Natural Childbirth VII: C-Section Risks and Complications | Chris Kresser

Natural Childbirth VII: C-Section Risks and Complications

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This is the final article in the Natural Childbirth series. If you’ve missed the other articles, make sure to check them out here.

There’s absolutely no question that cesarean surgery (c-section) can save both mothers’ and babies’ lives when performed appropriately. The purpose of this article is not to question the use of c-section in those circumstances.

Instead, my goal is to challenge the idea – now prevalent in the Western world – that elective c-section is a safe way of delivering our babies, and perhaps even safer than vaginal birth. This is simply not true.

The risks and complications can be broken into two categories: problems experienced by the mother, and problems experienced by the baby. The most significant risk for mothers is an increased risk of death, and the most significant risk for babies includes a variety of changes – such as the composition of the gut microbiota – that have lifelong effects.

Cesarean risks for mothers

Cesarean involves major abdominal surgery and increases the risk of maternal death by about four times in emergency situations and about three times during elective surgery on a healthy mother and baby.(1,2) The major causes of death in these cases are infection, blood clots and anesthetic accidents.(3)

Post-cesarean infections are also common. One study showed that 20 to 40 percent of women have post-cesarean complications, including infections of the uterus, wound, or urinary tract.(4) Cesarean mothers are twice as likely to have severe complications and five times more likely to require antibiotics after birth, compared to women giving birth vaginally.(5) Another study found a three times higher risk for serious complications such as major infection, hysterectomy or cardiac arrest.(6)

There are also psychosocial risks above and beyond the physical risks. For example, when compared with women who give birth vaginally, women who receive cesarean:

  • are less satisfied with their birth experience;
  • more likely to be re-hospitalized;
  • less confident with their babies;
  • less likely to breastfeed; and,
  • more fatigued, even up to four years later. (7,8,9,10)

Although cesareans are often portrayed as being less likely to produce pelvic floor dysfunction than vaginal birth, large population studies have demonstrated that this is not the case over the long term.(11)

Finally, mothers will continue to experience the effects of cesareans throughout her childbearing years. Studies show reduced fertility following a cesarean and greater levels of fear about giving birth five years later.(12,13) A previous cesarean may double the risk of a breech baby in subsequent pregnancies and increase the risk of uterine rupture.(14)

Cesarean risks for babies

The complications associated with cesarean for even low-risk, healthy babies are numerous. They include 1:

  • Increased risk of respiratory compromise, low blood sugar and poor temperature regulation.
  • Slower neurological adaptation after birth.
  • Differences in levels of hormones regulating calcium metabolism, renin-angiotensin, progesterone, creatine kinase, dopamine, nitric oxide synthesis, thyroid hormones and liver enzymes.
  • Depressed immune function, including poor function of neutrophils, natural killer cells and lymphocytes (all cells that fight infection).
  • Increased risk of oxidative stress.
But perhaps one of the most significant and lasting risks for babies delivered via cesarean is the alteration of the of gut flora.

Studies have consistently shown that cesarean babies have altered fecal microbiota compared with vaginally born babies, which can persist for at least six months and quite possibly for life.(16)

As I’ve explained elsewhere, the gut flora plays a crucial role in health. From that article:

Among other things, the gut flora promotes normal gastrointestinal function, provides protection from infection, regulates metabolism and comprises more than 75% of our immune system. Dysregulated gut flora has been linked to diseases ranging from autism and depression to autoimmune conditions like Hashimoto’s, inflammatory bowel disease and type 1 diabetes.

This probably explains why babies born via cesarean may have increased susceptibility to gut infections, asthma and allergies later in life.(17,18,19)

The marked changes in gut flora in cesarean babies are not greatly affected by the method of feeding (i.e. breastfeeding vs. formula) afterwards.(20) This means that breastfeeding after cesarean section can’t compensate for the alterations in gut flora experienced with that type of delivery.

If you did have a cesarean for any reason, I recommend using a high-quality infant probiotic to help populate your baby’s gut with beneficial flora. The brand I use in my practice is called Therbiotic Infant, from Klaire labs. (Important note: although they recommend starting with 1/4 tsp., that is far too high of a dose. I suggest lightly dusting the nipple with the powder once or twice a day before feedings. If you notice diarrhea, especially with green flecks or tint, decrease the dose.)

