Benefits and Risks of Caesarean Birth

Information to help you make a decision about your caesarean birth

A caesarean birth is a safe operation for both you and your baby. However, as with any major surgery there are some potential risks. Appropriate measures are always taken to reduce your risk of developing complications. You may be considering a planned caesarean birth for many reasons, such as medical issues for you or your baby or previous birth trauma. Sometimes your medical team will recommend a caesarean, your obstetrician will discuss the risks and benefits with you including offering a vaginal birth as an alternative if this is appropriate.

Using the BRAIN framework to make your decision

When thinking about your options, it can help to ask:

• Benefits – what are the intended benefits of this option for me and my baby?
• Risks – what are the possible risks or side effects?
• Alternatives – are there other options I could choose?
• Important – What is important to you?
• Nothing – what happens if I do not have this option?

Intended Benefits

A caesarean birth may be the safest option for you and your baby depending upon individual circumstances. Alongside it being indicated for you or your baby due to potential health issues, a planned caesarean may alleviate certain anxieties and reduce the chances of birth trauma.

Potential Risks and Complications of Caesarean Birth

Immediate Risks (During and immediately after surgery)

• Bleeding – significant blood loss requiring blood transfusion (around 1 in 67), in rare cases requiring emergency hysterectomy (1 in 500)
• Bladder or ureter damage – uncommon (around 1 in 1,000)
• Injury to other organs – damage to the bowel or blood vessels is rare but may require repair

Early Recovery Risks (First hours to weeks after surgery)

• Infection – wound infection, which may require readmission to hospital (around 1 in 14–50)
• Pain or numbness around wound – very common immediately after surgery and usually resolves within days or weeks. In rare circumstances some women or birthing people may experience chronic pain or numbness that persists for months or years.
• Blood clots in legs or lungs – potentially serious if not treated
• Increased length of hospital stay in hospital – compared to vaginal birth

Long-term Risks (Weeks to months after recovery)

• Chronic pain or numbness around the wound – can persist for months or years in some women
• Urinary or bowel problems – incontinence or other changes lasting more than a year after birth

Future Pregnancy Risks (If you have more pregnancies)

• Rupture of womb in future pregnancies – particularly if future vaginal birth is attempted
• Abnormal placental implantation in future pregnancies – including placenta accreta spectrum (1 in 1000, this is higher after multiple caesarean births)

Serious but Rare Complications

Further procedures may become necessary during the birth, including blood transfusion, repair of any damage to the bowel, bladder or blood vessels, and as a life-saving procedure an emergency hysterectomy.

Death within 6 weeks of childbirth is very rare, occurring in approximately 1 in 4,000 caesarean births. Death of your baby within 28 days of birth is also very rare.

Risks to Your Baby

• Minor cuts to baby's skin – around 1–2% of cases
• Temporary breathing difficulties – requiring admission to the neonatal unit in around 4–5% of births after 39 weeks gestation
• Increased risk of some long-term conditions – some studies indicate increased risk of asthma, allergies and certain metabolic conditions such as type 1 diabetes in future

Alternatives: Comparing Caesarean Birth with Vaginal Birth

The advantages and disadvantages of vaginal birth should also have been discussed with you as an alternative option, if appropriate to your circumstances.

If vaginal birth is an appropriate option for you, the Royal College of Obstetricians and Gynaecologists (RCOG) tables below compare the main risks and outcomes for caesarean birth and planned vaginal birth. These comparisons are based on research studies, but the actual risks will vary depending on your individual circumstances. Your obstetrician will help you understand which risks are most relevant to you.

Outcomes for You

Outcomes for Your Baby

* Figures based on planned and unplanned caesarean births.

# Using a scale where 1 is no pain through to 10 which is most severe pain.

Note: Studies including pregnant women and birthing people with breech presentations, multiple pregnancies, preterm births, babies who are small-for-gestational-age, placenta praevia, and maternal infections were excluded.

Who will perform my surgery?

The surgery will be performed by an obstetrician trained in the surgery. We often cannot confirm who this will be until the day. Your surgical team should go through the consent form with you on the morning of your surgery.

Potential delays

The Rosie Maternity Hospital is experiencing an increasing number of women and birthing people requesting planned (elective) caesarean births. At the same time, we must ensure we have sufficient operating theatre capacity and staffing to provide safe care for women and birthing people and babies who require emergency treatment.

