Possible benefits & risks
Comparison of caesarean and vaginal birth
Comparison of caesarean and vaginal birth
The benefits of caesarean birth, will depend on your circumstances, concerns, priorities and plans for future pregnancies.
The table summarises the the potential risks for planned caesarean birth or planned vaginal birth, mainly based on available evidence as reviewed by NICE and as listed in RCOG consent guidance. It is acknowledged there were some limitations with the quality of evidence and not all the evidence was from the best comparisons.
You will need to decide which risks are more (or less) acceptable to you.
The table gives general risks only to aid discussions, not your individual risk.
More likely with caesarean birth | ||
|---|---|---|
Outcome | Caesarean birth | Vaginal birth |
Hospital stay (average) | 4 days | 2.5 days |
Removal of your uterus (hysterectomy) | About 2 in 1,000 women/birthing people | About 1 in 1,000 women/birthing people |
Uterine rupture in future pregnancy* | About 200 in 100,000 women/birthing people. Chance increases with more caesarean births. | About 7 in 100,000 women/birthing people |
Abnormally adherent/invasive placenta in future pregnancy (placenta accreta spectrum)* | About 10 in 10,000 women/birthing people | About 3 in 10,000 women/birthing people |
Maternal death (within 6 weeks of childbirth) | About 25 in 100,000 women/birthing people | About 4 in 100,000 women/birthing people |
Neonatal death (within 28 days of birth) | 58 in 100,000 babies | 30 in 100,000 babies |
Childhood Asthma | 18 in 1,000 babies | 15 in 1,000 babies |
Less likely with caesarean birth | ||
Outcomes | Caesarean birth | Vaginal birth |
Perineal/abdominal pain (1=no pain 10=most severe pain) | Pain scores: 1 - during birth 4.5 - 3 days after birth | Pain scores: 7.3 - during birth 5.2 - 3 days after birth |
Urinary incontinence (>1 year after birth) | About 7 - 20 in 100 women/birthing people | About 49 in 100 women/birthing people |
Faecal (poo) incontinence (>1 year after birth) | About 8 in 100 women/birthing people | About 15 in 100 women/birthing people |
Third or fourth-degree perineal tears | 0 in 10,000 women/birthing people | About 56 in 10,000 women/birthing people |
Likely to be similar for caesarean or vaginal birth | ||
Blood clots in legs or lungs. Severe blood loss (more than 1500mls). Postnatal depression. Admission to neonatal unit. Your baby developing an infection. Persistent verbal delay in baby/child. Infant death (up to one year). | ||
Conflicting or limited evidence | ||
Admission to critical care. Stillbirth in next pregnancy. Lung problems in baby/child. Cerebral palsy. Childhood obesity. Autism in baby/child. Type 1 diabetes in baby/child. | ||
The NICE Caesarean Birth Guideline has more detailed evidence tables for 28 short and long-term outcomes that they believed were the most direct indicators of safety and would be the most informative for women’s decision-making. Further information can be found here NG192 Caesarean birth: Evidence review A 13/08/2024
Short-term outcomes for women and babies that may be more likely with a planned caesarean birth include peri-partum hysterectomy; Maternal death; and neonatal mortality.
Long-term outcomes for women and children that may be more likely with a caesarean birth include asthma; low-lying placenta (placenta previa) and uterine rupture in any future pregnancy.
Stillbirth in any future pregnancy is one of the outcomes for women and children that have conflicting or limited evidence about the risk with caesarean or vaginal birth.
Short-term outcomes for women and babies that are likely to be the same for caesarean or vaginal birth: Thromboembolic disease; Major obstetric haemorrhage; Bleeding complications; Postpartum haemorrhage; Admission to neonatal unit; Infectious morbidity.
Short-term outcomes for women and babies that have conflicting or limited evidence about the risk with caesarean or vaginal birth: Intensive therapy unit admission; Respiratory morbidity; Respiratory distress syndrome.
References
Caesarean birth. London: National Institute for Health and Care Excellence (NICE); 2024 Jan 30. PMID: 33877751. Available from: https://www.nice.org.uk/guidance/ng192/chapter/Recommendations.
