• Prolonged hospital stay and recovery: A caesarean section requires a longer stay in the hospital compared to a vaginal birth. The pain & soreness may take a longer time to improve & this sometimes interferes with the breastfeeding and bonding with the baby.
• Risks for the baby: Some studies indicate that the babies born after a caesarean section have a higher incidence of breathing difficulty after birth and may have more chances of developing asthma later on in life.
• Maternal death: Some women die as a result of problems during a cesarean delivery; however, this is extremely unusual. One or more of the consequences described above, such as an uncontrolled infection, a blood clot in the lung, or excessive blood loss, can result in death. Similar complications can rarely arise after a vaginal delivery as well and reducing maternal mortality is one of the topmost agendas of WHO & Ministry of Health & Family Welfare whereby, they have enforced strict protocols and treatment guidelines to minimize maternal death during delivery or in postpartum period.

The majority of serious complications linked with cesarean deliveries aren't caused by the procedure per se (Except the ones which involve injury to adjacent organs during surgery), rather they are the result of the underlying medical condition which lead to the decision for the cesarean delivery.

Apart from the above-mentioned complications that the mother can endure during a C-section, there is also a slight risk to the baby. There is a chance that while opening the womb of the mother, the baby might get a small cut on the skin. However, there is nothing to worry about. The cut is usually very small and heals quickly. If born before 39 weeks of pregnancy, breathing problems are common among babies. This problem typically goes away within a few days.

Are there any risks to future pregnancies?

In most cases, having a C-section does not cause any problem for future pregnancies. Most of the women go on to have healthy babies in the future.

Do not believe the age-old tale of ‘Once a caesarean, always a caesarean’. Many women can have a successful vaginal delivery after having a C-section. In fact, studies claim that 60-80% of women who decide to undergo a trial of labor in subsequent pregnancies, do have a successful outcome and deliver vaginally. Of course, there are strict criteria for deciding who is suitable for trial of labor after caesarean section in one pregnancy and we deal with that topic in a separate article.

However, at times, a past C-section can cause problems in the future such as:

• Placenta previa & placenta accrete: A caesarean raises your chances of a low-lying placenta (placenta praevia) or placenta accreta (placenta invading the wall of the uterus) in subsequent pregnancies which can increase your chances of bleeding during pregnancy & delivery, sometimes even necessitating a surgery to remove the uterus (Hysterectomy) as a lifesaving measure.
• Repeat Caesarean section: You may need to have another C-section in subsequent pregnancies as well. This repeat caesarean may be more challenging and there may be an increased chance of injury to the urinary bladder or bowel during surgery.
• Scar Ectopic pregnancy: Sometimes a future pregnancy may get implanted over the caesarean scar and may lead to complications like heavy bleeding or miscarriage. It may need to be removed surgically or with special medications and techniques.
• Scar dehiscence or rupture of uterus: There is a slight chance that the scar on your uterus will open up again during future pregnancies or births, although this is uncommon. This is called as rupture of the uterus & may lead to extensive blood loss & a life threatening condition for the mother as well as the baby.

There is light at the end of the tunnel!

Don’t be disheartened after reading about all the risks and complications. There is some good news. Recent studies have found some benefits of having a caesarean. These include:

• Lower risk of pelvic dysfunction: Caesarean delivery lowers your risk of pelvic organ prolapse and urinary incontinence. Pelvic organ prolapse is the weakness, sagging or drooping of the pelvic organs (urinary bladder, uterus, vagina, cervix, and rectum). Urinary incontinence occurs due to the loss of bladder control. Rectal prolapse can cause constipation and vaginal laxity or prolapse can compound the problem.
• No damage to the vagina: Vaginal birth can lead to a tear in the vagina, which is avoided in a C-section. Vaginal births can also make you feel "loose" down there, leaking urine and sometimes even the inability to control bowel movements. Although the vagina has a miraculous capacity to heal, sometimes vaginal tear repair or episiotomy may lead to scarring of the vagina that causes discomfort & pain during intercourse.
• Reduced risk of birth injuries to the baby: The benefits for the baby are that the risk of birth injuries associated with labor & vaginal delivery including hypoxia (oxygen deprivation), shoulder dystocia, and fractures, are much reduced with a scheduled cesarean section.
• No labor pains ! Lastly, the icing on the cake is that you don't have to endure hours of labor pains when you undergo a planned caesarean section.

Despite the few benefits of C-section, it is not recommended to opt for a surgery unless it is necessary for the well-being of the mother and the baby and that is why doctors recommend a caesarean section only when it is really indicated. You should not hesitate to discuss all the options with your doctor and trust the judgement when a caesarean delivery is recommended. It is not wise to opt for a caesarean section only with the motive to avoid the pain of labor as there are a multitude of pain relief options available to make your labor completely painless and safe. Having said that, do not hesitate to accept a caesarean section when it is recommended for you based on your medical condition to ensure yours & the baby’s wellbeing.