Editing Caesarean section (section)

===Mother===
In those who are low risk, the [[mortality rate|risk of death]] for caesarean sections is 13 per 100,000 vs. for vaginal birth 3.5 per 100,000 in the developed world.<ref name=ACOG2014/> The United Kingdom [[National Health Service]] gives the risk of death for the mother as three times that of a vaginal birth.<ref>{{cite web|url=http://www.nhsdirect.nhs.uk/articles/article.aspx?articleId=71&sectionId=7681 |title=Caesarean Section |publisher=[[NHS Direct]] |access-date=26 July 2006 |url-status=dead |archive-url=https://web.archive.org/web/20090201155120/http://www.nhsdirect.nhs.uk/articles/article.aspx?articleId=71&sectionId=7681 |archive-date=1 February 2009 }}</ref>

In Canada, the difference in serious morbidity or mortality for the mother (e.g. cardiac arrest, wound hematoma, or hysterectomy) was 1.8 additional cases per 100.<ref name=Liu2007/> The difference in in-hospital maternal death was not significant.<ref name=Liu2007>{{cite journal | vauthors = Liu S, Liston RM, Joseph KS, Heaman M, Sauve R, Kramer MS | title = Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term | journal = CMAJ | volume = 176 | issue = 4 | pages = 455–460 | date = February 2007 | pmid = 17296957 | pmc = 1800583 | doi = 10.1503/cmaj.060870 }}</ref>

[[File:Normal post-Caesarean.jpg|thumb|[[Transvaginal ultrasonography]] of a uterus years after a caesarean section, showing the characteristic scar formation in its anterior part]]
A caesarean section is associated with risks of postoperative [[Adhesion (medicine)|adhesions]], incisional hernias (which may require surgical correction), and wound infections.<ref name=Pai00>{{cite journal | vauthors = Pain M |title=Medical Interventions: Caesarean Sections as a Case Study |journal=[[Economic and Political Weekly]] |volume=35 |issue=31 |pages=2755–61 |year=2000}}</ref> If a caesarean is performed in an emergency, the risk of the surgery may be increased due to several factors. The patient's stomach may not be empty, increasing the risk of anaesthesia.<ref>{{cite web |url=http://www.gynaecworld.com/Pregnancy/pg9.html#3 |title=Why are Caesareans Done? |publisher=Gynaecworld |access-date=26 July 2006 |url-status=dead |archive-url=https://web.archive.org/web/20081203134401/http://www.gynaecworld.com/Pregnancy/pg9.html#3 |archive-date=3 December 2008  }}</ref> Other risks include severe blood loss (which may require a blood transfusion) and [[Post dural puncture headache|post-dural-puncture spinal- headaches]].<ref name=Pai00/>

Wound infections occur after caesarean sections at a rate of 3–15%.<ref name="Saee2017">{{cite journal | vauthors = Saeed KB, Greene RA, Corcoran P, O'Neill SM | title = Incidence of surgical site infection following caesarean section: a systematic review and meta-analysis protocol | journal = BMJ Open | volume = 7 | issue = 1 | pages = e013037 | date = January 2017 | pmid = 28077411 | pmc = 5253548 | doi = 10.1136/bmjopen-2016-013037 }}</ref> The presence of [[chorioamnionitis]] and [[obesity]] predisposes the woman to develop a surgical site infection.<ref name="Saee2017" />

Women who had caesarean sections are more likely to have problems with later pregnancies, and women who want larger families should not seek an elective caesarean unless medical indications to do so exist. The risk of [[placenta accreta]], a potentially life-threatening condition that is more likely to develop where a woman has had a previous caesarean section, is 0.13% after two caesarean sections, but increases to 2.13% after four and then to 6.74% after six or more.  Along with this is a similar rise in the risk of emergency hysterectomies at delivery.<ref>{{cite journal | vauthors = Silver RM, Landon MB, Rouse DJ, Leveno KJ, Spong CY, Thom EA, Moawad AH, Caritis SN, Harper M, Wapner RJ, Sorokin Y, Miodovnik M, Carpenter M, Peaceman AM, O'Sullivan MJ, Sibai B, Langer O, Thorp JM, Ramin SM, Mercer BM | title = Maternal morbidity associated with multiple repeat cesarean deliveries | journal = Obstetrics and Gynecology | volume = 107 | issue = 6 | pages = 1226–1232 | date = June 2006 | pmid = 16738145 | doi = 10.1097/01.AOG.0000219750.79480.84 | s2cid = 257455 }}</ref>

Mothers can experience an increased incidence of [[postnatal depression]], and can experience significant psychological trauma and ongoing [[Childbirth-related posttraumatic stress disorder|birth-related post-traumatic stress disorder]] after obstetric intervention during the birthing process.<ref name=Olde2006>{{cite journal | vauthors = Olde E, van der Hart O, Kleber R, van Son M | title = Posttraumatic stress following childbirth: a review | journal = Clinical Psychology Review | volume = 26 | issue = 1 | pages = 1–16 | date = January 2006 | pmid = 16176853 | doi = 10.1016/j.cpr.2005.07.002 | hdl-access = free | s2cid = 22137961 | hdl = 1874/16760 }}</ref> Factors like pain in the first stage of labor, feelings of powerlessness, intrusive emergency obstetric intervention are important in the subsequent development of psychological issues related to labor and delivery.<ref name="Olde2006"/>

