Based on the evidence published by the Royal College of Obstetricians and Gynaecologists on planned Caesarean birth (https://www.rcog.org.uk/media/kcudpb1g/pcb-ca14-minor-update-2024.pdf) the following is a comparison of the risks associated with planned Caesarean section (CS) and vaginal birth (VB). Note: these risks do not apply in emergency/unplanned situations.
Risks to the mother:
- Haemorrhage: higher with CS than VB
- Clots in the leg or lung: higher with CS than VB
- Accidental damage to the urinary tract: 1 in 1,000 (CS)
- Infection needing antibiotics: up to 1 in 14 (CS scar) vs. up to 1 in 7 (perineum)
- Hospital stay: 1-4 days (CS) vs. approx. 2 days (VB)
- Emergency removal of the uterus: 1 in 500 (CS) vs. 1 in 1,000 (VB)
- Maternal death: 1 in 4,000 (CS) vs. 1 in 25,000 (VB)
- Damage to the anal sphincter (muscle controlling continence) and/or rectum: No risk (CS) vs. 1 in 179 (VB; higher for first-time births and lower for women who have given birth before)
- Urinary incontinence later in life: similar for both (around 1 in 5)
- Faecal incontinence later in life: 1 in 13 (CS) vs. 1 in 7 (instrumental birth; but lower for uncomplicated vaginal birth)
- Pain: greater during birth, but lower after birth (vaginal vs. CS)
- Anaesthetic risks (depends on the type)
Risks to a future pregnancy
- Uterine rupture in labour: 1 in 500 (CS) vs. 1 in 14,000 (VB)
- Placenta accreta spectrum (placenta growing into/through the uterus): 1 in 1,000 (CS; higher if multiple surgeries) vs. 1 in 1,900 (VB)
Risks to the baby:
- Cut on the baby’s skin: up to 1 in 50 (CS) vs. very small risk (vaginal; slightly higher with instrumental birth)
- Neonatal death within 28 days: 1 in 1,700 (CS) vs. 1 in 3,300 (vaginal)
Useful notes (O&G, MFM) 