http://www.motherfriendly.org/Resour...bruary2010.pdf

What are the potential harms of cesarean surgery compared with vaginal birth?
Health outcomes after a cesarean may be worse because medical problems may lead to surgery. This fact sheet, however, is based on research that determined excess harms arising from the surgery itself. In other words, women with a healthy pregnancy who have a cesarean rather than a vaginal birth are at increased risk for the following complications as are their babies:

Potential Harms to the Mother
Compared with vaginal birth, women who have a cesarean are more likely to experience:
• Accidental surgical cuts to internal organs.53,60,72
• Major infection.43,48
• Emergency hysterectomy (because of uncontrollable bleeding).38,48,83
• Complications from anesthesia.28
• Deep venous clots that can travel to the lungs (pulmonary embolism) and brain (stroke).28,48
• Admission to intensive care.58
• Readmission to the hospital for complications related to the surgery.18,28
• Pain that may last six months or longer after the delivery.19 More women report problems with pain from the cesarean incision than report pain in the genital area after vaginal birth.19
• Adhesions, thick internal scar tissue that may cause future chronic pain, in rare cases a twisted bowel, and can complicate future abdominal or pelvic surgeries.19
• Endometriosis (cells from the uterine lining that grow outside of the womb) causing pain, bleeding, or both severe enough to require major surgery to remove the abnormal cells.27
• Appendicitis, stroke, or gallstones in the ensuing year.18,46,47,50 Gall bladder problems and stroke may be because high-weight women and women with high blood pressure are more likely to have cesareans.
• Negative psychological consequences with unplanned cesarean. These include:
o Poor birth experience, overall impaired mental health, and/or self-esteem.12
o Feelings of being overwhelmed, frightened, or helpless during the birth.20
o A sense of loss, grief, personal failure , acute trauma symptoms, posttraumatic stress, and clinical depression.37
• Death.12,22

Potential Harms to the Baby
Compared with vaginal birth, babies born by cesarean section are more likely to experience:
• Accidental surgical cuts, sometimes severe enough to require suturing.1,28
• Being born late-preterm (34 to 36 weeks of pregnancy) as a result of scheduled surgery.6
• Complications from prematurity, including difficulties with respiration, digestion, liver function, jaundice, dehydration, infection, feeding, and regulating blood sugar levels and body temperature.25,26 Late-preterm babies also have more immature brains,63 and they are more likely to have learning and behavior problems at school age.25,26
• Respiratory complications, sometimes severe enough to require admission to a special care nursery, even in infants born at early term (37 to 39 weeks of pregnancy).28 Scheduling surgery after 39 completed weeks minimizes, but does not eliminate, the risk.31,32
• Readmission to the hospital.25
• Childhood development of asthma,3,78 sensitivity to allergens,61 or Type 1 diabetes.11
• Death in the first 28 days after birth.51
Potential Harms to Maternal Attachment and Breastfeeding
Failure to breastfeed has adverse health consequences for mothers and babies. Breastfeeding helps protect mothers against postpartum depression, Type 2 diabetes, high blood pressure, heart disease, ovarian and pre-menopausal breast cancer, and osteoporosis later in life.36,71 Breastfeeding helps protect babies against ear infections, stomach infections, severe respiratory infections, allergies, asthma, obesity, Type 1 and Type 2 diabetes, childhood leukemia, sudden infant death syndrome (SIDS), and necrotizing enterocolitis (a severe, life-threatening intestinal infection).15,36
• Women who have unplanned cesareans are more likely to have difficulties forming an attachment to their babies.23
• Women who have cesareans are less likely to have their infants with them skin-to-skin (cradled naked against their bare chest) after the delivery.20 Babies who have skin-to-skin contact interact more with their mothers, stay warmer, and cry less. When skin-to-skin, babies are more likely to be breastfed early and well, and to be breastfed for longer. They may also be more likely to have a good early relationship with their mothers, but the evidence for this is not as strong.16,57
• Women are less likely to breastfeed.21,44

Potential Harms to Future Pregnancies
With prior cesarean, women and their babies are more likely to experience serious complications during subsequent pregnancy and birth regardless of whether they plan repeat cesarean or vaginal birth. The likelihood of serious complications increases with each additional operation.28
Compared with prior vaginal birth, prior cesarean puts women at increased risk of:
• Uterine scar rupture. Planning repeat cesarean reduces the excess risk, but it is not completely protective.8,49,55,75
• Infertility, either voluntary (doesn’t want more children) or involuntary (can’t have more children).7,12,56,70,74,79,80
• Cesarean scar ectopic pregnancy (implantation within the cesarean scar), a condition that is life-threatening to the mother and always fatal for the embryo.67
• Placenta previa (placenta covers the cervix, the opening to the womb), placental abruption (placenta detaches partially or completely before the birth), and placenta accreta, (placenta grows into the uterine muscle and sometimes through the uterus, invading other organs), all of which increase the risk for severe hemorrhage and are potentially life-threatening complications for mother and baby.17,28,85
• Emergency hysterectomy.42,53
• Preterm birth and low birth weight.6,40,65,73,76
• A baby with congenital malformation or central nervous system injury12 due to a poorly functioning placenta.
• Stillbirth.28,29,40,65,76