C-section: is it the right choice for me?

Highly regarded consultant obstetrician Ms Laura Fulwell-Smith explains why expectant mothers may undergo a caesarean (C-section), risks and potential long-term health implications linked to the procedure.

Why is a caesarean section recommended in my case?

There are many reasons why a C-section may be recommended - perhaps you've had one or two Caesarean births before, or your baby is not head-down in late pregnancy. Your placenta may be too near the birth canal to safely recommend vaginal birth (this can cause bleeding). You can also choose to have your baby by planned C section. I would be happy to discuss reasons for and against recommending C section in a telehealth appointment with you.

What are the risks associated with a C-section for both the mother and the baby?

Caesarean section is a safe operation, but it is still major abdominal surgery. The main risks for the mother are increased pain, bleeding and a longer recovery time. It will leave a permanent scar on your skin and on your womb, which will never heal to the same strength that the original tissue had. There is a risk of damaging other internal organs, and of blood clots forming in your legs and lungs.

For the baby, the main risk is with their breathing - babies born by planned C-section struggle more with their breathing than babies born vaginally because their lungs are full of fluid. Some babies will need to be admitted to special care whilst they are stabilised - and this likelihood increases the earlier the C-section is done. However, there are benefits to having a planned C-section and more and more women are choosing it over planned vaginal birth. In my experience, the main reasons for this are around its predictability over labour and being able to remain in control, but there are lots of other perfectly valid reasons.

How does a C-section compare to vaginal birth in terms of recovery time?

Recovery from a caesarean section is significantly harder and longer than recovery from vaginal birth for most women. C-sections are typically done under a "regional" anaesthesia (a "region" of you is numb) and your legs will slowly come back over 6-12 hours. Your partner will almost certainly have to leave the hospital overnight, and that first night can be a challenge. Your tummy will be very uncomfortable, especially in the first few days to weeks. This can make it harder to care for your newborn and other children. It will also affect driving, as it is usually at least two weeks before women are ready to drive again. We state that full recovery is 6-8 weeks but this will vary. Caesarean birth tends to involve more blood-loss than vaginal birth, and this can delay recovery even further as your body recuperates and creates more blood.

Are there any long-term health implications for choosing a C-section?

Yes, unfortunately there are some long-term health implications linked to C-section. Any kind of surgery will create scar tissue, which can lead to "adhesions", where internal parts stick together, which can lead to chronic pain. It also means any future surgeries might be more complex - for example future C-sections, or were you to need a hysterectomy in later life. For some women the womb stitches don't heal properly  - this can lead to a defect or "niche" in the womb, threatening future pregnancies. Fertility is slightly reduced in women who have had C-sections, and the stillbirth rate is slightly increased also. The rates of childhood asthma and obesity for the baby are also slightly worse compared to the background population.

How might a C-section affect future pregnancies?

It can be harder to get pregnant again after C section, and we also recommend at least 12 months before trying for another baby to allow your body time to fully heal. If the scar tissue is stretched too thin too early it can tear - this is uterine rupture and can be devastating for mum and baby.

Vaginal birth is an option after 1 or even 2 straightforward caesarean births, but there is a 1 in 250 chance of uterine rupture or tearing. With repeated C sections the scar tissue will get worse, which increases the chance of injury to other organs - this will typically be the bladder as it is "pulled" higher up on the womb by the scarring. The placenta can invade through the scar into the womb muscle itself or even through the womb and out the other side - this is a life-threatening condition called "Placenta Accreta Spectrum" or "PAS".

If you would like to learn more about C-sections, book a consultation with Ms Fulwell-Smith via her Top Doctors profile today.