Updated December 9th, 2023
Since 1970, the United States Cesarean rate has steadily climbed from 5% of births to over 30%, where it has remained since 2005. Unfortunately, C-section complications years later are rarely considered or discussed.
Even though Cesareans have become more common, when considering risks, doctors and parents often only look at the immediate risks.
Recovering from a Cesarean birth doesn’t happen in days or weeks. For many moms, a C-section means a surgery. That impacts them much longer than the initial physical recovery period. And no one is talking about it.
It can take years or even a lifetime to process emotional struggles that come with an unplanned C-section. There are also many physical side effects of a C-section related to the pelvic floor, internal scar tissue, uterus, and abdominal muscles that may not manifest until years after surgery.
The long-term complications after C-section should be discussed and considered when deciding whether to choose a VBAC or repeat Cesarean, because having multiple Cesareans has a higher likelihood of bringing on long-term issues. As always, we recommend discussing the risks and benefits of each delivery method based on your own unique needs with a care provider that you trust.
This article covers 20+ C-section complications that can happen years after the initial surgery, how C-section can impact future pregnancies, long-term effects on your baby’s health, and what signs to watch for if you are suffering from complications.
If you are currently experiencing complications or would like more in-depth information on your birth and pregnancy history, we recommend that you consult your health care provider immediately.
Side Effects of C-Section
Only 5.2% of Cesareans with first-time moms are planned ahead of time; this means that most parents are often unprepared for even the short-term side effects of having a Cesarean.
Knowing what to expect immediately post birth and in the first few weeks is a necessary first step in becoming familiar with Cesarean complications.
According to The Mayo Clinic, possible short-term Cesarean side effects include:
- Breathing problems for the baby
- Surgical injury to the baby
- Increased likelihood if NICU admission
- Infection of the incision site
- Postpartum hemorrhage
- Reactions to anesthesia
- Blood clots
- Infection of the uterus
- Surgical injury to the mother, including organ damage and (very rarely) death
These are all important things to be aware of and need medical attention; however, you will likely be in the hospital still if any of the above-listed issues happen. If you are at home, it is crucial to get in touch with a doctor immediately.
Along with the immediate side-effects of a Cesarean, several new studies show that mothers who have Cesareans have a higher chance of long-term health risks later in life.
In 2018, a systemic review and meta-analysis of long-term risks and benefits of Cesarean for mother, baby, and subsequent pregnancies, including over 30 million parents, was performed. The findings of this analysis are significant and show the undeniable impact that Cesarean births have on both parents and children long-term.
Pregnancy and Fertility Complications After C-Section
Some of the most relevant concerns for new parents delivering by Cesarean are the ability to have more children and what effect Cesarean birth has on their future fertility, pregnancy, and birth options.
This is not to put fear in anyone who is expecting, keep in mind we are sharing risks of CS weeks, months, and even years later. In a 2018 review it showed that mothers who had a C-section have a 17% higher risk for miscarriage and are 27% more likely than those with an unscarred uterus to experience a stillbirth.
Fertility issues are sometimes caused by the scarring left on the organs and tissues surrounding the uterus as the wound heals. When scar tissue connects to the bladder, uterus, and other organs, it can make getting pregnant harder or even almost impossible or very painful due to less than ideal areas for the fertilized egg to implant in the uterus.
Basically, there are fewer areas on the uterus for the baby to attach and grow.
Placenta Issues: Placenta Previa, Placenta Accreta, and Placental Abruption
Having an anterior placenta is not a problem for VBAC, as long as the placenta is not covering the Cesarean scar. However, other placenta issues cause serious complications that need medical attention, usually a repeat Cesarean. These complications increase drastically after just one C-section.
Placenta Previa happens when the placenta partially or fully covers the cervix. It can cause bleeding during pregnancy, increases the likelihood of placental abruption, and makes vaginal delivery impossible. Parents who have had a cesarean birth are almost twice as likely to have Placenta Previa 0.027% compared to 0.05%.
Placenta Accreta happens when the placenta implants too deeply into the uterus. The risk for Placenta Accreta increases with each Cesarean birth. This is a dangerous condition that threatens both the mother and baby and necessitates an early Cesarean delivery.
The rate for Accreta has increased drastically since the 1980s, and the increase closely follows the drastic rise in Cesarean rates. The risk for Accreta doubles after just one Cesarean. The risk is still relatively low, going from roughly 0.00029% to 0.0006%.
Placental Abruption is when the placenta separates from the uterus before birth or during labor. It causes heavy bleeding in the mother and deprives the baby of oxygen and nutrients. Parents with a prior Cesarean are almost twice as likely to have a placental abruption 0.005% to 0.007%.