Articles in this series:

  1. Buckley, Sarah J. Gentle Birth, Gentle Mothering: A Doctor’s Guide to Natural Childbirth and Gentle Early Parenting Choices. Celestial Arts, 2009. pp. 120
  1. I was also a victim, having uterine fibroid for many years. The size of my fibroid was very large as a grapefruit in my womb, trying to conceive was so hard. My difficulty was not only getting pregnant, but keeping the pregnancy. I occasionally had reoccurring bouts with dysfunctional uterine bleeding due to fibroid tumors. I even came close to having a hysterectomy, but due to future/possible complications, I refused. I learned about some herbs mixture prepared by Priest Iyare and that was my breakthrough to a long standing problem. I already gave birth to a bouncing baby boy, very healthy, happy, and bright. I forgot to mention that my non-existent sex drive returned within just a few weeks of starting the herbs, this was a pleasant surprise. If interested and ready to give a try contact him http://iyareyarespellstemple.webs.com/

  2. The stories her,e though interesting and often sad, cannot be the basis on which decisions are made about whether to have a natural birth or a c-section. If 1 in 50 c-sections result in long and short term maternal and newborn problems, and 1 in 100 vaginal births do, which would you encourage? In 2 million births, it makes a big difference what is chosen or encouraged. Whatever decision women makes, some will have sad stories to tell, but the proportion will be different. To make a rational decision, you have to have studies of lots of deliveries with lots of long term follow up. Those studies tell us that, overall, vaginal birth is better. But pregnancy is risky and there will always be some people who have troublesome outcomes.

  3. Hi Chris.
    I’m glad I stumbled upon this article. I’m trying to seek advice for my specific case.
    I’m 33 years old, been married for 4.5 years. My Husband and I wanted kids straightaway. However, he was diagnosed with a low sperm count + low motility and I had PCOS. I have one failed IUI and one failed IVF as well. We had given up on baby project when last year, we got pregnant naturally. Pregnancy has been great. However, a few months back I was diagnosed with gestational diabetes and had to be put on metformin and even insulin. I finally learned how to control my sugar levels by following right diet plan. The doctor has put me off of insulin but I’m continuing metformin. I’m 34 weeks along but our baby is measuring 35 weeks and 5 days. My doctor wants us to discuss our birth options. She says that with my history, a c section would be a more viable and safer option. They consider my baby precious and don’t want to take any risks as she openly told me to be realistic about the odds of conceiving again. I’m not too sure considering my baby is in birth position and I’d like to give vaginal birth a chance. My due date is May 18th. Can you please advice?

  4. What about babies delivered vaginally but born in the caul where the amniotic sac didn’t break until after the baby was delivered? Will these baby’s biome act like those delivered via cesarean?

  5. Why would you list the risks of c-section without mentioning the risks of the alternative? I was 4 months pregnant before I even learned what shoulder dystocia was (long story short, it can kill your baby during childbirth, or cause permanent brain damage, and/or brachial plexus palsy a.k.a. permanent partial paralysis).

    I was also about that far along before I learned what third degree and fourth-degree tears are. Until then I had no idea that vaginal birth could cause tears that require surgery under general anesthesia, that such tears could leave you with not just urinary incontinence (which is bad enough) but fecal incontinence too.

    Shoulder dystocia is a complication of vaginal birth. It can’t happen from a cesarean. Ditto third and fourth degree tears.

    And those are real problems, not theoretical possibilities like the gut flora stuff you mention. Teeny tiny studies of two dozen babies in Scandinavia, which is the kind of evidence we’ve got so far of gut flora differences, do not exactly prove a major medical issue is occurring. And even if studies do eventually prove that (1) c-section babies have different gut flora than vaginal babies, and (2) the difference actually matters healthwise, the solution is simple: swab the mother’s vagina and put her vaginal flora into the child’s mouth. Sounds gross, but that’s what happens during vaginal birth.

    Is there any mother here who would REALLY rather risk killing her baby, or giving it brain damage or paralysis, than risk causing an easily fixed difference in the baby’s gut flora? I doubt it.

