Authored by Evelyn Kim, Human Biology, Health, and Society '25
Art by Constance Newell, Biological Sciences '24
The birth of an infant is a surreal experience for not only the mother but the surrounding healthcare team as well. Having witnessed a cesarean section (c-section) at a hospital, I realized both the dangers and beauty of this procedure. The shock I experienced while watching the continuous flow of blood gush out of the mother’s abdomen soaking the OBGYN’s entire arm was instantly replaced with tears the moment I heard the infant’s cry. C-sections are a relatively quick procedure taking only 30-45 minutes with minimal pain compared to vaginal birth due to the use of anesthetics. Although it is evident that c-sections put both the mother and infant at risk, c-section delivery rates are high all around the world. In the US specifically, c-sections have increased from 5.5% to 30-32% from the 1970s to 2019 [1]. Premature or breech position of the infant and previous c-sections may cause the mother to opt for a c-section due to safety and health concerns. Hospitals may push for c-sections because it saves them resources and time. Elective c-sections are also becoming more common due to the lack of knowledge about short and long-term consequences and also the fear of pain and/or pelvic floor dysfunction, which is a disruption in urinary continence and bowel movements [1,2,3]. The decision to give a vaginal birth versus a c-section requires an important conversation between the mother and provider about what is the safest option, weighing both the pros and cons.
Anesthesia, surgical techniques, infection control, and blood banking have improved greatly for c-sections over the past 40 years. These are life-saving procedures, especially if the mother or infant comes across last-minute complications during a vaginal birth [1,2]. A study comparing the consequences of planned vaginal birth and planned c-sections has shown that for planned c-sections, there was a reduction in risk for vaginal injury, abdominal and perineal pain during birth, early postpartum hemorrhage (PPH), and obstetric shock (cardiovascular collapse) [3]. PPH is the most common yet dangerous birth complication where the mother can lose up to 1000 mL of blood caused primarily by uterine atony, which can occur after delivery when the uterus cannot contract, leading to life-threatening blood loss [4]. Furthermore, since c-sections are a surgical procedure and are associated with an increased risk for maternal morbidity and mortality, the long-term consequences need to be considered and fully understood. The most common complications are abnormal placentation, uterine rupture, pelvic adhesions (scar tissues sticking to other organs), infertility/subfertility (spontaneous pregnancies), and irregular bleeding [1,3]. There are 3 types of abnormal placentation: placenta previa (placenta covering the cervix), placenta accreta (placenta deeply attached to the uterine wall), and cesarean scar pregnancy (egg implanted on previous c-section scar) [1,5]. Cesarean scar pregnancy is associated with uterine rupture and may require a peripartum hysterectomy in order to prevent severe blood loss. The rate of peripartum hysterectomies due to previous c-sections has increased from 27% in 1969 to 57% in 2009 [1], which could be devastating news to a mother wanting more children in the future.
One of the infant complications related to c-sections include an alteration in the neonate’s immune system/microbiome because of an inadequate transfer of the mother’s microbiome. This is associated with a greater risk of obesity, asthma, diabetes, allergies, autoimmune gastrointestinal diseases, high blood pressure, changes in liver function, and neurological/stress-related problems in the early childhood years [3]. There is not enough research on the relationship between c-sections and the long-term effects of neurological, emotional, and behavioral outcomes of these children. However, some immune effects can be found to be detrimental in adulthood by increasing susceptibility to certain cardiometabolic and autoimmune disorders due to the absence of microbial colonization [3]. The lack of exposure to the mother’s stress hormones and physical forces of vaginal birth for a child born via c-section negatively affects the infant’s development of the Hypothalamic-Pituitary-Adrenal (HPA) axis in the brain, which regulates most of the body’s physical and psychological processes including maturation of the immune system and other organs [3]. Despite all these risks, c-sections are necessary to protect the infant’s life in life-threatening situations such as if they are born prematurely or in a breech position.
Once a c-section, always a c-section. The effects are both short and long-lasting, therefore, the decision to get a c-section will impact the mother beyond mere pain reduction and comfortability during childbirth. For future expecting mothers, it is important to be aware of the dangers and beauty of c-sections to ensure both the mother and infant have the best health outcomes.
Works Cited
Antoine, C. & Young, B. (2021). Cesarean section one hundred years 1920–2020: the Good, the Bad and the Ugly. Journal of Perinatal Medicine, 49(1), 5-16. https://doi.org/10.1515/jpm-2020-0305
Lavender, T., Hofmeyr, G. J., Neilson, J. P., Kingdon, C., & Gyte, G. M. (2012). Caesarean section for non-medical reasons at term. The Cochrane database of systematic reviews, 2012(3), CD004660. https://doi.org/10.1002/14651858.CD004660.pub3
Sandall, J., Tribe, R. M., Avery, L., Mola, G., Visser, G. H., Homer, C. S., Gibbons, D., Kelly, N. M., Kennedy, H. P., Kidanto, H., Taylor, P., & Temmerman, M. (2018). Short-term and long-term effects of caesarean section on the health of women and children. Lancet (London, England), 392(10155), 1349–1357. https://doi.org/10.1016/S0140-6736(18)31930-5
Wormer KC, Jamil RT, Bryant SB. Acute Postpartum Hemorrhage. [Updated 2022 Oct 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499988/
Mayo Clinic Staff (2022, June 16). C-Section. Mayo Clinic. https://www.mayoclinic.org/tests-procedures/c-section/about/pac-20393655