Post-Caesarean Section (C-Section) Drawbacks

1. Wound & Infectious Complications

• Wound infection - occurs in up to ~3% of caesarean deliveries despite prophylactic antibiotics. Risk is higher in second-stage caesareans, obese patients, and those with suprafascial drains.
• Wound haematoma - usually from faulty haemostasis; requires drainage.
• Necrotizing fasciitis - rare but life-threatening; obese women are at particularly elevated risk.
• Endometritis (uterine infection) - the most common infectious morbidity. 25-30% of wound infections are caused by Staphylococcus aureus, not from endometrial contamination, making sterile technique critical.
• Urinary tract infection - associated with catheterization; risk reduced with early catheter removal and intermittent rather than indwelling catheters.

2. Thromboembolism

• Deep vein thrombosis (DVT) - occurs in 1-2% of caesarean deliveries.
• Pulmonary embolism (PE) - rare but one of the leading causes of maternal mortality after C-section.
• Risk factors: obesity, prolonged operative time, endometritis, inherited thrombophilias.
• Pelvic/ovarian vein thrombophlebitis - presents with fever not responding to antibiotics + right-sided flank pain and palpable tender mass.

3. Gastrointestinal Complications

• Adynamic ileus - not uncommon after bowel manipulation during surgery; usually resolves conservatively.
• Ogilvie syndrome (pseudo-obstruction) - marked cecal dilation; serious, requires early recognition and surgical decompression to avoid cecal rupture.

4. Haemorrhage

• Increased blood loss compared to vaginal delivery.
• Risk of postpartum haemorrhage - tranexamic acid prophylaxis has been shown in a 2024 meta-analysis to reduce PPH and transfusion rates (Lee et al., 2024 - Am J Perinatol).
• Possible need for blood transfusion.

5. Risks in Future Pregnancies (Long-term)

• Uterine scar rupture - 0.5-1% risk in trial of labour after caesarean (TOLAC/VBAC). Symptomatic rupture in a large cohort study was 0.7%, with no cases of perinatal death in the elective repeat caesarean group.
• Placenta praevia & placenta accreta spectrum - each subsequent caesarean significantly raises the risk of abnormal placentation in future pregnancies, which can cause catastrophic haemorrhage.
• Intraperitoneal adhesions - repeated caesareans are strongly associated with adhesion formation, which complicates subsequent surgeries and increases risk of bowel/bladder injury. A 2023 systematic review (PMID 37302234) specifically examined adhesion prediction in repeat caesareans.
• Cesarean scar ectopic pregnancy - a rare but dangerous complication in future pregnancies.

6. Anaesthetic Risks

• Spinal anaesthesia - highest incidence of hypotension; can reduce uteroplacental perfusion.
• Epidural - slower onset; may not be usable in emergencies requiring delivery within 20 minutes.
• General anaesthesia - risk of Mendelson syndrome (aspiration pneumonitis) due to delayed gastric emptying in labouring patients. Also associated with decreased uteroplacental perfusion during induction.

7. Neonatal Drawbacks

• Respiratory morbidity - neonates delivered by elective caesarean (before labour begins) have higher rates of transient tachypnoea of the newborn (TTN) and respiratory distress, as they miss the fluid-clearing benefits of the birth canal and labour-induced cortisol surge.
• Altered gut microbiome - C-section babies miss exposure to maternal vaginal flora, which may predispose to allergies, asthma, and immune dysregulation (emerging evidence).
• Iatrogenic prematurity - if gestational age is miscalculated, elective repeat caesarean can result in unintended premature delivery.

8. Longer Hospital Stay & Recovery

• C-section requires a longer in-hospital recovery (typically 3-4 days vs. ~1-2 days for vaginal delivery).
• Postoperative pain limits early ambulation, breastfeeding initiation, and newborn bonding.
• Return to normal activity takes 6-8 weeks vs. sooner for uncomplicated vaginal birth.

Summary Table