All three of these issues will require a repeat Cesarean birth. Although these issues are more common for parents who have had a prior Cesarean, doctors can recognize these things quickly and make plans with you to deliver your baby safely in a way that can still leave you feeling supported.
Birth Trauma and Postpartum Depression
No matter how a baby is delivered, there is a flood of emotions surrounding the birth. Some of these emotions can be negative and leave parents feeling lost, alone, and unsupported.
Birth PTSD affects seven in 100 parents after having a baby, and women who have Cesarean births are at a higher risk for PTSD due to its unexpected nature and drastic change of plans.
Women who deliver by Cesarean are sometimes told that they should just be grateful that they have a healthy baby. I want to tell you that it is ok to mourn the loss of a birth experience you worked and prepared for and still be happy that you have a beautiful baby in your arms. These two different emotions can exist together in the same space, and it can be complicated.
While hormone fluctuations and the “baby blues” are normal, signs of postpartum depression include anxiety, extreme sadness, exhaustion, insomnia, and even anger.
Having an emotional outlet is essential for parents after birth, and talk therapy coupled with antidepressants can be especially beneficial when dealing with birth trauma, PTSD, or postpartum depression.
Fear of Getting Pregnant Again
Recovering from a Cesarean is usually more challenging in physical and emotional ways than recovering from vaginal birth. The recovery process coupled with the trauma they experienced during the birth can cause mothers to fear getting pregnant and having more children.
Due to a traumatic Cesarean experience, some women go from wanting a huge family to deciding that one child is more than enough. According to The New York Times, women with a C-section birth are less likely to want more children when compared to women who had a vaginal birth.
It is ok to change plans but it can sadden parents who wanted larger families and see the possibility of future C-sections as crushing that dream.
Finding Support in Future Pregnancies
VBAC (Vaginal Birth After Cesarean) is a reasonable option for 90% of parents who have had a C-section. However, if a mother wants to have a VBAC, she might have problems finding a VBAC supportive doctor or VBAC midwife.
In some parts of the world, providers prefer repeat Cesareans and are not fully supportive of VBAC due to the fear of uterine rupture.
The emotional struggles that come with that can be overwhelming and make parents feel like they do not have options other than having a repeat Cesarean.
Most parents who have an initial Cesarean will have Cesareans in subsequent pregnancies due to the lack of VBAC support and simply not knowing that VBAC is possible.
Every C-section a mother has increased her chances of complications in future pregnancies and births and limits the number of children a mother can have. I know of many healthcare providers who recommend not having more than 4 Cesarean deliveries.
Complications in Future C-Sections
Providers are more likely to restrict the number of Cesareans you have because with each abdominal surgery, it gets more challenging to perform and increases the chance of severe complications.
Because women often have more than one baby, we are the only surgeons that routinely cut on the same scar over and over again, and that makes surgery technically harder each time. The internal tissue starts to fuse together and can look like a melted box of crayons. C-sections and hysterectomies are two of the most common surgeries performed on women, and those who require both are at significantly higher risk of complications.
Dr. Neel Shah, OBGYN
Long-Term Effects of C-section for Baby
As referenced in the study above, children born via Cesarean are 21% more likely to develop asthma before the age of 12, 59% more likely to become obese by the age of 5, and are linked to other adverse outcomes such as:
- Type 1 Diabetes
- Developing allergies
- Lower academic performance up to the age of 8
- Lower rates of breastfeeding
- Impairment of the initial bonding time between mother and baby
- Decrease immune function up to the age of 7 due to not getting passed through the beneficial gut flora that is in the vaginal canal
Other Common Long-Term Complications After C-Section
Outside of future pregnancies and births, there are other long-term adverse outcomes related to C-section deliveries that can be directly tied back to the birth. Some of these are seemingly unrelated, so it is important to be aware of their ties to your birth history as it might change how your provider cares for you.
Scarred Tissue After C-section and Dense Adhesions
One of Cesarean deliveries’ most common complications is dense adhesions, which is pretty much a fancy way to refer to thicker than normal scar tissue.
Scar tissue starts to form within days of surgery. Unfortunately, there is no way to tell whether you will have thicker than usual scar tissue; it is just how the body heals and responds to intense changes.
Dense adhesions can even appear years after the surgery. Sometimes adhesions can grow onto the surrounding organs and restrict blood flow or create blockages on many organs in the pelvic floor area, including the uterus, bladder, and intestines.
To reduce the chance of developing excess scar tissue after your Cesarean and even reduce it, you can incorporate Cesarean scar massage into your routine or see a pelvic floor therapist. Or check out our friend Janette and her programs for scar massage.