    • Also, I’m surprised that you would refer your readers to a TEENY TINY study indicating that cesarean is dangerous–seriously, in your second footnote you link to a study of 65 women who got c-sections?! And that study didn’t even separate emergency c-sections from elective ones?!–when much, much bigger studies show that elective pre-labor cesarean is actually the safest option.

      For instance, a UK study of ALL BIRTHS in the UK over a three-year period (2003 through 2005), so over 2 million births (which included more than 200,000 elective c-sections), showed that women who chose an elective cesarean were LESS LIKELY to die than women who tried to deliver vaginally. Here is a major media article about that study:
      http://www.telegraph.co.uk/news/uknews/1584671/Women-choosing-caesarean-have-low-death-rate.html

      • I mean first footnote, sorry. That’s the one where you linked to the French study of 65 c-section moms.

  6. I had an emergency cesarean with my first baby and thought it was my fault for ‘failing’. Second baby I didn’t know what to choose (elective or VBAC) and was talked into trial of labour as it’s ‘safer’. Labour actually went well 12 hours with no pain relief, but my baby got stuck in the birth canal and I had to have low forceps. I can honestly say that it’s taught me that you have zero control in labour no matter that you do! .The issues I had post cesarean were less distressing than the issues post low forceps so I’m regretting my decision. My babies were both big (for me) at 8 lbs 15 and 8 lbs 10 with large heads. Personally I think on reflection our lifestyles, inactivity with desk jobs and better diet mean that natural birth is often quite damaging to women as babies are simply bigger than they used to be and our bodies less capable. So I’m quite in favour of the cesarean despite the risks. But we are all different and it’s hard to predict how it will go… Forceps (even low ones) though are nasty.

    • I’m so sorry you went through that. I really wish that doctors were legally required to explain the risks of BOTH ways of birthing, instead of just explaining the risks of c-sections and not telling you the risks of vaginal delivery.

  7. In this article you state start with just a nipple brushed with the infant probiotics. When do you recommend going to the full 1/4 tsp per day for an infant & toddler? Thank you.

  8. Chris, thank you for this article. My daughter was born vaginally with no meds but then was on antibiotics for the next two days after that due to concern of an infection. She is almost three months old now and has been exclusively breastfed. I am planning to start her on the Klaire Labs Ther-Biotic Infant Formula to restore her good bacteria. Will one bottle be enough, or how long would you recommend that I give it to her?

  9. My research into C-sections is ongoing. I do believe most moms are great about picking up the relationship after a C-section, especially necessary if general anesthesia was used as conscious connection with the baby was lost temporarily…..Mine was not…..there were other issues – conception (“conceived in [marital] rape!”) and pregnancy (unwanted pregnancy) and mom’s relative degree of health, or lack thereof (I am talking major, major mental/emotional health issues out the wazoo, probably based upon genetics, nutrition, etc.). Also, if the baby has health issues, there may be some bonding difficulties for which the best mom is going to need all her wits and strength about her. The OB diagnosed my mother with “hypothyroidism” during the pregnancy, but not after, making it gestational. It was treated – she did not remember with what, as she just felt so bad that she did not care (and she was a nursing professional with a fancy degree from a world-renowned teaching hospital). She said it made her feel a little better. From everything I am learning, B12 Deficiency, Pernicious Anemia can throw a thyroid out of whack. The thyroid slows down to try to protect cells and organs from this type of anemia. Red Flag!!!! There is more need for thyroid and B12 during pregnancy, as there is for most other nutrients. I believe my mother’s hypothyroidism was secondary to a B12 Deficiency, that went undiagnosed for the rest of her life, and the lives of the children onto whom she passed her particular type of genetic B12 Deficiency. You can’t live without B12. You can’t live without B12. You can’t live without B12. With minimal stores, things may seem somewhat normal, but quality of life is greatly diminished. Ask my brother who completed suicide, and my mother who attempted, as did others in my family. Ask my older sister with mood/undiagnosed mental/emotional health issues. Ask my younger sister with diagnosed, poorly treated fibromyalgia, misdiagnosed bipolar, etc. There are so many reasons for a mom/baby duo to need a c-section delivery. I believe it is the responsibility of the medical professionals who help to make this decision to determine exactly why a C-section is necessary. Is it something metabolic? Is it something genetic? Is it something that needs to happen with just this generation due to some nutritional deficiencies in this particular generation only? Or a combination thereof? But, sadly, most medical professionals do not even begin to accept this responsibility, at least they did not in the scheme of my family of origin. Life is holy. Birth is holy. Conception is holy. Pregnancy is holy. When you bypass Mother Nature, who always has excellent reasons for doing what she does, for long term karmic reasons, you really need to be prepared to help folks see it through when you do so. You don’t bypass Mother Nature just to abandon a baby to a mentally ill mom who has absolutely no intention of taking responsibility for her babies…..that is beyond cruel.

