What problems are more common with C-section as compared to vaginal birth (but have not been sorted out for women giving birth after previous cesarean)?

Short-term maternal problems. Systematic reviews have found that cesarean is worse than vaginal birth for women (but have not been specifically sorted out for women with a past cesarean):

  • Impaired physical health for at least the first two months after birthVan der Woude, D.A., Pijnenborg, J.M., & de Vries, J. (2015). Health status and quality of life in postpartum women: A systematic review of associated factors. European Journal of Obstetrics & Gynecology and Reproductive Biology, 185, 45-52.
  • Not establishing breastfeeding, which benefits both women and babies; this especially occurs when cesareans are scheduled before laborPrior, E., Santhakumaran, S., Gale, C., Philipps, L.H., Modi, N., Hyde, M.J. (2012). Breastfeeding after cesarean delivery: a systematic review and meta-analysis of world literature. American Journal of Clinical Nutrition, 95,1113-35
Maternal problems that only happen with cesarean birth. The following would not occur with vaginal birth:
  • Mistaken surgical cut (for example, a nicked bladder) to the mother
  • Opening the wound to take care of a problem
  • Severe and/or long-term pain at the site of the cesarean cut
  • Infection introduced through the surgical cuts
  • A pregnancy that grows in a previous scar (cesarean ectopic pregnancy)
  • A placenta that implants in a previous scar (placenta accreta)
  • Internal scar tissue (dense adhesions) that make future surgeries more difficult and can cause more complications

Short- and longer-term problems for the baby. Systematic reviews have found that cesarean is worse than vaginal birth for babies (but have not been specifically sorted out for babies of women with a past cesarean):

  • Not establishing breastfeeding, which especially occurs when cesareans are scheduled before laborPrior, E., Santhakumaran, S., Gale, C., Philipps, L.H., Modi, N., Hyde, M.J. (2012). Breastfeeding after cesarean delivery: a systematic review and meta-analysis of world literature. American Journal of Clinical Nutrition, 95,1113-35
  • Increased risk of breathing problemsHansen, A.K., Wisborg, K., Uldjerg, N., & Henriksen, T.B. (2007). Elective caesarean section and respiratory morbidity in the term and near-term neonate. Acta Obstet Gynecol Scan, 86,389-94.
  • Less blood flowing from the placenta at birth and less ironZhou, Y., Li, H., Zhu, L., & Liu, J. (2014). Impact of cesarean section on placental transfusion and iron-related hematological indices in term neonates: A systematic review and meta-analysis. Placenta, 35, 1-8.
  • Likelihood of developing series of chronic diseases in childhood:
    • Childhood-onset (Type 1) diabetesCardwell, C., Stene, L., G, J., Cinek, O., Svensson, J., Goldacre, M., . . . Patterson, C. (2008). Caesarean section is associated with an increased risk of childhood-onset type 1 diabetes mellitus: A meta-analysis of observational studies. Diabetologia, 51(5), 726-35
    • Childhood obesity,Kuhle, S., Tong, O., & Woolcott, C. (2015). Association between caesarean section and childhood obesity: A systematic review and meta-analysis. Obesity Reviews, 16, 295-303. obesity in adulthoodDarmasseelane, K., Hyde, M., Santhakumaran, S., Gale, C., & Modi, N. (2014). Mode of Delivery and Offspring Body Mass Index, Overweight and Obesity in Adult Life: A Systematic Review and Meta-Analysis. PLoS One, 9, e97827. or bothLi, H., Zhou, Y., & Liu, J. (2013). The Impact of Cesarean Section on Offspring Overweight and Obesity. Obstetrical & Gynecological Survey, 37, 9-11.
    • Autism spectrum disorderCurran, E., O'Neill, S., Cryan, J., Kenny, L., Dinan, T., Khashan, A., & Kearney, P. (2014). Research Review: Birth by caesarean section and development of autism spectrum disorder and attention-deficit/hyperactivity disorder: A systematic review and meta-analysis. Journal of Child Psychology and Psychiatry, 56, 500-508.
    • Chronic inflammatory bowel disease with abdominal pain, diarrhea, weight loss, anemia and fatigue (Crohn's disease)Li, Y., Tian, Y., Zhu, W., Gong, J., Gu, L., Zhang, W, & Li, J. (2014). Cesarean delivery and risk of inflammatory bowel disease: A systematic review and meta-analysis. Scandinavian Journal of Gastroenterology, 49(7), 834-844.
    • AsthmaThavagnanam, S., Fleming, J., Bromley, A., Shields, M., & Cardwell, C. (2008). A meta-analysis of the association between Caesarean section and childhood asthma. Clinical & Experimental Allergy, 38, 629-633. AND Bager, P., Wohlfahrt, J., & Westergaard, T. (2008). Caesarean delivery and risk of atopy and allergic disease: Meta-analyses. Clinical & Experimental Allergy, 38(4), 634-642.
    • Food sensitivities and allergiesKoplin, J., Allen, K., Gurrin, L., Osborne, N., Tang, M., & Dharmage, S. (2008). Is caesarean delivery associated with sensitization to food allergens and IgE-mediated food allergy: A systematic review. Pediatric Allergy and Immunology, 19, 682-687.
    • Hay feverBager, P., Wohlfahrt, J., & Westergaard, T. (2008). Caesarean delivery and risk of atopy and allergic disease: Meta-analyses. Clinical & Experimental Allergy, 38(4), 634-642.

