Surgical Complications and Short-Term Risks Associated with Cesarean Delivery

The content discusses the risks associated with cesarean deliveries, including infection risks, anaesthetics complications, lower likelihood of breast-feeding, postoperative febrile illness, and surgical complications such as haemorrhage requiring hysterectomy or transfusion. Long-term risks include adverse outcomes in subsequent births, prolonged labor, malpresentation, emergency caesarean, premature birth, uterine rupture, small for gestational age, low birth weight, and stillbirth.

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Compare and contrast the cost & benefit of ‘Cesarean section’ with ‘Normal Delivery’.
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Table of Contents
Abstract............................................................................................................................................3
Introduction......................................................................................................................................3
Maternal and Neonatal Benefits of Vaginal Delivery..................................................................3
Maternal and Neonatal Benefits of Caesarean Delivery..............................................................4
Maternal and Neonatal Risks of Vaginal Birth............................................................................4
Maternal and Neonatal Risks of Caesarean Birth........................................................................5
References........................................................................................................................................8

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Abstract
Worldwide with the increase in caesarean section rates, the questions regarding the economic
implications of the alternative modes of delivery and caesarean section. The article aims towards
reviewing the economic aspects and benefits of the caesarean section and normal modes of
delivery. The paper analyses their cost and benefits along providing evidences for labour cost
and delivery. A positive and negative perception regarding these types of delivery including the
absence of pain while undergoing the caesarean section, easier recovery in vaginal birth,
dissatisfaction with the medical care being received have been discussed in the study.
Introduction
The birth of a child is seen to be one of the most important event in the lives of women and is
marked by the transformation of the woman to that of being a mother. With the development in
science and technology, various improvements have been seen in cases of child birth which were
associated with high risk which were resultant of the lower neonatal and maternal morbid
mortality. But when these practices are applied in the low-risk childbirth, the use of advanced
technology might result in the feelings of insecurity, fear, anxiety etc. resulting in the various
difficulties especially during the evolution of the child birth processes. Various studies have been
performed on the comparing the vaginal and caesarean delivery.
Also most of the women of low
socioeconomic status prefer
VBAC which might be

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accounted for in part by cost
consideration. Cost is an
important factor in our region
where majority of the
hospitals operate the policy of
pay-as-you-go for health
care services. The preference
for CS among women of
high socioeconomic class has
earlier been reported in
Turkey (Buyukbayrak et al.,
2010) and Australia (Roberts
et al., 2012).
Also most of the women of low
socioeconomic status prefer
VBAC which might be
accounted for in part by cost
consideration. Cost is an

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important factor in our region
where majority of the
hospitals operate the policy of
pay-as-you-go for health
care services. The preference
for CS among women of
high socioeconomic class has
earlier been reported in
Turkey (Buyukbayrak et al.,
2010) and Australia (Roberts
et al., 2012).
Maternal and Neonatal Benefits of Vaginal Delivery
Some of the researches have suggested that the factors like faster recovery, little suffering,
requiring less care, returning to the daily chores sooner, shorter hospital admission, experiencing
less pain post the delivery, and increased rates of breast-feeding etc. are suggested as the
preferential or advantageous factors of the vaginal birth (Roberts, C. L., 2012). It is seen that the
vaginal birth provides the strength to cope up with the child birth and helps in demonstrating
high confidence to their capability of coping with the labor pains. This process helps the women
to deal with the pain and requires lesser use of medication. The vaginal delivery helps in
avoiding the major surgery and risks that are associated with the childbirth which counts as the
primary maternal benefit of vaginal delivery (Chervenak FA, McCullough LB 2004). Various

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clinicians are seen to recommend the planned vaginal birth viewing that the vaginal birth has
repeatedly been associated with lower morbidity for the mother, requires lesser number of
health-care resources, and is less costly. It has been seen that cost is one of the critical factor
while considering between the vaginal or caesarean birth. The women belonging from the low
socioeconomic status are seen to prefer vaginal birth and the women among the high
socioeconomic status are opting for caesarean (Lyerly AD, Little MO, 2012).
Maternal and Neonatal Benefits of Caesarean Delivery
The advantages of the caesarean section includes the absence of labor pains, speed of the
procedure, no fear of childbirth, safety of the baby, possibility of tubal ligation at the same time,
having a control over the process etc. The whole process is comparatively pleasant one and the
safety of the child is enjoyed. However, it has to be highlighted that the choices must be based on
the psychosocial aspects as compared to the clinical advice.
Maternal and Neonatal Risks of Vaginal Birth
Liu S, et. al (2007) suggested that the labour pain is not risk free and around 10 percent of the
women who achieve or are planning to experience the vaginal birth are bound to experience
some sort of complication and issues. Usually the reservations on going for the vaginal delivery
is based on the concerns about the perineum. It has been considered that the vaginal delivery
leads to the risk of pelvic floor dysfunction and urinary, fecal, or flatal incontinence.
Additionally, the vaginal delivery is related to the elevated risk of fecal incontinence from third-
and fourth-degree lacerations (Chongsuvivatwong V, Bachtiar H, Chowdhury ME, et al, 2010).
The epidemiological data from time to time has been consistently demonstrating the increased
risk of urinary in-continence from 3 or even 6 months after the child birth through the vaginal
delivery in comparison to the caesarean delivery (Farrell SA, Allen VM, Baskett TF, 2010). The
vaginal delivery also includes the neonatal risks like birth trauma, namely shoulder dystocia and