  10. I’m a mother of 3 children, who were all delivered by c-section. My first child I had him at 17. My due date was January 19th. I didn’t experience a contraction until my labor was induced January 30th. After 24 hours he was in distress and they gave me an emergency csection, January 31st. My second son the doctor tried to convince me to have another csection, however my husband and I wanted to experience a vaginal birth. His due date was April 30th and believe it or not I was having some hard core contractions and didn’t dilate pass 2 centimeters. The same thing happen with my first child (didn’t dilate past 2 centimeters). I had a doc app on the first and told him I changed my mind I wanted to have a csection. My husband was working and there was no guarantee he would see the birth. My csection was schedule for May 3rd. I ended up going to labor and delivery May 2nd because my contraction where only 2 minutes apart. Nothing happened. My doc came and saw me and said,” would you like to have the baby today”. I said sure. She ask me,”when was the last time I ate anything”?. I told her the prior night. I had my son within the next hour, csection. My last child we elected csection, I was scared after being unsuccessful the other two times. I had her and August 15th and that was a scary experience for me. A day after my csection I felt a blot clot rush out of me. I called the nurse in and she looked and your fine. All of a sudden more and more where coming out. They were huge. She started paging people in the room and I was scared. I felt cold and light headed. They took the iv out earlier that day and when they tried to stick it back in they couldn’t find a vein. I just knew I would die. My cervix went back up come to find out. That was the worse experience ever. I don’t know why it happen I just know I’m still here and NO MORE KIDS FOR ME. Thank goodness I didn’t need a blood transfusion.

  11. Is a matter of choice i don’t believe your side effects… women we have to make our own choices no man should say otherwise

  12. My wife and I are 37 weeks pregnant in Taiwan. Right now the doctor is nudging us toward c-section because the baby is, in his opinion, unusually large, especially in head circumference. When I point out that the baby is not large enough to warrant such a drastic action, my wife says it’s a different situation because Asian body types make childbirth more difficult. This was the same response the doctors gave to defend their practice of routine episiotomy when I mentioned that is was not supported by research (even though outcomes for Asian women was worse in those findings). My wife is indeed a small lady, and yes, she is Asian. Is there any evidence to support the distinction?

    • I guess you’ve had your baby by now (congratulations!) but yes, Asian women have a higher incidence of shoulder dystocia and of severe tearing when they choose vaginal birth. Here are some links that mention that:

      http://www.ncbi.nlm.nih.gov/pubmed/25476878

      http://www.ncbi.nlm.nih.gov/pubmed/23834484

      I’d also like to say that when your wife explained her reasons for wanting a c-section, you really had no business trying to talk her into a type of delivery that she didn’t want. It is her body, not yours. I very much hope she got what she wanted and everything is ok with her and the baby.

  13. I have a question I have been struggling to find an answer to and hoped I might find some help here!

    My husband and I are planning a home birth for our first baby, due this August. I’ve wanted a water birth for years, and my midwife is supportive of this idea, as she has seen a huge decrease in transfers in her practice (with a previously low rate of 2-3% — she reduced it further via water births!) since encouraging her moms to labor and birth in the water. My husband has also been very supportive of this plan, but today wondered if there is any adverse effect on the gut bacteria obtained during a vaginal delivery, if the baby is born into water? He ran across an article discussing the results of a study on GBS and water birth, which found that there was something like 1 case in over 3,000 water births of GBS. The idea seemed to be that the water washed the bacteria off the baby before it could colonize. I’ve been scouring PubMed.gov and the internet in general for hours now for any information on whether or not the same thing could be true to an extent for the good bacteria and can’t seem to find anything besides a mom here or there asking the question (and not receiving what I would consider an “adequate” answer). Any thoughts? I know that they’re finding now that the baby receives *some* beneficial bacteria from amniotic fluids before birth, but it seems quite clear that the good bacteria obtained from the birth canal is the most significant for the future good health of the baby.

