The number of births via cesarean section, more commonly known as c-section, has increased in the U.S. over the years. According to the Centers for Disease Control and Prevention (CDC), the C-section rate in the U.S. rose from 20.7% in 1996 to a peak of 32.9% in 2009. Since then, the rate has stabilized, with the most recent data from 2021 showing a C-section rate of 32.1%. That means nearly one in three pregnancies are delivered via C-section.

While C-sections can be a life-saving procedure and may be medically necessary in certain situations, according to the U.S. Department of Health and Human Services, many people are choosing to schedule an elective C-section versus delivering naturally, which may account for the increase.

“You have to remember that while a C-section is one of the most common surgical procedures performed, at the end of the day, it is still a major surgical procedure and it is not without risk,” says Sheri Puffer, M.D., an OB/GYN and physician on the medical staff at Texas Health Arlington.

The rapidly rising rate of C-sections among low-risk births has sparked the Department of Health and Human Services to set a national goal of reducing the number of C-sections among low-risk pregnant people with no prior births by 23.6% over the next year. It’s important to note that this does not pertain to C-sections that are medically necessary for the health of the mother or the baby.

If you’re considering an elective C-section, it’s important to weigh the potential risks against the potential benefits.

The Risks of a C-section for Mom and Baby

Like any surgical procedure, a C-section carries some risks, both during and after the procedure.

“We’ve been having babies since the beginning of time, so it’s easy to forget that having a baby is a big deal. After all, the leading cause of fetal-maternal mortality is childbirth,” Puffer explains. “So, I strongly urge people to really sit with their doctor and talk over any concerns they may have and why they feel strongly pulled towards an elective C-section.”

Some of the risks associated with a C-section may include:

1. Infection: There is a risk of infection with any surgery, and C-sections are no exception. Infection can occur in the incision site or the uterus, and may require antibiotics to treat.
2. Bleeding: A C-section involves cutting through several layers of tissue, including blood vessels. There is a risk of bleeding during and after the procedure, which may require blood transfusions or additional surgery.
3. Blood clots: C-sections can increase the risk of blood clots, which can be dangerous if they travel to the lungs or brain. Blood thinners may be used to reduce this risk.
4. Injury to nearby organs: In rare cases, a C-section can cause damage to nearby organs such as the bladder or bowel.
5. Longer recovery time: C-sections involve a longer recovery time compared to vaginal births, and may require more pain management and assistance with daily activities.
6. Future pregnancy risks: Women who have had a C-section may be at increased risk of certain complications in future pregnancies, such as placenta previa, a condition in which the placenta partially or wholly blocks the neck of the uterus, and placenta accrete, a condition in which the placenta attaches itself too deeply and too firmly into the uterus. Both interfere with the normal delivery of a baby.

Beyond the potential risks for mom, there are also potential risks for baby. Some of the risks for the baby during a C-section may include:

1. Respiratory problems: Babies undergo a process during a vaginal birth that readies their lungs, which are filled with fluid in the uterus, to breathe oxygen after birth. Therefore, babies born by C-section are at a higher risk of respiratory issues with extra fluid in their lungs at birth because they don’t have the chance to undergo this process.
2. Increased risk of some conditions: Babies born vaginally also receive a dose of good bacteria as they travel through the birth canal which may boost the baby’s immune system and protect the intestinal tract. Babies born by C-section may be at a slightly increased risk of certain conditions since they are not exposed to these good bacteria during birth.
3. Higher risk of some complications: Babies born by C-section may have a higher risk of certain complications, such as jaundice, hypoglycemia, and admission to the neonatal intensive care unit (NICU).

Benefits of Vaginal Birth

While vaginal delivery is not completely without risk, Puffer notes, under normal circumstances, it is the safest mode of delivery for both mother and baby. If you’re weighing the pros and cons of a vaginal birth over a C-section, some benefits may include:

1. Shorter recovery time: Vaginal births typically involve a shorter hospital stay and a shorter recovery time compared to C-sections. Additionally, women who have vaginal births may be able to return to their normal activities more quickly.
2. Lower risk of complications: Vaginal births are generally considered to be safer and have fewer risks than C-sections, particularly for women with uncomplicated pregnancies.
3. Lower cost: Vaginal births are generally less expensive than C-sections, which can be a consideration for some families.
4. Better outcomes in future pregnancies: Women who have had a vaginal birth may have better outcomes in future pregnancies, including a lower risk of placenta previa and accrete.

Contrary to popular belief, Puffer says that once you have a C-section, you are not locked into having one for every pregnancy after.

“Any time you have a prior C-section, whether it was elective or medically necessary, you are always eligible to have another C-section with any additional pregnancy down the road. However, it’s not required,” she explains. “If you want to try to deliver naturally after delivering via C-section with an earlier pregnancy, we can always try. There is something called a Trial of Labor After Caesarean, or TOLAC.

“You have to speak with your doctor to see if they offer a TOLAC, but most women are eligible,” she continues. “There’s a calculator that doctors can use to help estimate their success rate for a future vaginal delivery, and there are certain guidelines that have to be followed, but if it’s something you’d like to try, we’re more than happy to try to make it possible for you.”

A Healthy and Happy Baby and Mom

Puffer says she understands the appeal of choosing an elective c-section over a vaginal delivery, especially for first-time moms. However, if you’re weighing the pros and cons, it’s worth having a discussion with your doctor.

“There are a lot of very personal factors involved in why you may want to elect to have a C-section over a vaginal birth, and from that regard, they’re all valid concerns,” she explains. “I think there is a fear aspect and a pain aspect involved. Your vagina is going to change after you have a baby, and some people are a bit more sensitive to that than others.

“I also think there is a convenience aspect of ‘hey, this sounds nice. I’ll just schedule it and I’ll know exactly when my baby is going to come, and I’m not going to be exhausted when I get to meet my baby.’ Trust me, I get that,” she continues. “But I also think this proposes the perfect opportunity for you to have a good conversation with your doctor about those concerns and weigh the risks and benefits for you individually.”

No matter what you choose, Puffer says the ultimate goal is to have a healthy and happy baby and mom.

“We always tell people that the No. 1 goal is a safe baby and a safe mom, and if you have that, then you are blessed. While elective C-sections are not the standard method of delivery for a low-risk pregnancy or delivery, we are very fortunate that we are able to perform C-sections safely in this country. When medically necessary, C-sections can save so many lives,” she explains.

No matter which delivery method you have, Puffer adds that a happy, healthy baby, and a happy, healthy mom is the goal for everyone involved and your health care team will work hard to help deliver that for you.

For more help and guidance about what to expect during your pregnancy, visit Women and Infant Services and join the Texas Health Moms Facebook page, a private group where you can network with other moms, swap ideas and share helpful advice.