Newborn problem that only happens with cesarean birth. A mistaken surgical cut to the baby would not occur with vaginal birth

Problems in future pregnancies. Systematic reviews have found that women with pregnancies after previous cesarean birth are more likely than those with previous vaginal birth (but have not sorted out differences in mode of birth after cesarean birth) to experience:

  • Splitting open of the uterus (uterine rupture)Hofmeyr, G.J., Say, L., & Gülmezoglu, A.M. (2005). WHO systematic review of maternal mortality and morbidity: The prevalence of uterine rupture. BJOG, 112(9), 1221-1228.
  • Emergency surgery to remove the uterus (hysterectomy)Rossi, A., Lee, R., & Chmait, R. (2010). Emergency Postpartum Hysterectomy for Uncontrolled Postpartum Bleeding: A Systematic Review. Obstetrics & Gynecology, 115(3),1453-1454. AND de la Cruz, C., Thompson, E., O’Rourke, K., & Nembhard, W. (2015). Cesarean section and the risk of emergency peripartum hysterectomy in high-income countries: A systematic review. Archives of Gynecology and Obstetrics, 292(6), 1201-15
  • Serious condition of the placenta covering the opening of the cervix (placenta previa)Gurol-Urganci, I., Cromwell, D., Edozien, L., Smith, G., Onwere, C., Mahmood, T., & Meulen, J. (2011). Risk of placenta previa in second birth after first birth cesarean section: A population-based study and meta-analysis. BMC Pregnancy and Childbirth, 11, 95. AND Klar, M., & Michels, K.B. (2014). Cesarean section and placental disorders in subsequent pregnancies: A meta-analysis. Journal of Perinatal Medicine, 42(5), 871-883.
  • Serious condition of the placenta growing into the wall of the uterus (placenta accreta)Klar, M., & Michels, K.B. (2014). Cesarean section and placental disorders in subsequent pregnancies: A meta-analysis. Journal of Perinatal Medicine, 42(5), 871-883.
  • Serious condition of the placenta separating from the wall of the uterus before the birth (placental abruption)Klar, M., & Michels, K.B. (2014). Cesarean section and placental disorders in subsequent pregnancies: A meta-analysis. Journal of Perinatal Medicine, 42(5), 871-883. AND Guise, J.M., Eden, K., Emeis, C., . . . McDonagh, M. (2010). Vaginal birth after cesarean: New insights. Evidence Report/Technology Assessment No.191. (Prepared by the Oregon Health & Science University Evidence-based Practice Center under Contract No. 290-2007-10057-I). AHRQ Publication No. 10-E003. Rockville, MD: Agency for Healthcare Research and Quality.
  • A stillborn babyMoraitis, A.A., Oliver-Williams, C., Wood, A.M., Fleming, M., Pell, J.P., & Smith, G.C.S. (2015). Previous caesarean delivery and the risk of unexplained stillbirth: retrospective cohort study and meta-analysis. BJOG: An International Journal of Obstetrics & Gynaecology 122(11), 1467-1474. AND O’Neill, S., Kearney, P., Kenny, L., Khashan, A., Henriksen, T., Lutomski, J., & Greene, R. (2013). Caesarean Delivery and Subsequent Stillbirth or Miscarriage: Systematic Review and Meta-Analysis. PLoS One, 8(1), e54588.

Longer-term problems for women. Systematic reviews have found that women who have given birth by cesarean versus vaginal birth (but have not sorted differences by mode of birth after cesarean) are more likely than those with vaginal births to experience in the future:

  • Difficulty becoming pregnant, leading to a lower pregnancy rateGurol-Urganci, I., Bou-Antoun, S., Lim, C., Cromwell, D., Mahmood, T., Templeton, A., & Meulen, J. (2013). Impact of Caesarean section on subsequent fertility: A systematic review and meta-analysis. Human Reproduction, 28(7), 1943-1952.
  • Difficulty remaining pregnant, leading to a lower birth rateGurol-Urganci, I., Bou-Antoun, S., Lim, C., Cromwell, D., Mahmood, T., Templeton, A., & Meulen, J. (2013). Impact of Caesarean section on subsequent fertility: A systematic review and meta-analysis. Human Reproduction, 28(7), 1943-1952.
  • A desire to wait longer before becoming pregnant againO’Neill, S., Kearney, P., Kenny, L., Khashan, A., Henriksen, T., Lutomski, J., & Greene, R. (2013). Caesarean Delivery and Subsequent Stillbirth or Miscarriage: Systematic Review and Meta-Analysis. PLoS One, 8(1), e54588.
  • Ongoing pain in the pelvis areaLatthe, P., Mignini, L., Gray, R., Hills, R., & Khan, K. (2006). Factors predisposing women to chronic pelvic pain: a systematic review. BMJ,332, 749-55.