Women who had at least one Cesarean are 50% more likely to need a hysterectomy later in life than those who only had vaginal births. Cesarean parents are also 16% more likely to have post-operative complications like bleeding and infection. They are also 30% more likely to require reoperation.
Those who had two or more C-sections are almost twice as likely to need a blood transfusion during the hysterectomy. (Oonagh, et al., 2018).
C-section Scar Infection Months to Even Years Later
In rare cases, the Cesarean incision doesn’t heal properly, which leaves it weakened and vulnerable. It is possible for the scar to develop an infection. Although it is most common for the infection to develop a few months after it can still occur years after having the Cesarean Section.
The infection can occur in the layers of the skin at the incision site and lead to abscesses if not addressed quickly; this is extremely rare but, it is something to be aware of if you notice something unusual happening on your Cesarean scar.
Sepsis is the body’s extreme response to an internal bacterial infection. If not handled quickly, it can spread throughout all the organs in the body. This is typically something that would happen weeks vs years later but is still a concern no one mentions. Previous studies have shown that it can varies from 0.48% to 1.12%
Uterine infections can usually be treated with antibiotics before they get to be out of control. Still, it can turn into septic shock if left untreated and is very dangerous and fatal in rare cases. Paying attention to your body as it changes and making sure to be seen by a doctor when you have concerns, especially anywhere in your pelvic area, is important to resolve any issues related to your prior Cesarean before becoming severe.
Pulled Muscle after C-section and Weaker Abdominal Muscles
Cesarean birth is major abdominal surgery, and the abdominal muscles face a lot of strain and stress during the procedure. For some people, it takes months or even years for their abdominal muscles to regain their full strength. Some may need physical therapy if the muscles do not heal together properly (diastasis recti).
…tissues and muscles that have been damaged during a C-section need to be rehabilitated just like any other orthopedic procedure to help regain proper stability and function for women.Dr. Graham from Finish Line Physical Therapy
Pelvic Floor Issues and Urinary Incontinence
Many people think that delivering a baby by C-section helps you avoid trauma to the pelvic floor that causes urinary incontinence, organ prolapse, and other pelvic floor issues. While the risk of urinary incontinence and pelvic organ prolapse are lower in parents who choose to have a Cesarean, 44% and 71%, respectively, avoiding them altogether is a myth.
Pregnancy creates a lot of changes in your body and pelvic floor, and it is not unheard of for parents who had a Cesarean, especially those who made significant progress towards a vaginal birth before the surgery, to have pelvic floor issues.
Having a cesarean creates its own kind of trauma in the pelvic floor. Keep an eye out; a doctor or pelvic floor specialist should address any type of incontinence, bladder cramping, spasms, or other pain in the pelvic floor area.
Urinary Tract Infections (UTI) can increase because of the weaker pelvic floor caused by pregnancy and Cesarean birth. Weakened pelvic floor muscles can cause the urine to reside in the urinary tract for longer than usual, leading to recurrent infections.
Watch out for pelvic pain, strong urges to use the bathroom more frequently, fever, and fatigue. These can be signs of a UTI and can lead to a bladder infection if left untreated.
Caring for the Scar
Having a scar on the abdomen can trigger some parents who don’t want to be reminded of a less-than-ideal birth experience. It can be challenging for some mothers to see the scar as a beautiful symbol of their child’s birth. Some may struggle to view their Cesarean as giving birth at all.
After the initial 4-6 weeks of physical care for the incision, your scar shouldn’t need much maintenance. Performing Cesarean scar massage can not only prevent adhesions but can help you become more comfortable with it on an emotional level and begin an emotional healing journey.
Detachment or Attachment Issues
We all want to feel an instant bond and attachment when we hold our babies for the first time. Cesareans make that initial bonding more complicated, primarily due to the absence of immediate skin-to-skin time, more typical with a vaginal birth.
Some new moms do not feel a complete connection with their babies for weeks or even months after their birth. Some can even feel they are less of a mother for not birthing their baby vaginally.
I am here to tell you that each mother and baby bonding experience looks different than the next. Some connections happen immediately, and others take time.
If you are worried about attachment issues, it might help talk to a professional therapist to work through those feelings and connect on a better level with your child.
Endometriosis can become an issue for women who have C-sections, even if they didn’t have it prior to birth.
According to the US National Library of Medicine, Endometriosis:
…can be a direct consequence of a Cesarean delivery and chances are 5 to 20-fold increased for women who’ve had Cesarean deliveries.US National Library of Medicine
Luckily, endometriosis can often be treated and resolved quickly, usually with antibiotics. In rare circumstances, it will need surgery or other forms of treatment.