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its sequela. The further complications also include asphyxia due to delay in delivery or can be
considered as the birth trauma from manipulations used for delivering the fetus. The other
complications include the injury to the phrenic nerve or the brachial plexus, fracture of humerus
or clavicle etc. around 0.2 to 2.0 percent of the vaginal deliveries are seen to encounter the
shoulder dystocia and in 10 to 20 percent of these cases of shoulder dystocia, the brachial plexus
injuries are encountered. (Acker DB, Sachs BP, Friedman EA, 1986; Gross SJ, Shime J, Farine
D 1987; Nocon JJ, McKenzie DK, Thomas LJ, Hansell RS, 1993; Baskett TF, Allen AC, 1995;
McFarland LV, Raskin M, Daling JR, Benedetti TJ, 1986).
However, the cases of fetal dystocia and birth trauma are also prevalent in the caesarean
delivery. The brachial plexus injuries are specifically seen to take place in the infants born via
cesarean and is seen to be reported to take place before the onset of labor.
Maternal and Neonatal Risks of Caesarean Birth
With subsequent pregnancies, the risk of uterine rupture is seen to increase from 0.5 to 1 percent.
This rate is even higher for the women who were attempting to labor trial as compared to the
planned repeated caesarean delivery. Owning to the potential for neonatal or maternal death or
the uterine rupture or neonatal compromise and inability of guaranteeing the prompt delivery,
various clinicians are seen to open for the repeated caesarean. This leads to a long-term risk
owning to the caesarean delivery which is the risk of the recurrent caesarean delivery. 92 percent
of the women in United States are seen to undergo recurrent caesarean delivery (Ananth CV,
Smulian JC, Vintzileos AM, 1997). Adding to this, the risk of abnormal placentation which
included previa/accreta has also been reported.
The risk of death in case of caesarean section is comparatively high where the middle resource
settings is seen to be placed between 1/2000 and 1/4000. With subsequent pregnancies, the cases

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of placenta accrete, placenta previa and uterine rupture is seen to increase. The conditions
mentioned are seen to increase the maternal morbidity and maternal mortality cumulatively with
each subsequent caesarean section (Lydon-Rochelle M, Holt VL, Easterling TR, Martin DP,
2001). Additionally, various researches have proved that the women with spontaneous vaginal
deliveries are seen to experience elevation in self-esteem and improvement in their mood across
the late pregnancy to early postpartum interval. In contrast to the caesarean deliveries which led
to diminution in self-esteem and deterioration in mood.
The caesarean delivery also has some short-term risks which include the surgical complications
including death, infection risks, anaesthetics, lower likelihood of breast-feeding etc.
Postoperative febrile illness has also been reported ranging from 2 to 5%. In over 3 percent of the
caesarean deliveries, the infections and hematomas are seen to take place. Further, the case of
urinary catheterization is related to the postcesarean bacteriuria in almost 11.2 percent of the
cases. The cases of surgical complications are seen to include post-operative ileus, haemorrhage
requiring hysterectomy or transfusion, amniotic fluid embolism, thromboembolic disease, air
embolism, and maternal death. The case of haemorrhage during the caesarean delivery have been
reported to range from 1 to 8 percent. The risk associated with the hemorrhage is less as
compared to the planned caesareans is higher comparable to the vaginal birth. The case of
recurrent caesarean or the abnormal placentation has highest vulnerability towards the
haemorrhage (Silver RM, Landon MB, Rouse DJ, 2006). In terms of long-term risks, it has been
evaluated by Kennare et al (2007) that the next birth have higher chances of adverse outcomes
followed by a caesarean delivery as compared with vaginal delivery. The further increased risks
can be prolonged labor, malpresentation, emergency caesarean, premature birth, uterine rupture,
small for gestational age, low birth weight, and stillbirth.

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