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Medical Author:

Harish M Sehdev, MD

Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Medical Editor:

Jerry R. Balentine, DO, FACEP

Jerry R. Balentine, DO, FACEP

Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.

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A normal vaginal delivery in later pregnancies is often possible, depending on the type of incision that was performed and the reason the birth was performed by cesarean section.

Cesarean childbirth may have these types of complications:

Excessive bleeding: This is the most common complication of a cesarean delivery and may be caused by many different factors.

• In short, at the time of active labor, the uterus receives 20% (up to 30% in some cases) of the blood pumped to the body by the heart. When a surgeon cuts the uterus, a certain amount of blood loss will occur.
• On average, cesarean deliveries result in more than twice the blood loss of vaginal deliveries. Various factors contribute to this difference. Because most childbearing women are young and healthy, they tolerate the blood loss well and recover a normal blood volume within a relatively short time after delivery.
• Women who have had multiple deliveries in quick succession, especially cesarean sections, are susceptible to significant anemia (loss of volume of red blood cells). Excessive bleeding along the incision line or from the uterus after the delivery of the infant may require the doctor to prescribe medications to promote contraction of the uterus and therefore control the bleeding.
• Sometimes, an artery supplying blood to the uterus is cut. This requires stitches to control bleeding from the artery.
• Bleeding may at times be so difficult to control that the uterus has to be removed as a means to control the bleeding. This is called a cesarean hysterectomy.

Infection: The risk of infection of the uterus is up to 20 times greater after cesarean delivery than after vaginal delivery. A number of factors contribute to infection, above and beyond the simple fact that an operation with an incision of the uterus has been performed. Generally, many conditions, such as a prolonged labor course, that often put a woman in a position of requiring a cesarean section may also make her more prone to developing infections.

• Infection of the skin incision is much more common than infection in the incision made in the uterus, although they often occur together. The risk for infection in the skin incision can be decreased by giving antibiotics during the surgery.
• Doctors can use certain types of skin preparations to clean the abdomen for surgery.
• Proper wound care after the surgery is essential.

Clots: Blood clots can form in the pelvis or the leg. If a clot breaks off and travels (embolizes) to the lungs, it can cause of death and disability after delivery, whether it is vaginal or cesarean. However, women who undergo cesarean childbirths are much more prone to clots than women who deliver vaginally. Therefore, it is imperative that if you deliver by cesarean section, you must get up and walk within 24 hours after the operation.

Urinary function and bladder injury: Typically, a catheter is inserted into the bladder before the surgery to remove urine. Usually, the catheter is removed within 24 hours after the surgery as soon as the woman is ready to begin walking. Often, some initial pain occurs when urinating - as with vaginal deliveries. However, with a cesarean delivery, significant damage can occur to the bladder in the course of the surgery.

• The frequency of this type of injury is more common in women who have had abdominal surgery or infection that results in scarring in the abdomen. Sometimes, a catheter may need to be in place for weeks after discharge from the hospital.
• In the course of a cesarean hysterectomy, the tubes emptying urine from the kidneys to the bladder (the ureters - one ureter on each side) can be damaged. Repair of this injury usually depends on the surgeon recognizing the injury during the operation and fixing it then.

Bowel function and bowel injury: Typically, bowel function after a cesarean section returns quickly. Return of normal bowel function is usually aided if the woman is aggressive about frequent walking. Sometimes, bowel function does not return normally after cesarean delivery, even without specific damage to the bowel. This is termed postoperative ileus. The causes are many and are not completely understood. In the case of actual bowel injury, the nature and degree of complication depend on the size, severity, and location of the injury. Unrecognized bowel injury can lead to life-threatening illness with severe abdominal pain and fever (usually but not always present in such cases). The incidence of bowel injury, as with bladder injury, is increased if the woman has had other abdominal surgery or infection.

Prolonged hospital stay: After vaginal delivery, the woman is typically free to go home within 48 hours. However, observation after a cesarean section typically runs a minimum of 2 days. If infection, significant bleeding, slow return of bowel and bladder function, or injury to internal organs occurs, the hospital stay can be extended.

Anesthesia and pain medications: Anesthesia for a cesarean section can be delivered by an injection into the spinal fluid (spinal anesthesia), placed via a catheter into the space outside of the spinal fluid but surrounding the spinal column (epidural anesthesia). General anesthesia may also be given; this makes the person completely "asleep."

• General anesthesia is typically reserved for emergency deliveries when there is not enough time to provide spinal or epidural anesthesia.
• All of the methods can be supplemented with an injection of local anesthesia into the incision site during the surgery. After surgery, oral and injection drugs can be used to help control the pain.
• The advantage of epidural anesthesia is that repeat doses of pain medication can be given after the surgery for pain control.
• Properly dosed, these medications do not necessarily interfere with the woman's ability to get up and about after surgery.

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