When a caesarean section is necessary, it can be a life-saving operation for both mother and child. In addition, some of the pain of labour may be avoided, and it may be possible to schedule the time of the delivery. The latter is particularly important, if the baby needs to be born before the due date when there is placental insufficiency (insufficient supply of oxygen and nourishment from the placenta to the baby).

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Often, labour will be induced by means of drugs administered through a drip. If there is a good response of the uterus with adequate contractions and good labour progress, the baby may be born vaginally. If, however, labour is not progressing sufficiently or the baby develops foetal distress, a caesarean section may be necessary.

What are the risks of caesarean section?
A caesarean section poses certain medical risks to the health of both mother and baby. An elective (scheduled rather than an emergency) C/S before the due date increases the risk of foetal prematurity and respiratory distress syndrome (in which a premature infant has impaired oxygen intake).

Prematurity and respiratory distress syndrome are associated with several complications, which may necessitate intensive care for the newborn baby with added financial costs. These complications need to be balanced against the potential risks for the baby if a C/S is not done, and only an experienced obstetrician (sometimes together with a paediatrician and a neonatologist) will be able to make the right decision.

Risks to the mother include:

• Anaesthesia complications. A regional anaesthetic block may not numb the area sufficiently and the patient may feel some minor discomfort. Also, in rare cases, an allergic reaction to the anaesthetic drug may occur. In most cases, regional anaesthesia is considered safer than general anaesthesia, which always carries certain risks in any operation. The anaesthetist will advise the patient about these.
• Haemorrhage. Some of the blood vessels which were cut and later sutured again during the operation, may open up and cause internal bleeding.
• Thrombosis and embolism. Due to the spontaneous activation of clotting factors in the blood during the operation, a blood clot may form on the inner wall inside one of the veins of the legs or pelvis (thrombosis). The clot may even break off and go through the bloodstream into the lungs (pulmonary embolism).
• The cut in the wall of the uterus may result in a weakness in that part of the wall.
• Any future children may need to be delivered by C/S, depending on the indication for the C/S, how the operation was done and its outcome.
• Infection.
• Injury to other organs.
• Psychological complications. C/S can delay interaction and bonding between the mother and newborn baby. (Also see emotional changes.)
• Maternal mortality is two to four times greater than for a vaginal birth.

The doctor should be asked about the chances for complications and the various risks.

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