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

Natural Childbirth VII: C-Section Risks and Complications

by Chris Kresser

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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


Join the conversation

  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

  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:

  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:

      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 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


  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…

  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.

  19. Great article! C-sections are certainly saving lives of moms and babies everyday but they are completely overused as is every medical intervention at Drs., midwives, and hospitals disposal these days – to our collective health’s detriment as well as our national and personal healthcare pocketbook. And for the record, I naturally (unmedicated) birthed, in a hospital with a midwife, a 41+3 week, posterior (known to be for weeks and he did not turn) 8lb 13oz healthy baby boy. It can be done.

    • Sure it can be done. It can also NOT be done (i.e. many women in your situation would have ended up with a dead or injured baby and/or severe tearing, or would have gotten a c-section to prevent those horrific results). You gambled on it working and it did. But what if you had gambled and lost?

      I would never presume to write an article or post saying you shouldn’t have had a vaginal birth without meds, since it’s your body, your baby and your right to choose. And I would hope that you would also not judge other women for their decision to have a c-section, or pain relief (epidural) during a vaginal birth–for the exact same reason: it’s their body, their baby, their right. Your decision to gamble that it would work should be respected just as much as other women’s decision not to take that gamble.

  20. Claire, I’ve had three children via c-section, and they are the healthiest babies I know — never an ear infection, I finally had to use a thermometer last year because I thought one was warm, only two colds amongst all three in 5 years. I breastfed exclusively for six months (and I had never used birth control pills, so my gut flora was really good). Just breastfeed, breastfeed, breastfeed!

    • Sure it can be done. It can also NOT be done (i.e. many women in your situation would have ended up with a dead or injured baby and/or severe tearing, or would have gotten a c-section to prevent those horrific results). You gambled on it working and it did. But what if you had gambled and lost?

      I would never presume to write an article or post saying you shouldn’t have had a vaginal birth without meds, since it’s your body, your baby and your right to choose. And I would hope that you would also not judge other women for their decision to have a c-section, or pain relief (epidural) during a vaginal birth–for the exact same reason: it’s their body, their baby, their right. Your decision to gamble that it would work should be respected just as much as other women’s decision not to take that gamble.

  21. I’ve just left my midwife appointment. I ‘might’ be breach, I will have a scan to check. If this is the case then I have to have a c section – my hospital won’t deliver breach babies naturally. I’m so upset because I had my heart set on a home/ natural birth. Can anyone recommend some reads on getting my babies health back after a c- section? All being well i’ll be breast feeding. Thanks

  22. Thank you Elizabeth for sharing your stories. It is hard for a Mum to know when a ceserean is needed. Sara R. I did read the disclaimer at the top but how can anyone know what an ideal cesarean rate should be? Babies can be born vaginally but yet have handicaps as a result of being born too late, etc. So techinically yes, great, the baby was born vaginally, but the price?
    I didn’t think a Dr could tell whether a baby is posterior until the Mum had dialated enough for them to be able to tell? I had assumed that to be the case. When I went in to the hospital I was 1cm dialated and the Dr didn’t know the baby was posterior. I was already three days in with a lot of pain and no sleep. The baby was wedged in and my water had broke, making her even more wedged on bone and even more pain for me. Even if the baby had turned, which I don’t think was possible at that point, I certainly did not have the energy to push!
    The Dr told me that 8 of every 10 babies that are posterior turn during labour. How the heck is anyone to know whether they have a baby that is one of the eight? It’s dangerous to get Mums to second guess their Drs and have doubts about cesareans. I didn’t want one and my husband had to convince me to. THANK GOD he did because I dread to think what could have happened to my baby girl if I had foolishly let me own agenda of a natural, vaginal birth get in the way. Mums aren’t in a position to play Dr, especially when in labour.
    If cesarean rates are too high, then the Drs have to make the change. It can’t be a change fueled by Mums taking risks without being properly informed.

  23. I had a baby via c-section last April. I started to have contractions every 20 minutes on Tuesday, painful contractions every 7 minutes on Wednesday, then on Thursday evening, my waterbroke and the contractions increased to every four minutes. I was in agony for 48 hours. When I arrived at the hospital that Thursday evening I could barely walk and talk I was so exhausted. I hadn’t slept in three days. I was 1cm dialated. My daughter was wedged in tight, sunny side up, my cervix was swollen. The more contractions I had, the more swollen I became, the more cone shaped her head became. I “elected” to have a cesarean because her heart had decels. (Not before I had morphine to get me to sleep, which got me to 6cm dialated. Anyway, Friday at 5pm I had the cesarean. There wasn’t a chance I could have PUSHED her out even if I had fully dialated. Even with meds and extra 24 hours, could only get to 6cm. I am sick of hearing all this crap about how bad cesareans are. If I had waited until it became an emergency, my Dr said my daughter may well have had cerebral palsy. STOP DEMONIZING THESE LIFE SAVING SURGERIES and scaring Mums into being hell-bent on vaginal deliveries to the point of jeopardising their own safety or the safety of their babies.

