It was reported in the news this week that pregnant women who ask for a caesarean delivery should be allowed to have one. You can read the full story on the BBC website.
A vaginal birth is generally safer than a caesarean birth. However, a caesarean section may be 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 obvious and it will 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. Although a caesarean is a common procedure, it involves major surgery in your abdominal and pelvic area, and all operations carry risks.
Disadvantages of a caesarean:
- Pain. The main disadvantage is pain after the caesarean. This may last for a few weeks or more after the operation. You will be given medication to help cope with the pain but it will affect your daily activities.
- Infection. Before the operation, you will be offered a single dose of antibiotics, but about 8% of women still go on to get an infection.
- Blood clot. Any surgery carries a risk of developing a blood clot. This can be serious, or even life-threatening, depending on where the clot develops. You will be given blood-thinning drugs and support stockings to improve the blood flow in your legs after the caesarean. You'll also be encouraged to get up and move around as soon as possible afterwards. This helps your circulation and reduce your risk of developing a clot.
- Adhesions. These are bands of scar tissue which form as you heal and can make organs in your abdomen stick to each other or to the inside of your abdominal wall. About half of women who have had a caesarean get adhesions, and this can increase with more caesareans. Adhesions can be painful because they limit the movement of your internal organs.
- Infertility. Occasionally, adhesions can lead to problems with fertility, as they can press on or block fallopian tubes. Sometimes women experience unexplained infertility after a caesarean.
- Anaesthetic. Most caesareans are done with an epidural or spinal, which numbs you from the abdominal area down. 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 can have; a severe headache (affects about 1% of women); nerve damage. This rarely happens and, if it does, it usually only lasts for a few days or weeks although very rarely it’s permanent.
- Injury to the bladder, to the tubes connecting the kidneys to the bladder (ureters) or to the bowel.
- Very occasionally, if there are major complications, to protect a woman's health, doctors may have to perform an operation to remove the uterus (hysterectomy).
- A blood transfusion. 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.
- Breathing difficulties for the baby. About 35 in every 1,000 babies have breathing problems after a caesarean compared with five in 1,000 babies born vaginally. Breathing problems are more common for premature babies born by caesarean or babies born by a caesarean before labour started.
- About 2% of babies get a nick or cut from the doctor's scalpel.
- 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.
- 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.
- It can affect future pregnancies. 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. This is called a uterine rupture but is rare and affects 0.5-1% of women in future pregnancies.
Advantage of a caesarean:
- If it’s planned, you will know when your baby will be born.
- Although you'll have a very sore tummy, you won't have some of the discomforts that can result from a vaginal birth, such as pain and bruising and tears and stitches around your vagina.
- Caesarean birth may help protect against the slight risk of urine leaks and in later years, vaginal prolapse. However, other factors such as the number of births, having big babies, having assisted deliveries and obesity also contribute to these conditions. Pregnancy itself is also a risk factor for these conditions as it can weaken your pelvic floor, so you still need to do your pelvic floor exercises!
If you have any questions about either a caesarean or a vaginal birth, don't be afraid to ask your midwife and talk through all of the options with her.
Best wishes - Amber