After the baby is born, hormones don’t stop pumping through a woman’s body. They continue to make a parent feel emotional and moody and mess with the predictability of the menstrual cycle. A C-section still impacts the reproductive organs; it plays a significant role in how the body reacts to the return of its cycle.
A lot of factors come into play when it comes to the return of a predictable menstrual cycle. Some moms may not have their period for six months or even a year after delivery.
Though some women see this as a perk to having their baby, it can also be emotionally stressful, leading to difficulty with future pregnancies and regulating those hormones long after the baby has been born.
Fear of Judgement
There are a lot of people with negative views on Cesarean. A new mom who only has family and friends who had vaginal deliveries might feel judged or out of place, even if it was the safest option for her and her baby.
Other people can make hurtful comments that stick with parents for years afterward and leave them feeling embarrassed or inadequate about the birth.
These emotional stains and feelings linger, especially when tied to such a traumatic event to the body like a Cesarean. It isn’t fair to the mother, her family, or her baby, but, unfortunately, it happens and can impact many of the other complications listed above.
C-section Complication Symptoms to Be Aware Of
Phew! That was a LOT of stuff to unpack. But don’t worry, most of the time, there are ways to heal from them both physically and emotionally if you know what to look for.
Here are some signs you might be having Cesarean-related complications and need to be seen by a health care provider.
C-section Incision Pain Years Later
As nerves regrow around your incision site, you might feel cramps and pain. These c-section complications can manifest even years later. However, it might be a sign of internal damage or scar tissue growing too thick.
Pay attention to any pain around your incision site, and make sure to bring it up with your doctor.
Period Pain after C-section
If you have blood clots, increased period pain, or irregular flow patterns during your menstrual cycle, it might be your body adjusting to normal after pregnancy.
In some cases, those are signs of endometriosis at the site of the incision, which can make periods more painful and affect flexibility in your abdominal area. It is a good idea to address any period abnormalities with your provider.
Cramps after C-section
Cramping after both C-section and vaginal deliveries is expected. It’s how your uterus returns to normal and prevents excessive bleeding.
If Motrin or ibuprofen doesn’t reduce the pain, you have a fever, or you notice any unusual discharge, check in with a medical professional.
Abdominal Pain Years after C-section
Tissue damage can be internal, and scar tissue develops internally. Sometimes, this can be a sign of disease or infection.
If your scar tissue becomes painful or you develop low back pain, pain during sex, along with other unusual symptoms in your pelvic area, it’s time to give your provider a call, or see a pelvic floor therapist. See episode 198 on The VBAC Link Podcast
Lump Under C-section Scar Years Later
Formations of lumps, an unusual mass, or any type of growth are common symptoms of endometriosis. If you feel a lump or mass around your Cesarean scar, even if it is years later, check in with your medical provider to rule out endometriosis or dense adhesions.
When to Seek Help after C-section Complications
C-sections happen for many reasons. Some are scheduled, many are unplanned, some are truly life-saving, and some may have been preventable.
If you consider planning a repeat Cesarean, it is important to consider both the short and long-term risks associated with them in your decision. Only you can decide the right choice for your birth.
Regardless of how or why your Cesarean happened, being aware of the signs c section complications years later is important to ensure you are in good health.
As a summary, here are some times it is necessary to check in with your medical provider:
- Pain around your incision site
- Redness, swelling, or pus coming from the incision site
- Excessive bleeding
- Fever over 101°
- Chest pain
- Swelling or redness in your legs
- Difficulty breathing
- Unusual vaginal discharge
- Anytime you feel something’s not quite right
Can C-Section cause problems years later?
Recent studies show that moms who give birth by Cesarean have higher chances of facing long-term health and surgical complications, including the need for a hysterectomy, endometriosis, mental health issues, and difficulties in future pregnancies. Babies born by Cesarean also face an increased risk for adverse health outcomes.
Why does my C-section scar hurt years later?
In some cases, pain from scar tissue is noticeable right away. In others, the pain may come on years later. Sometimes this has to do with nerves that develop after the injury itself heals; however, sometimes, it is a sign of excessive scar tissue interfering with pelvic floor organs or endometriosis.
What are the long-term side effects of a C-section?
Long-term side effects of Cesarean include long-term gynecological morbidity, intermenstrual bleeding, birth trauma, the likelihood of future abdominal surgeries. Chronic pelvic pain and risk of secondary infertility, scar pregnancy, uterine rupture, placenta previa, and accreta are also increased risks after Cesarean section.
Can your C-section scar get infected years later?
If the C-section scar heals incorrectly, it leaves itself vulnerable to the risk of infection. Bacteria can more easily enter the incision site and cause inflammation, redness, swelling, and pain. If left untreated, it can result in further complications in the abdominal area.