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.
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:
- Natural childbirth I: is homebirth more dangerous than hospital birth?
- Natural childbirth IIa: is ultrasound necessary and effective during pregnancy?
- Natural childbirth IIb: ultrasound not as safe as commonly thought
- Natural childbirth III: why undisturbed birth?
- Natural childbirth IV: the hormones of birth
- Natural childbirth V: epidural side effects and risks
- Natural childbirth VI: Pitocin side effects and risks
- Natural childbirth VII: Cesarean risks and complications
- Buckley, Sarah J. Gentle Birth, Gentle Mothering: A Doctor’s Guide to Natural Childbirth and Gentle Early Parenting Choices. Celestial Arts, 2009. pp. 120 ↩