Disadvantages of Cesarean Birth on Request
- Recovery is typically 2 weeks longer and there is more pain after a Cesarean Birth than after a vaginal birth.
- There is a scar from the 4-inch incision across the lower abdomen.
- Occasionally adhesions develop around the uterus and cause pain and pulling under the incision. These adhesions can be removed by laparoscopic surgery, usually with complete pain relief and going home several hours later.
- The risk of placental complications increase with each Cesarean Birth, especially after three Cesareans. The placenta infrequently will implant under the previous Cesarean scar on the uterus, and grow into and thru the uterus. When this happens, it is difficult and sometimes impossible to separate the placenta from the uterus and hemorrhage can occur. Rarely, hysterectomy is required. This problem can be diagnosed in advance with ultrasound, but cannot be corrected. There is no increased risk to the baby with this condition.
- There is increased risk of placenta previa with each Cesarean Birth. The risk is 10% after 4 Cesarean Births. Placenta previa is when the placenta covers the inside of the cervix blocking the opening to the vagina from the baby’s side. Most commonly it is a random occurrence. This condition can be associated with bleeding at anytime during pregnancy and occasionally requires a Cesarean Birth when the baby is still premature.
- Sometimes women decide they want a vaginal birth after having a Cesarean Birth in a previous pregnancy. This requires the entire OB team to be on standby during the labor in case a rapid Cesarean Birth is necessary because of uterine rupture caused by strong contractions at the weakened, previous cesarean incision on the uterus. The exact risk of this happening is controversial but is considered to be 1-6%.
- A Cesarean Birth is a major surgery and there are surgery risks that include injury to the bladder, intestines or baby. Injuries are rare in scheduled Cesarean Births, but the risk gradually increases the more Cesarean Births a woman has because of the scar tissue that develops. The amount of scar tissue varies from person to person and is affected by genetic predisposition to form scar tissue during the healing process. Injuries are most common in emergent Cesarean Births associated with fetal distress in labor. These injuries are repairable and usually there are no long-term consequences, but there can be a longer hospital stay and recovery.
- Cesarean Births require anesthesia. For scheduled Cesarean Births the atmosphere is relaxed and festive. Usually the mother is awake and comfortable and talking with her partner or other family member sitting next to her. When the mother is awake, pain relief is accomplished with spinal anesthesia which takes the anesthesiologist about 10 minutes to place. The medication is injected thru a needle in the lower spine which usually gives complete pain relief for at least 12 hours. The risk of any permanent injury from spinal anesthesia is extremely low.
- Skin incisions occasionally become infected and require frequent dressing changes and cleaning until healed (2-3 weeks). Incision infections are most common in obese people and diabetics.
- With Cesarean Birth, bonding is delayed between mother and baby until the Cesarean Birth is over and the new mother returns to her room (usually less than an hour). In a scheduled Cesarean Birth, after the baby is born, the family member in the operating room for support, holds the baby for 10-15 minutes, sitting next to the mother. Mom can reach over and touch the baby, but not hold the baby until later. The baby then goes with the family member and the nurse to the nursery for a short time to be bathed, etc. Then the family member and the baby join the new mother in their hospital room to begin breastfeeding and recovery.
In the past 23 years my Cesarean Birth rate has been 25%. I have never had to do a hysterectomy with a Cesarean Birth. Three times women experienced pain under the Cesarean scar severe enough that they wanted treatment. Laparoscopy was done to remove the adhesions and they had complete pain relief. I've had several patients that have had as many as 5 Cesarean Sections and didn't have any complications.
I do not recommend Cesarean Birth on request for women who want to have more than 3 children because of the increased risks discussed above.
