How Does a Cesarean Affect the Baby?

For the first time in more than a decade the U.S. cesarean birth rate decreased, if only by .1%.  The rate decreased from 32.9% to 32.8% in 2010. But still, one in three mothers gives birth by cesarean and scheduled cesareans for non-medical reasons have been rising. Surgical birth without labor impacts the health of newborns.

Birth by cesarean poses several challenges for a baby. Compared to babies born vaginally, babies born by cesarean are at risk for health complications they are less likely to face with a normal birth. Especially if the mother did not labor, babies are more likely to have difficulty breathing on their own. With a scheduled cesarean, babies are more likely to be born preterm, before the lungs have fully developed. Respiratory complications can be serious enough to require admission to a special care nursery.

With a cesarean,  mothers and babies are less likely to have skin-to-skin contact immediately after birth. 1_Page_18Skin-to-skin contact has several adaptive benefits for the newborn. Pain medications that sedate the mother can affect the newborn’s ability to latch on and breastfeed. Drugs used for anesthesia, including epidurals, cross the placenta and can make it more difficult for babies to initiate breastfeeding. The American Academy of Pediatrics encourages all maternity care providers to collaborate to support breastfeeding. That includes avoiding common but often unnecessary procedures that interfere with breastfeeding and that may traumatize the newborn. Routine procedures following a cesarean birth such as suctioning the newborn’s mouth, esophagus and airways can also make it more difficult for babies to begin and continue breastfeeding.

Planned Cesareans and Late Pre-Term Birth

Many cesareans that are scheduled before labor put newborns at risk. Often, the birth takes place a few weeks before the due date and babies are born late-preterm. Late  preterm birth is defined as a live birth before 37 completed weeks gestation. A baby born between the 34th and 36th week of pregnancy is considered  late-preterm . When cesarean sections are scheduled there is a margin of error in pinpointing fetal maturity. Being born only one week earlier can make a difference in terms of complications babies are likely to suffer. The March of Dimes (MOD) is concerned that increasing inductions and planned cesareans may be contributing to the rising number of babies born preterm.  Late- preterm births account for 70% of all premature births in the United States and are the fastest growing subgroup of premature babies. Low-birthweight infants (less than 5 pounds, 8 ounces)  are at higher risk of death or long-term illness and disability than are infants of normal birthweight.

Breathing Difficulties and Admission to Intensive Care

Birth by cesarean increases the risk for breathing problems. Infant respiratory distress syndrome, a complication related to scheduled cesareans, was the most expensive condition of all hospital stays in 2005. The cost for each stay with this diagnosis was $114,200. Newborns with this condition were hospitalized for about 25.7 days. Cost and length of hospital stay surpassed those for spinal cord injury, heart valve disorders, and leukemia.

Contractions of labor help to prepare the baby’s lungs for respiration at birth. In her article on the role of stress, pain, and catecholamines (produced by the body in response to stress), Penny Simkin explains that during each contraction of labor there is temporary reduction in the amount of oxygen that is available to the fetus. Contractions reduce the amount of oxygenated blood that is passed through to the placenta. This causes the baby’s heart rate to slow down.

To adapt to this level of stress the baby increases her production of catecholamines which shunts the blood going to her vital organs and preserves her energy stores. This adaptive response allows the baby to receive the same amount of oxygen as before labor contractions. This increased surge of catecholamines accumulated during labor also helps to prepare the baby’s lungs to breath on their own at birth by absorbing the liquid in her lungs. Babies born by a scheduled cesarean have lower levels of catecholamines than babies born vaginally. A scheduled cesarean (without labor) is more likely to make it more difficult for the baby to initially breathe on her own.

Babies born before term  have a higher risk of persistent pulmonary hypertension, a potentially life-threatening condition. To facilitate the transition from the uterine environment to the outside world, the blood vessels in the baby’s lungs relax and allow blood to flow through them with the first breaths after birth. This function allows the blood to exchange carbon dioxide for oxygen. When this adaptation fails the blood vessels do not relax and pulmonary high blood pressure (hypertension) prevails. Newborns who experience persistent pulmonary hypertension and low blood oxygen levels can suffer from damage to vital organs and the brain. Persistent pulmonary hypertension is four times higher for babies born by elective cesarean than for babies born vaginally.

Increased Risk for Asthma

Some reports have suggested a link between cesarean birth and later development of asthma. Recent studies conducted in the Netherlands and in Norway  found  that children delivered by cesarean  are at an increased risk of developing  asthma later in life.   Babies were more likely to have a certain kind of bacteria in their intestines if they were born  by cesarean. Babies with these intestinal bacteria have a greater risk for developing allergies or asthma later on.

Mother-Infant Attachment is More Likely to Be Delayed

Holding, touching and caring for healthy, sick, premature infants or infants with congenital problems enhances attachment between mothers and babies. Minimizing or avoiding separating babies from their mothers after birth reduces stress in healthy newborns and mothers. The World Health Organization and the American Academy of Pediatrics encourage skin-to-skin contact between mother and baby as soon as possible after the birth for at least one hour and until the newborn has successfully completed the first breastfeed.

cute mother breast feeding her baby

Placing a newborn belly-down directly on her mother’s chest has several important health benefits. Skin-to-skin contact calms the mother and her baby and helps to stabilize the baby’s heartbeat and breathing. The mother’s body heat keeps the baby warm, reduces the newborn’s crying, stress and energy use. Skin-to-skin contact helps with the baby’s metabolic adaptation and stabilizes its blood glucose level. If the mother is the first person to hold the baby rather than a staff person, it helps to colonize the baby’s gut with her mother’s normal body bacteria gut.