    • Good for you for speaking out. I agree with you that given certain circumstances c-sections are for the best. My grandmother should have had a c-section for her 5th — instead she wound up holding a dead baby because the doctor or she couldn’t get him out in time. My aunt should have had a c-section, instead she cared for her severely disabled son until he died in his late 30s. My cousin’s wife should have had a repeat c-section; instead she tried for a VBAC resulting in her uterus rupturing, her baby dying, and she wound up in a coma for 15 days, awakening to learn her baby had died.

    • Did you miss the misclaimer in the beginning of the article? Sometimes women need c-sections, but it’s almost certainly not 30%. or 50%, or whatever. And it’s possible that you could have birthed your baby vaginally had she turned. There are techniques to encourage babies to turn, but most care providers are unaware of this. I have several friends who have had c-sections for babies who were posterior but they were not told this, instead, “their pelvis was too small”. Then again I know a few other friends who had skilled, experience care providers who supported them and their babies turned and were born vaginally. I personally kept a close eye on the position of my babies during pregnancy so that I could take action if they were not in an optimal position for birth. Not ALL babies will turn (or have to, for that matter), but many will, if the mother is well-supported.

  24. My two children were born via c-section. Ultimately, I wanted them to be born without problems to them or to me. I believe the c-sections were the right thing to do given my circumstances. That said, I am shocked to hear that even though my babies were exclusively breastfed for the first six months of life, that they have gut flora that will lead to problems. How well did that study include breast-fed c-section babies and the gut flora of their mothers? My children have NEVER had an ear infection, I’ve NEVER recorded a fever on them, and they are always healthy (except for one very light cold once a year, which has been over a year now). In contrast, I know so many people (my brother, for instance) born vaginally and have health issue after health issue, etc. I’m just very curious about that study and how reliable it is about breastfeeding not mattering.

    • Hi Elizabeth, don’t believe the scare tactics. The gut flora studies are MINUSCULE–the main researchers looking at this are in Scandinavia and they seriously publish articles after only looking at 30 kids born by c-section and 34 born vaginally:

      The only other time I’ve ever heard of such tiny studies is with studies of incredibly rare diseases/conditions. I can’t imagine why they would go to press with articles about such small numbers of children that the results could be down to chance.

      And even that minuscule study didn’t find permanent differences or health effects. Instead it just found that the colonization of the intestinal tract in c-section babies “was delayed”–and not even by very long: “Bifidobacterium-like bacteria and Lactobacillus-like bacteria colonization rates reached the rates of vaginally delivered infants at 1 month and 10 days, respectively.” Also, it specifically said there were no additional gastrointestinal problems in babies born by c-section: “The occurrence of gastrointestinal signs did not differ between the study groups.”

      And here’s another study that looked at the issue and found NO DIFFERENCE in food allergies between babies born the two ways:
      Same result in another study:

      And here’s a study that looked at oral microflora (like gut bacteria but in the mouth), and actually found that babies born vaginally were actually MORE likely to have cavity-causing bacteria in their mouths:

      Long story short, the evidence on this issue is weak and inconclusive. And if you think about it, even if it does end up turning out that getting mom’s vaginal flora in your mouth while being born matters to your health, the solution is simple: swab mom’s vagina and put that swab into the baby’s mouth. Problem (if there even is a problem) solved.

  25. I am 37 weeks pregnant and tested positive for Group D Strep, therefore I will be on antibiotics during labor and delivery. I know that you recommend Klaire Labs infant probiotic, but I live in Thailand and it is impossible to get that here. What other options do I have to help establish good gut flora in my newborn. Can I use adult probiotics? Are there specific bacteria strains that the baby should not be given as a newborn? Thanks for your help.

    • The author of the Body Ecology Diet, in a YouTube video with Natasha Cambell-McBride, recommends coconut water kefir on the nipple at every feeding. As I recall that is a recommendation for all babies, not just those with known complications in gut flora, but it’s a good start – and should be reasonably doable for you, right?

  26. I empathize with Peggy the Primal Parent. I was also born vaginally (despite being a breech baby, and my mom being in 48 hours of labor with me – probably something a modern hospital would never allow to happen) and was also breastfed, and I struggle with obesity (though have lost 127 pounds), gluten intolerance, diabetes type 2, Hasimoto’s. My two bottle-fed sisters are both slender and in much better health!

