Complications of the birth process may affect either the mother or the infant. Whereas the risk of complications for the mother is somewhat greater in a cesarean birth than in a vaginal birth, the risk of complications for the infant is greater from vaginal birth than from cesarean birth. Moreover, the type and severity of complications from each method of birth differs for both the mother and the infant. Complications of cesarean birth for the mother during the operative procedure include adverse reactions to anesthetic agents, injury of abdominal organs and hemorrhage from the surgical incisions; and after the procedure, pneumonia, urinary or wound infections, and blood clots in the legs, abdomen, or lungs. The most common long-term complication of cesarean birth is the risk of rupture of the uterine incision in a subsequent pregnancy, and the consequent increase in risk of future pregnancies having to be delivered by cesarean.
Complications of vaginal birth for the mother include many of the complications that occur in cesare-an birth, but they occur much less often and are usually less severe. The long-term complication of vaginal birth is the increased risk of pelvic muscle dysfunction that manifest as urinary or rectal incontinence.
Overall, the risk of maternal death from a cesarean birth (4 per 10,000 births) is four times greater than from a vaginal birth (1 per 10,000 births). Cesar-ean births, however, are often performed for medical or obstetrical complications that, by their nature, increase the risk of death for mothers. If one excludes pregnancies with such complications, there still remains a one and one-half times greater risk of the mother dying as a result of cesarean birth as compared to vaginal birth.
Complications of vaginal birth for an infant include birth trauma (fractured limbs or injured nerves resulting in paralysis of an arm), asphyxia (lack of oxygen) causing brain damage, and acquiring an infection from the mother's birth canal (herpes simplex virus or group-B streptococcus). Complications of ce-sarean birth for infants include lacerations from the surgeon's knife and a respiratory illness caused by the failure of excess fluid to be cleared from the infant's lungs.
Balancing the benefits and risks of vaginal birth as compared to cesarean birth for both the mother and the infant in a wide variety of birthing situations is the complex problem faced by doctors and mid-wives, who care for women during their pregnancies. Increasingly, women are becoming more involved in the decisions about the way in which they will give birth. During her pregnancy, a woman should be provided with accurate and updated information about the benefits and risks of the alternative methods of delivery for her situation so that together with her physician or midwife she can make an informed decision about the method of birth.
See also: BIRTH; MIDWIVES
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