Adverse outcomes in low-risk pregnancies occur in 8.6% of vaginal deliveries and 9.2% of<unk>  deliveries. Mother In those who are low risk, the risk of death for<unk> s is 13 per 100,000 vs. for vaginal birth 3.5 per 100,000 in the developed world. The United Kingdom National Health Service gives the risk of death for the mother as three times that of a vaginal birth. In Canada, the difference in serious morbidity or mortality for the mother (e.g. cardiac arrest, wound hematoma, or hysterectomy) was 1.8 additional cases per 100. The difference in in-hospital maternal death was not significant. Transvaginal ultrasonography of a uterus years after a<unk> , showing the characteristic scar formation in its anterior part A<unk>  is associated with risks of postoperative adhesions, incisional hernias (which may require surgical correction), and wound infections. If a<unk>  is performed in an emergency, the risk of the surgery may be increased due to a number of factors. The patient's stomach may not be empty, increasing the risk of anaesthesia. Other risks include severe blood loss (which may require a blood transfusion) and postdural-puncture spinal headaches. Wound infections occur after<unk> s at a rate of 3–15%. The presence of chorioamnionitis and obesity predisposes the woman to develop a surgical site infection. Women who had<unk> s are more likely to have problems with later pregnancies, and women who want larger families should not seek an elective<unk>  unless medical indications to do so exist. The risk of placenta accreta, a potentially life-threatening condition which is more likely to develop where a woman has had a previous<unk> , is 0.13% after two<unk> s, but increases to 2.13% after four and then to 6.74% after six or more. Along with this is a similar rise in the risk of emergency hysterectomies at delivery. Mothers can experience an increased incidence of postnatal depression, and can experience significant psychological trauma and ongoing birth-related post-traumatic stress disorder after obstetric intervention during the birthing process. Factors like pain in the first stage of labor, feelings of powerlessness, intrusive emergency obstetric intervention are important in the subsequent development of psychological issues related to labor and delivery. Subsequent pregnancies Women who have had a<unk>  for any reason are somewhat less likely to become pregnant again as compared to women who have previously delivered only vaginally. Women who had just one previous<unk>  are more likely to have problems with their second birth. Delivery after previous<unk>  is by either of two main options: * Vaginal birth after<unk>  (VBAC) * Elective repeat<unk>  (ERCS) Both have higher risks than a vaginal birth with no previous<unk> . A vaginal birth after<unk>  (VBAC) confers a higher risk of uterine rupture (5 per 1,000), blood transfusion or endometritis (10 per 1,000), and perinatal death of the child (0.25 per 1,000). Furthermore, 20% to 40% of planned VBAC attempts end in<unk>  being needed, with greater risks of complications in an emergency repeat<unk>  than in an elective repeat<unk> . On the other hand, VBAC confers less maternal morbidity and a decreased risk of complications in future pregnancies than elective repeat<unk> . Adhesions Suturing of the uterus after extraction Closed incision for low transverse abdominal incision after stapling has been completed There are several steps that can be taken during abdominal or pelvic surgery to minimize postoperative complications, such as the formation of adhesions. Such techniques and principles may include: * Handling all tissue with absolute care * Using powder-free surgical gloves * Controlling bleeding * Choosing sutures and implants carefully * Keeping tissue moist * Preventing infection with antibiotics given intravenously to the mother before skin incision Despite these proactive measures, adhesion formation is a recognized complication of any abdominal or pelvic surgery. To prevent adhesions from forming after<unk> , adhesion barrier can be placed during surgery to minimize the risk of adhesions between the uterus and ovaries, the small bowel, and almost any tissue in the abdomen or pelvis. This is not current UK practice, as there is no compelling evidence to support the benefit of this intervention. Adhesions can cause long-term problems, such as: * Infertility, which may end when adhesions distort the tissues of the ovaries and tubes, impeding the normal passage of the egg (ovum) from the ovary to the uterus. One in five infertility cases may be adhesion related (stoval) * Chronic pelvic pain, which may result when adhesions are present in the pelvis. Almost 50% of chronic pelvic pain cases are estimated to be adhesion related (stoval) * Small bowel obstruction: the disruption of normal bowel flow, which can result when adhesions twist or pull the small bowel. The risk of adhesion formation is one reason why vaginal delivery is usually considered safer than elective<unk>  where there is no medical indication for<unk>  for either maternal or fetal reasons. Child Non-medically indicated (elective) childbirth before 39 weeks gestation "carry significant risks for the baby with no known benefit to the mother." Newborn mortality at 37 weeks may be up to 3 times the number at 40 weeks, and is elevated compared to 38 weeks gestation. These early term births were associated with more death during infancy, compared to those occurring at 39 to 41 weeks (full term). Researchers in one study and another review found many benefits to going full term, but no adverse effects in the health of the mothers or babies. The American Congress of Obstetricians and Gynecologists and medical policy makers review research studies and find more incidence of suspected or proven sepsis, RDS, hypoglycemia, need for respiratory support, need for NICU admission, and need for hospitalization > 4–5 days. In the case of<unk> s, rates of respiratory death were 14 times higher in pre-labor at 37 compared with 40 weeks gestation, and 8.2 times higher for pre-labor<unk>  at 38 weeks. In this review, no studies found decreased neonatal morbidity due to non-medically indicated (elective) delivery before 39 weeks. For otherwise healthy twin pregnancies where both twins are head down a trial of vaginal delivery is recommended at between 37 and 38 weeks. Vaginal delivery, in this case, does not worsen the outcome for either infant as compared with<unk> . There is some controversy on the best method of delivery where the first twin is head first and the second is not, but most obstetricians will recommend normal delivery unless there are other reasons to avoid vaginal birth. When the first twin is not head down, a<unk>  is often recommended. Regardless of whether the twins are delivered by<unk>  or vaginally, the medical literature recommends delivery of dichorionic twins at 38 weeks, and monochorionic twins (identical twins sharing a placenta) by 37 weeks due to the increased risk of stillbirth in monochorionic twins who remain in utero after 37 weeks. The consensus is that late preterm delivery of monochorionic twins is justified because the risk of stillbirth for post-37-week delivery is significantly higher than the risks posed by delivering monochorionic twins near term (i.e., 36–37 weeks). The consensus concerning monoamniotic twins (identical twins sharing an amniotic sac), the highest risk type of twins, is that they should be delivered by<unk>  at or shortly after 32 weeks, since the risks of intrauterine death of one or both twins is higher after this gestation than the risk of complications of prematurity. In a research study widely publicized, singleton children born earlier than 39 weeks may have developmental problems, including slower learning in reading and math. Other risks include: * Wet lung: Retention of fluid in the lungs can occur if not expelled by the pressure of contractions during labor. * Potential for early delivery and complications: Preterm delivery may be inadvertently carried out if the due-date calculation is inaccurate. One study found an increased complication risk if a repeat elective<unk>  is performed even a few days before the recommended 39 weeks. * Higher infant mortality risk: In<unk> s performed with no indicated medical risk (singleton at full term in a head-down position with no other obstetric or medical complications), the risk of death in the first 28 days of life has been cited as 1.77 per 1,000 live births among women who had<unk> s, compared to 0.62 per 1,000 for women who delivered vaginally. Birth by<unk>  also seems to be associated with worse health outcomes later in life, including overweight or obesity and problems in the immune system.
Caesarean section
Labor induction
Natural childbirth
Forceps
Trial of labour
Cordotomy
Obstetrical forceps
Vaginal delivery