====Subsequent pregnancies====
{{Further|Delivery after previous caesarean section}}
Women who have had a caesarean for any reason are somewhat less likely to become pregnant again as compared to women who have previously delivered only vaginally.<ref name="Gurol-UrganciBou-Antoun2013">{{cite journal | vauthors = Gurol-Urganci I, Bou-Antoun S, Lim CP, Cromwell DA, Mahmood TA, Templeton A, van der Meulen JH | title = Impact of Caesarean section on subsequent fertility: a systematic review and meta-analysis | journal = Human Reproduction | volume = 28 | issue = 7 | pages = 1943–1952 | date = July 2013 | pmid = 23644593 | doi = 10.1093/humrep/det130 | doi-access = free }}</ref>

Women who had just one previous caesarean section are more likely to have problems with their second birth.<ref name=ACOG2014/> [[Delivery after previous caesarean section]] is by either of two main options:<ref>{{Cite web |title=UpToDate |url=https://www.uptodate.com/contents/choosing-the-route-of-delivery-after-cesarean-birth |access-date=2024-02-10 |website=www.uptodate.com}}</ref>
* Vaginal birth after caesarean section (VBAC)
* [[Elective surgery|Elective]] repeat caesarean section (ERCS)

Both have higher risks than a vaginal birth with no previous caesarean section. A vaginal birth after caesarean section (VBAC) confers a higher risk of [[uterine rupture]] (5 per 1,000), blood transfusion or [[endometritis]] (10 per 1,000), and [[perinatal death]] of the child (0.25 per 1,000).<ref name=rcog2007>{{cite web |url=https://www.rcog.org.uk/globalassets/documents/guidelines/gtg4511022011.pdf |title=Birth After Previous Caesarean Birth, Green-top Guideline No. 45 |date=February 2007 |publisher=Royal College of Obstetricians and Gynaecologists |url-status=dead |archive-url=https://web.archive.org/web/20141207031819/https://www.rcog.org.uk/globalassets/documents/guidelines/gtg4511022011.pdf |archive-date=7 December 2014  }}</ref> Furthermore, 20% to 40% of planned VBAC attempts end in caesarean section being needed, with greater risks of complications in an emergency repeat caesarean section than in an elective repeat caesarean section.<ref name="americanpregnancy"/><ref name="mayoclinic"/> On the other hand, VBAC confers less [[maternal morbidity]] and a decreased risk of complications in future pregnancies than elective repeat caesarean section.<ref name="American Congress of Obstetricians and 450–63">{{cite journal | vauthors =  | title = ACOG Practice bulletin no. 115: Vaginal birth after previous cesarean delivery | journal = Obstetrics and Gynecology | volume = 116 | issue = 2 Pt 1 | pages = 450–463 | date = August 2010 | pmid = 20664418 | doi = 10.1097/AOG.0b013e3181eeb251 }}</ref>

====Adhesions====
[[File:Suturing uterus.JPG|thumb|Suturing of the uterus after extraction]]
[[Image:C-sec suture.jpg|thumb|right|Closed incision for ''low transverse abdominal incision'' after stapling has been completed]]
Several steps can be taken during abdominal or pelvic surgery to minimize postoperative complications, such as developing [[adhesions]]. Such techniques and principles may include:
* Handling all tissue with absolute care
* Using powder-free surgical gloves
* Controlling bleeding
* Choosing sutures and implants carefully
* Keeping tissue moist
* Preventing infection with antibiotics given intravenously to the mother before skin incision

Despite these proactive measures, adhesion formation is a recognized abdominal or pelvic surgery complication. To prevent adhesions from forming after caesarean section, [[adhesion barrier]] can be placed during surgery to minimize the risk of adhesions between the uterus and ovaries, the small bowel, and almost any tissue in the abdomen or pelvis. This is not current UK practice, as there is no compelling evidence to support the benefit of this intervention.{{cn|date=April 2025}}

Adhesions can cause long-term problems, such as:
* [[Female Infertility|Infertility]], which may end when adhesions distort the tissues of the ovaries and tubes, impeding the normal passage of the egg (ovum) from the ovary to the uterus.  One in five infertility cases may be adhesion-related (stoval)
* Chronic pelvic pain, which may result when adhesions are present in the pelvis. Almost 50% of chronic pelvic pain cases are estimated to be adhesion-related (stoval)
* Small bowel obstruction: the disruption of normal bowel flow, which can result when adhesions twist or pull the small bowel.

The risk of adhesion formation is one reason why vaginal delivery is usually considered safer than elective caesarean section where there is no medical indication for section for either maternal or fetal reasons.