According to a 2009 study published in "Clinics in Perinatology," C-sections now account for about 32 percent of deliveries, compared to less than five percent in 1970. Deliveries in older women, women with multiple fetus pregnancies due to assisted reproduction and women with obesity-related health problems account for part of the increase. In some cases, women request C-sections because of concerns about urogenital problems after vaginal delivery or desire to schedule delivery, rather than wait for spontaneous delivery. Regardless of the indication, a C-section exerts long term effects on maternal health, fetal health and subsequent pregnancies.
Scars
A C-section always entails an abdominal scar. Although most obstetricians use the Pfannenstiel or "bikini-line" incision that produces a thin, three to five inch horizontal line that is easily concealed by clothing and undergarments, C-sections performed under emergency conditions or for preterm deliveries require the longer "classical" incision higher on the abdomen. All C-section wounds are subject to complications, such as infections, which result in wider scars with an irregular surface.
Adhesions
Trauma to the abdominal cavity caused by C-sections results in the formation of a type of internal scar tissue, called adhesions. Adhesions can cause serious complications such as bowel obstruction or even strangulation, often years after the procedure.
Chronic Pain
Both scarring and adhesions set the stage for chronic pain syndromes when nerves become entrapped in the scar tissue. According to a 2008 study in the "Annals of Surgery," most patients require surgical release of the entrapped nerve in order to obtain relief.
Uterine Rupture
Mark H. Incerpi, M.D., professor of maternal-fetal medicine at the University of Southern California's Keck School of Medicine, reports that patients who have undergone a prior C-section face increased risk of uterine rupture during subsequent pregnancies---between 4 and 9 percent for patients with a classical uterine incision and 0.7 to 1.5 percent for patients with a low transverse uterine incision. Although the risks appear low, the consequences of rupture for both mother and baby are severe, including hemorrhage, hysterectomy and fetal or maternal death.
Placental Abnormalities
C-section increases the risk of abnormal placental development in subsequent deliveries. Placenta increta, accreta, percreta, previa and abruption all necessitate repeat C-section with many of the same complications as uterine rupture. While the first three usually allow scheduled delivery close to term, the latter two usually require urgent or emergent delivery before term.
Fetal Loss
In a 2010 review published in "Seminars in Perinatology," maternal-fetal medicine specialist Melissa Gilliam, M.D., M.P.H. describes increased rates of unexplained fetal loss in subsequent pregnancies. Before 24 weeks, doctors use the term "spontaneous abortion," while after 24 weeks the term "stillbirth" is used. In addition to unexplained fetal losses, C-section increases the risk of ectopic pregnancies which require termination because of incompatibility with fetal and maternal life.
Fetal Injury
Fetal injury, in the form of small lacerations caused by surgical instruments, occurs in approximately 0.2 to 0.4 percent of C-sections, according to Incerpi. The most common site is the face, especially the cheek; other common sites include the buttocks, ears and head. Although lacerations are easy to repair, they usually leave a scar.
References
- "Clinics in Perinatology;" Total Cesarean Delivery Rate: United States; M.F. MacDorman et al.; 2009
- "Current Diagnosis and Treatment: Obstetrics and Gynecology, 10th edition;" A.H. DeCherney and L. Nathan (eds.); 2007
- "Seminars in Perinatology;" Cesarean Delivery on Request: Reproductive Consequences; M. Gilliam; 2006
- "Williams' Obstetrics, 23rd edition;" F.G. Cunningham et al.; 2010
- "Annals of Surgery;" Surgical Management of Inguinal Neuralgia After a Low Transverse Pfannenstiel Incision; M.J. Loos et al.; Nov. 2008