    • I have been wondering this same thing and have looked for information everywhere. Not much has turned up. What did you ultimately decide?

    • That makes no sense. Babies catch group B strep from their moms during labor–after the water breaks bacteria can migrate into the amniotic fluid, and the baby “breathes” it in or ingests it. Even if the bacteria doesn’t migrate up, the baby can get the GBS in its nose or mouth on the way down the vaginal canal.

      And that can’t be “washed off” by a water birth (or for that matter a bath after birth), because the presence of GBS on the baby’s skin is not the problem. The problem is GBS in its nose, mouth or (when it “breathes in” infected amniotic fluid) in its lungs.

  14. In response to Kia’s November’s comment, even though the expectant mother signs a consent for C-section, is it considered gross malpractice if feces is being expelled from the vagina? In light of all the risks, shouldn’t this warrant legal counsel???

    • Hi Phyllis

      I’m no expert, so i would strongly recommend you get advice from a trusted GP, OBGYN (and/or lawyer if they think you need it), but i’m curious about the following:
      are you talking about the baby’s faeces? as in meconium? and only once?
      or are you talking about the mother’s faeces, as in a breach in the vaginal/colon wall? and an ongoing issue?
      Assuming its the mother’s faeces, did the mother labour before an emergency c section or was it a planned c section?

      if labouring created some kind of perforation and or prolapse in the vaginal/colon wall, i think (and once again, i would check with your GP, OBGYN or other trusted medical advisor) that this is something that is considered to be a (hopefully rare) risk of labouring/birth .

      If it was the surgery itself that created the tear (which doesn’t seem to be intuitively possible but hey – they stitch people up with instruments still inside them so i guess ANYTHING is possible) well I would most definitely be getting that fixed up pronto!! the hospital who performed the original surgery should surely be expected to rectify that!

      The mother should be having a check up with the doctors at 6 weeks post op, and def discuss this, If it were me, i would definitely get a second, third, fourth etc opinion until i heard someone say “we can fix this” !! and i wouldn’t wait the six weeks.

      MIL just had a prolapse in that particular section of the vagina fixed after only 38 years… i definitely would NOT be waiting that long!!

      Hope you sort it out and sending lots of karmic mama positivity across the ether to you

      Kea

  15. Hi Cris,

    I was trying to investigate the case of my cousin’s wife as she have died last Thursday while giving birth to my niece. As informed by my relatives she was scheduled for a CS procedure last Wednesday and as when the anesthesiologist started to inject the anesthesia suddenly the baby’s heart beat stopped and declared dead and the baby’s mother was in a comma and died the next day.

    Is their anyway to save them in this case? Actually the doctor already informed her when the last time she gave birth that this may happened to her as she was having a delicate pregnancy due to diabetes.

    Some information that I have gathered was she had a kidney failure and water on her lungs…

    • I am very sorry to hear of this. It sounds dreadful. I hope you have managed to overcome this horrible event. Kind regards.