    My own son was born vaginally and breastfed for a year, and he struggles with obesity too. One of my sisters had her first child vaginally and the second via emergency C-section. She said the C-section was such a wonderful experience compared to a vaginal birth that she would have demanded a C-section for her first child too if she had only known! 🙂

  27. Great article Chris! I have to say, the thought of cutting someone open and surgically removing a child has always unsettled me, especially as an elective procedure. However, at the end of the day, the woman is in charge of her own body, and if it is a choice she wants to make, than so be it. It’s just important that people know exactly what risks they are putting themselves and their babies in by doing so, so cheers to ya for the post!

  28. Great, concise article on this topic. Two years ago I had a really difficult decision to make: I intended to have my baby girl at home until at 36 weeks we suspected she was breech. I did massive research and decided to continue with the home birth, but hired an extra midwife with scores of breech baby deliveries under her belt. It turned out to be a good choice and my girl was born butt first, quickly and easily, but I totally understand why this is not a choice most people would make. Not to be morbid, but I felt like in the end I was the one who needed to be the most safe as I am already alive and have a family that loves and needs me, while if anything should happen to the baby, well, I could always have another baby…maybe not if a c-section went terribly wrong though…
    Dr.’s are not trained to deliver breech babies and I found a MW who was very skilled, so I actually felt safer staying out of the hospital and avoiding c-section.

  29. Chris, thank you for this post! What is your opinion on VBACs? I had twins a couple years ago. My OB told me early on to pretty much expect a c-section. I ended up with gestational hypertension and was on at-home bed rest for the last month of my pregnancy (up to then I was perfectly healthy). Because of this complication, my doc didn’t want me to go past 38 weeks which meant I had to have a c-section. My recovery from the c-section was pretty difficult, especially while trying to breastfeed two babies.

    So, because I had a c-section for my first two, if I were to have another I am guaranteed to have another one since most doctors are unwilling to do VBACs. However, I’ve heard that VBACs aren’t as risky as previously thought. Have you found anything about this?

    Thanks again for all of the information you put out there!!

    • Yes, the risk has been overstated. According to most studies, 75% of VBACs are successful, with excellent outcomes for mothers and babies.

      • But, Chris, that means that 25% of all VBACs are UNsuccessful. My cousins’s wife is one of those. She tried for a VBAC, her uterus ruptured, her full-term baby died, she wound up in a coma for two weeks, she lost her uterus, and when she woke up, instead of holding her baby, she had to go visit him at the cemetery.

        • Please keep in mind that VBACs termed “unsuccessful” can be due to any number of different reasons – it doesn’t mean that all 25% or even a small percentage ended in someone’s death. As a pregnant mom I bought everything Ina May Gaskin ever published – she has an enormous amount of experience on the subject & has a ton of references for free on her website. I would recommend her as an essential read to any new mom – she will relieve your anxiety & empower you to do exactly what your body is designed to do.

        • Hi, Beverly. NO, I do not know what kind of stitching my cousin had. It’s very sad. My grandmother is someone else that should have had a c-section; instead, they tried for natural childbirth, and her baby (who would have been my uncle) was stillborn. There are so many sad stories out there.

    • I had twins by c-section as well. All my other babies were born vaginally in the hospital. In order to have vbac for my baby after the twins, the best route for me was to have a homebirth with a midwife. This decision wasafe after talking to many, many doctors about vbac and the various parameters that govern that in the hospital. It would have been a sure c-section again with their rules. Anyways, we don’t regret fighting for our vbac, but it was not easy!

  30. It’s not just the Western World that believe C sections are perfectly safe and possibly preferable. The Chinese deliver a huge percentage of babies via c-section, a touch less than 50% which is way above the US rate. The reasons are partially economic- hospitals can charge more and partially practical- you can schedule the birth and know about how long the process will take. Neither of these are good reasons of course but that’s how it is.

    My wife had her first baby by c- section and hospitals here won’t even consider the possibility of a natural birth for the second.

  31. Tyler,

    I think there are only two options. One is the you mentioned and the other, probably more important, is the vaginal route itself that provides first bacterial exposure to the child.

    Which brings to mind… if uteral/cervical and vaginal excretions are the main reason for the benefits of natural childbirth, why bothering with any supplementsl magic, at all. Some stupid christian beliew surely must keep people from seeing the plain truth wide open… (keyword: vaginal microbiota, the first exposure to evil world)

    Also, the birth trauma itself may have some recuperative effects in itself.

    Oh and I was born via cesarean. Got 13 allergies and Crohn’s disease, thank you very much!

  32. Thank you, thank you, thank you. This neatly encapsulates the issue and will be my send-to article in the future when someone asks why I’m so vehemently anti-CS.
    Tyler, we evolved by, with, and because of birth. It is triggered by a signal in the baby’s brain when the child is done gestating; it forcefully massages the airways, removing fluids, and the spine; and it generally takes longer than surgery, and the child’s body needs that transition time to adapt to the biggest change of its life. So you are right with the “too early” hypothesis, but it’s not just when, but HOW.
    Fast food makes sick bodies, and “fast birth” makes sick babies.