During busy periods, we cannot always offer your caesarean birth within your preferred timeframe. All planned caesarean births are scheduled according to clinical priority, and this process is overseen by a multidisciplinary team of clinicians to ensure safe and equitable access to care.

If we are unable to offer you a suitable date at the Rosie Maternity Hospital, we may offer you the option of having your planned caesarean birth at another local maternity unit with available capacity. This may help avoid further delays.

A member of the obstetric or midwifery team will discuss this option with you, explain what it involves, and answer any questions you may have. You can then decide whether you wish to accept this offer. If you choose not to have your caesarean birth at another maternity unit, you will remain on the Rosie Maternity Hospital waiting list until a suitable surgical slot becomes available.

There may be occasions when your planned caesarean birth is delayed on the day of your procedure. This may be due to emergency activity, operating theatre or staffing capacity, or the availability of neonatal cots. If this happens, the team caring for you will keep you informed of any delays or, if necessary, postpone your planned caesarean birth. If your procedure is postponed, you will have an individualised ongoing plan.

Further Information about Caesarean Birth

The RCOG also has a planned caesarean birth video - click here to view it (opens in a new tab).

For information about anaesthesia, please see the Benefits and Risks of Anaesthesia for Caesarean Birth leaflet.

Contraceptive Options and Sterilisation

The following sections provide additional information for those considering their contraceptive options at the time of caesarean birth.

Sterilisation (Tubal Ligation or Occlusion)

Following discussion with your obstetrician, you may wish to consider sterilisation (tubal ligation or occlusion) at the time of caesarean birth to prevent further pregnancies. This procedure involves cutting and tying the fallopian tubes, or removing them altogether, after delivery of the baby and closure of the uterus.

Effectiveness and safety

Sterilisation is very effective (>99.5%). However, sterilisation performed at the time of caesarean birth may have a higher failure rate, partly because the fallopian tubes may be swollen due to pregnancy.

If you become pregnant after sterilisation has been performed, there is an increased risk of an ectopic pregnancy (pregnancy outside the womb). An ectopic pregnancy is a potentially serious condition that requires urgent medical care. You should seek an early pregnancy scan.

Benefits of Removing the Entire Fallopian Tube

Removal of the entire fallopian tube is thought to potentially reduce your future risk of ovarian cancer.

Risks of Removing the Entire Fallopian Tube

Removal may be more technically challenging due to increased blood supply to the area supporting the pregnancy. This carries an increased risk of injury to surrounding blood vessels and bleeding.

Limitations

Occasionally, we cannot complete the sterilisation procedure at the time of caesarean birth due to limited access to the fallopian tubes. This often occurs if there is significant scar tissue from previous abdominal surgeries.

Effects on Menstruation

Female sterilisation itself should not adversely affect your menstrual function.

Regret and Reversal

Studies indicate a greater risk of regret among women who have had sterilisation performed at caesarean birth compared to those who had it performed at a later date. Reversal of sterilisation is often not possible and is not available on the NHS.

It is therefore important practice to obtain your informed consent for this procedure. We will discuss this decision at different stages during your pregnancy and delivery planning journey.

Alternative Contraceptive Options

Long-Acting Reversible Contraceptives

You may wish to consider long-acting reversible contraceptives, such as:

• Intrauterine device (coil)
• Implant

Intrauterine Device (Coil) at Caesarean

We can offer insertion of a coil at the time of caesarean birth. A coil is a small device placed into the uterus (womb) to prevent pregnancy.

Types of Coils

There are two main types:

• Hormone-releasing coils – containing the hormone progestogen
• Copper coils – non-hormonal

Hormone-containing coils can also be used effectively to manage heavy periods.

Advantages

• Generally, very safe
• Painless insertion (you already have an anaesthetic for your operation)
• Effective for several years
• Both hormonal and copper coils are safe to use whilst breastfeeding

Effectiveness and Risks

• Failure rate – very low (<1 in 100 women per year).
• Expulsion risk – greater when fitted at caesarean (around 1 in 20), or displacement.
• Womb perforation – <1 in 1,000 chance of injury to the womb itself at time of insertion.
• Infection – small chance (<1 in 100) in the first few weeks following insertion, this is the same as if the coil was fitted later.

Post-Insertion Care

You will require a thread check and likely trimming postnatally. This should be arranged via your local GP surgery. We recommend using additional contraception until this time.

Changes in Menstruation

Changes in menstruation may occur with coil use.

Implant and other Contraceptive Options

Alternative contraceptive options are available for use in the post-natal period, please discuss this with your midwife or doctor.