  16. These kind of articles (and comments) make me livid, because they are written under the premise of ‘educating’ women, yet all they do is evoke fear and a hard-headed mentality that vaginal (and preferably natural) birth should always be attempted before a c-section is performed. Many women are terrified of having a c-section, because of articles like this. If we truly want to educate women, we need to present all options to women and speak candidly about the dangers of vaginal birth as well! Unfortunately I was one of those naive women who believed (after reading many articles like this) that a c-section should be a last resort. My body was made to do this, right? Despite laboring for 71 hours (52 of the hours at home, with my doula), my daughter was stuck and would not come out. After 3.5 hours of pushing, instead of an emergency c-section (because I was terrified to have a c-section), I had a vaccuum assisted delivery. Her head was sideways and when she popped out, I sustained a fourth degree tear which required reconstructive surgery after the birth, and my recovery from this vaginal birth was 12 weeks+. And when I say recovery, I mean able to walk around, sit and have a bowel movement without pain. And for the rest of my life, i will be dealing with fecal incontinence. All because of my vaginal delivery. Will I opt for an elective c-section next time around? You betcha. Had I fully known the risks of vaginal birth the first time around, I would never have been afraid of a cesarean. Although my vaginal birth experience was rare, so are the risks of cesarean mentioned above! There are so many anti-c-section articles out there, but where are the articles where people talk about the dangers of vaginal birth? Women need to be educated, not made to feel scared or guilty about having a c-section. For anyone who has had a bad c-section experience, my heart does go out to you. For those who have had a traumatic vaginal birth, I feel for you as well, and can relate. We all dream of a perfect uncomplicated childbirth, but it’s not a reality for everyone. Natural childbirth advocates need to educate themselves and stop saying ‘anyone can do it’ and ‘avoid a c-section at all costs’. Rather, we should educate women about their options, and the risks and benefits associated with those options.

    • Poppy, absolutely agree, I too was hell bent on a vaginal delivery after being “brainwashed” through the Bradley method birthing classes. In these classes absolutely no mention was made of the risks of vaginal delivery in order not to scare the mothers. If we are grown adults seeking out information on birth, it is patronizing to assume we are not able to handle the truth about birth risks across the spectrum and come to an informed decision ourselves.

      I ended up changing doctors midway through my pregnancy to one that was more accommodating of “natural” childbirth. As it was, I suffered a 4th degree tear, subsequent fistula (opening between rectal canal and vagina) and hospitalization. As you say recovery was far more delayed than in most c-sections. I agree, being able to sit down at 12-weeks was a milestone!

      It is a matter of weighing up the risks to mother and baby and this time around I have decided that although a c-section is not the ideal for my baby, I believe I will be able to be a better mother for my baby if I am healthier and fitter. So those who judge mothers that opt for elective c-sections please do not assume we are ignorant, lazy or vain. The decision to elect is often more complicated that it would seem.

      • Just thought I would follow up on my previous post. Above, I mentioned some unfortunate circumstances of my vaginal delivery. Despite my intent to deliver naturally (no meds), I labored 54 hours at home with a doula before going to the hospital. We were at the hospital 17.5 more hours until our daughter was born, via vacuum delivery. She was stuck, with her head turned at an angle and face up as she came out. Fourth degree tear, awful recovery. Anyhow, above I mentioned that I would not hesitate to request an elective cesarean for subsequent deliveries. In July 2014, I gave birth to our second daughter via elective cesarean. It was beautiful, magical, and wonderful. I cannot speak highly enough of my elective cesarean. I am writing this post ONLY because I truly care about other women, and their vaginas, and their quality of life after giving birth. To say that an elective cesarean is a risky choice, or a vain decision, or a decision made out of fear, is just not helpful to women. Women deserve to know, and need to know, the risks of vaginal delivery. I know I am in the small percentage of women who sustain 3rd or 4th degree tears. But it happens. Just like c section complications. Those happen too. So if we are talking about risks, lets be honest and lay it all out there…there are risks either way. But i can personally attest to the fact that my elective cesarean was a walk in the park compared to recovering from a fourth degree tear, and the only lasting reminder I have, is an itty bitty scar. Like i said, its easy to look at a c section and point out the risks, but lets not be blind to the risks of vaginal delivery. A c section can be a beautiful thing.

    • I completely agree with this. I was lucky! After a long labour and wrong position I ended up having a c section. The c section was great no complications, and felt back to normal after a week! Also baby had no complications eIther!

    • Poppy, you are SO SO right, and I’m really sorry that you went through that! I hope you recover and I hope that doctors develop a fix for the fecal incontinence!

  17. thank you for the great information.Just that am still worried about my situation.First i had an operation for a fibroid mass.(2005) then c-section (2006) then c-section (2011) then last month i lost the baby from the senond c-section.Now i was told i can only have one more baby.All because my babies cant come normally due to tight cervics.
    DR. please tell me what are my chances of having kids

  18. Doctor, your article was very useful. I was given epidural and my son did have a bad gut for a long time(many years) till it was cured by homeopathy.
    Regards
    Kshama