    • I’m glad to see some pro c section people. I don’t think mothers should be able to choose a c section over vaginal birth if vaginal birth is possible. I was two weeks late with my daughter and was induced unfortunatley i was in labor for around 50 hrs and after every attempt was made including cervadil, potocin, and breaking my water I could not give birth to my daughter. I received an emergency c section and she is a perfect. I’m 30 weeks pregnant now and will be delivering via c section in 9weeks 🙂

  33. I’m one of the women who tried to give birth at home and ended up at the hospital with a doctor shouting to my husband “Dead wife or dead baby” when I insisted I just wanted pain relief (after baby flipping backwards during labor and a swollen cervix) and the doctor insisted upon a c-section. The doctor won and due to that, I could not physically give birth to my second baby. My uterus was scarred. I had adhesions. This second time my wonderful MW recognized the problems and insisted upon taking me to the hospital where even she said that a c-section was inevitable given my symptoms. Giving birth naturally is no longer an option for me despite being a good healer, eating well, and having great pregnancies.

    The medical industry has so many problems and giving women support for natural birth is just one. Beyond the obvious problems with c-sections, women are not counseled on the post birth complications such as gut flora for the babies. Both of my children spent their infancy reacting severely to proteins in my breastmilk and have dealt with severe food intolerances. Then you have the arduous recovery from surgery while trying to care for a newborn.

    So thank you for writing about the problems for mothers and babies. Getting this information into the hands of pregnant women and especially the medical profession is a must. I know that the surgeons operating on me thought I was an idiot for attempting a home and then a birth center birth and verbally told me so during the operation. These abuses need to be addressed and the medical profession needs to be educated appropriately. I just don’t know how this can be done.

  34. Chris, what is your stance on things like Rhogam during pregnancy rather than waiting until after birth? Or treating newborns with antibacterial eyedrops and vit k shots? All these treatment are to prevent diseases that are rare, but then you are the dummy if it happens to you. Do you feel the side effects are bad enough to avoid these preventative treatments?

  35. I don’t understand why anyone would elect to have their baby pulled out of a huge incision when we are perfectly well equipped to push babies out through an elastic birth canal. I had an “emergency” c-section in a hospital and wish I had experienced natural child birth. Hospitals are much to hasty in their decision to do c-sections and allowing women to elect a c-section is just crazy (or money driven).

    I healed amazingly well and quickly and my daughter has no signs of any of the problems you speak of after 6 years, but we also ate a Paleo diet the whole time which includes plenty of naturally fermented foods. I’m sure we would have been better off with natural childbirth, but with a meticulously healthy diet, we turned out ok.

    • Hi Peggy

      Interesting comment. I also had an emergency C section (the doc who performed the surgery said afterwards that I am probably one of those women who in ‘the olden days’ would have either died, or the baby died, or both, due to a bunch of different reasons.) Preferring not to have just one child, I will now be considering electing for a C section for #2. There’s one reason for you!

      But in doing a LOT of research regarding C sections vs VBAC (which thankfully the hospital is supportive of), I’ve noticed a recurring theme of legality, especially here in Australia. You see, there has never been a lawsuit regarding a C section here raised against the ob, whereas with a vaginal birth there have been several (Ie damage to baby from forceps, extreme tearing etc). When you elect/consent to a C section you acknowledge the risks involved and sign something saying that the hospital won’t be held liable. You don’t sign anything like this for a vaginal birth. You do sign it for a VBAC. Also, the public hospital is funded $5000 (approx) for each C Section performed, whereas a vaginal birth is only funded $3000. I think this is why they tend towards a C section – much safer for them!

      My daughter also experienced no signs or negative responses to the C Section mentioned in the article and (despite our SAD and lack of fermented food) we have also turned out ok.

    • How dare you judge. I went through a 30 od hour intense labour and was still only 2-3 cen dilated. I had walked miles and trief everything. My son was 2 weeks late and I ended with a raised temp due to infection and he had a raised heartbeat. So yes after 30+ hours I adked for a c sect as was told I would he another 24 hours! How dare you judge others. Have my labour then comment.

      • hi there I no its a little late but I totally agree with you, ive had 2 vaginal births now and both were horrific! my 2nd ending me in hospital for 8 days with a catheter in for 5 days couldn’t walk for 5 days or lift the baby ended up delivering baby by having a episiotomy and getting her out with forceps! after over 20 hours of labour! im now pregnant and have opted for a c section, surley this is the way the to go after my experiences

      • You are absolutely right – I am the product of a c-section after 27 hours of labor (my mother’s birth canal was too small and I was almost 9 lbs.), and my youngest son was born by c-section because his heart rate was dropping and it was likely that he would die if left inside full-term.

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