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Evidence LibraryCesarean deliveryThe basics
Evidence Library · The basics

Planned and unplanned cesareans are not the same operation

The risks, the recovery and the emotional aftermath all differ.

A cesarean scheduled weeks in advance, performed on a rested woman who has not labored, is a different event from one decided at three in the morning after eighteen hours of labor.

Unplanned cesareans after labor carry more infection risk. In a randomized trial of women having a cesarean during labor or after their membranes broke, 12.0% of the placebo group developed an infection within six weeks. They also carry a higher chance of the baby's head being wedged deep in the pelvis, which complicated 11.3% of emergency cesareans in one UK cohort.

Planned cesareans before labor carry more newborn breathing problems, because labor helps clear fluid from the lungs. In a series of 33,289 term births, respiratory problems occurred in 35.5 per 1,000 births after a cesarean before labor and 12.2 per 1,000 after a cesarean during labor.

Trauma symptoms afterward are also more common when the cesarean was unplanned. In a study of nearly 2,800 women across 27 hospitals, 9.0% had post-traumatic stress symptoms two months after a cesarean, and labor that was induced before the cesarean was one of the factors that raised the risk.

If this was not the birth you picturedA birth that looked routine on paper can still be experienced as traumatic, and that is the pattern the evidence predicts rather than an overreaction. See Part 4, When it did not go that way.
Where this comes from:
291. Cornthwaite K, Draycott T, Bahl R, Hotton E, Winter C, Lenguerrand E. Impacted fetal head: a retrospective cohort study of emergency caesarean section. Eur J Obstet Gynecol Reprod Biol. 2021;261:85-91.
302. Tita ATN, Szychowski JM, Boggess K, et al. Adjunctive azithromycin prophylaxis for cesarean delivery. N Engl J Med. 2016;375(13):1231-1241.
332. Froeliger A, Deneux-Tharaux C, Loussert L, Madar H, Sentilhes L. Posttraumatic stress disorder 2 months after cesarean delivery: a multicenter prospective study. Am J Obstet Gynecol. 2024;230(5):543.e1-543.e36.
335. Morrison JJ, Rennie JM, Milton PJ. Neonatal respiratory morbidity and mode of delivery at term: influence of timing of elective caesarean section. Br J Obstet Gynaecol. 1995;102(2):101-106.

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