Cesarean vs. vaginal births: The reasons & risks

Cesarean section (C-section) is a major surgical procedure in which a physician cuts through a pregnant woman’s abdomen and into the uterus to deliver her baby. The procedure has become so common in the United States that the risks are seldom discussed.

Medically indicated C-sections can prevent maternal and infant deaths and complications. But elective C-sections may do more harm than good. 

When are C-sections medically indicated? 

According to the American College of Obstetricians and Gynecologists (ACOG), medical reasons for delivering a baby by C-section include: 

  • a pregnancy involving multiple babies
  • failure of labor to progress (but ACOG’s latest guidance on labor practices addresses what constitutes normal, full-term labor and urges health care providers not to rush but to wait for labor to progress) 
  • problems with the placenta, such as placental abruption (the placenta prematurely breaking away from the wall of the uterus) or placenta previa (an abnormally placed placenta)
  • maternal infection, such as human immunodeficiency virus or herpes 
  • maternal medical conditions, such as preeclampsia, high blood pressure, or diabetes 
  • fetal distress 

What are the risks for babies delivered by C-section?

Sometimes pregnant women are encouraged to have C-sections for nonmedical reasons, such as because they had a previous C-section, they’ve reached their due date, they’re told they have “large baby,” they experience family or social pressures, or doctors have concerns about malpractice charges.

But though C-sections are common in the United States, they’re still surgical procedures with risks. ACOG advises women to refrain from requesting a C-section “without medical indication.” 

Before considering an elective C-section, talk with your health care provider about potential adverse outcomes. For infants, a C-section can increase the risk of:

  • Death. The infant mortality rate for babies born by C-section is nearly three times that of babies born vaginally.
  • Respiratory distress. Infants born by C-section without labor have a risk of breathing difficulties that’s three times that of infants born by C-section with labor, and nearly seven times that of babies born vaginally. Labor triggers the release of hormones and chemicals in unborn babies that lead to the release of proteins that enhance lung function. Also, the release of epinephrine and the compression of the baby during labor and vaginal birth help to remove fluid from the baby’s lungs so that they can breathe easily on their own. Babies born through C-section also are at higher risk for asthma.
  • Circulation problems. The risk of persistent pulmonary hypertension is as much as five times higher in babies born by elective C-section than in those born vaginally. 

In addition, C-sections that result in babies being born preterm or “late preterm” make babies vulnerable to health complications like slow growth, feeding difficulties, or immature respiratory function.

What are the C-section risks for mothers? 

For mothers, C-sections can increase the risk of… 

  • longer hospital stays 
  • higher rates of readmission to the hospital 
  • higher rates of maternal mortality due to complications from anesthesia 
  • increased bleeding (hemorrhage) 
  • increased risk of infection and blood clots 
  • injuries to the bowel or bladder 
  • increased risk of placenta previa, placenta accreta, and abruption in subsequent pregnancies 
  • possible association with stillbirth in future pregnancies 
  • breastfeeding difficulties related to post-surgery pain and weakness 
  • death (very rarely)

In contrast, vaginal birth at full term has benefits like mothers recovering faster and experiencing less pain and babies being exposed to beneficial bacteria that colonize the intestines and enhance immune system function. Vaginal birth does carry some risks for mothers, such as tears, pain in the perineum, urinary or anal incontinence, and hemorrhoids. 

If you are planning on having a C-section or had one unexpectedly, read this to learn more about breastfeeding following a C-section. 

Last updated October 11, 2020

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