The Lamaze Institute for Normal Birth recommends no separation of mother and baby after birth with unlimited opportunity for breastfeeding.  “Nature prepares a mother and her baby to need each other from the moment of birth. Oxytocin, the hormone that causes a woman’s uterus to contract, also causes the temperature of her breasts to rise and helps her feel calm and responsive. This hormone stimulates “mothering” feelings as the woman touches, gazes at, and breastfeeds her baby. More oxytocin is released as she holds her baby skin-to-skin. Endorphins, narcotic-like hormones, are also released and enhance mothering feelings. High levels of adrenaline, which are normal in babies at birth, make the baby alert and prepare him to look for his mother, find his way to her breast, and breastfeed.”

The Listening to Mothers II U.S. national survey of women’s childbearing experiences revealed that only 14% of mothers who gave birth by cesarean had their baby in their arms immediately after birth compared to 43% of the mothers who had a vaginal delivery.  With a cesarean delivery babies are more likely to be taken to the nursery for observation and monitoring for potential problems during the first hour of life. They are also more likely to spend time in a newborn nursery than rooming in with their mothers. The separation seems to have an impact on the mother’s initial ability to respond to and care for her infant. When mothers and babies stay together, babies cry less, it improves the mother’s perception of her infant, and enhances her confidence in her mothering skills.Babies are more likely to be breastfed and for a longer period of time if they have early skin-to-skin contact.

When the mother is not able to receive her infant immediately after a cesarean birth, a Swedish study found that the baby’s father can provide skin-to-skin contact with his newborn and offer the same calming and comforting benefits as the baby’s mother. This skin-to-skin contact between the father and his baby also facilitates the newborn’s pre-breastfeeding behavior. A calm newborn is better prepared for breastfeeding when mother and baby are able to be together. The researchers of this study recommend that the fathers should be the primary caregivers for their newborns when mothers and babies are separated.

With a Cesarean Breastfeeding is Likely to be Delayed

A cesarean birth makes it more difficult for mothers to initiate and establish breastfeeding.  The Centers for Disease Control established that hospital birth practices have a significant impact on the initiation and continuation of breastfeeding. The use of medications during labor and cesarean birth have a negative effect on breastfeeding, so does the separation of mother and baby after birth and during the hospital stay. The maternity care experience exerts a unique influence on both breastfeeding initiation and later infant feeding behavior. Although  the hospital stay is typically very short, events during this time have a long and lasting impact.

Medications and procedures administered to the mother during labor affect her  infant’s behavior at the time of birth, which in turn affects her  infant’s ability to suckle in an organized and effective manner at the breast.  If hospitals provide  mothers with  the support, guidance, and education  from  a lactation specialist mothers are more likely to initiate and continue breastfeeding. Encouraging more mothers to breastfeed is a national priority.

Planned Cesareans and Risk of Neonatal Death

Increasingly in many countries around the world women are having a planned cesarean without a medical indication. These are considered low-risk cesareans. In the United States the number of healthy women who have a primary cesarean (first cesarean delivery) at term (37-41 weeks and a singleton pregnancy) without any medical indication. These are cesarean deliveries for which no medical diagnosis were reported on the birth certificates.

How do these planned cesareans affect neonatal (the first 28 days of life) and infant (less than 1 year of life) health? In 2006 researchers examined live births between 1999 and 2001. They reported that newborns of mothers who had a planned cesarean were more likely to die in the first four weeks of life (1.77 per 1,000 births) than newborns of mothers who had a vaginal birth (0.62 per 1,000 births). Almost three times the risk. The infant mortality rate for first time mothers with a planned cesarean was 2.85 per 1,000 compared to 1.83 for mothers who had a vaginal birth.  A 56 percent  higher rate. For  mothers who had one or more children before their planned cesarean  the infant mortality rate was 4.51 per 1,000 compared to 2.18 for a similar group of women who had a vaginal birth. More than twice the increase.

Especially for Mothers

Birth by cesarean affects you as well as your baby. A long labor preceding a cesarean, pain from the surgery, complications such as developing a fever, your reaction to medications, or developing an infection may make it difficult for you to be with your baby right after birth. Holding, feeding, and soothing your baby may be more painful than you anticipated. You and your baby will benefit from skin-to-skin contact and rooming in (having the baby in your room as opposed to the nursery) as soon as possible. But, you should  take the time you need to feel ready to have your baby.

Should you have a cesarean delivery, the following suggestions can help you and your baby get off to a more healthy and satisfying start together.

  1. In the operating room, after your baby has been born if you are feeling well, ask that one of your arms be released and your baby be placed belly-down on your chest as soon as it is safe. You can also ask that the baby be placed skin-to-skin with your partner as soon as it is safe. Your baby will be less fussy and more ready to breastfeed.
  2. Ask that a lactation specialist help you to recognize your baby’s hunger signs, to position your baby to latch on correctly at your breast, to support you to continue to breastfeed while in the hospital, and to provide you with a list of community resources that you can access once you are home.
  3. Your health insurance may reimburse you for the services of a lactation consultant once you’re home and for the rental of a breast pump if you need one.
  4. You may want to draft a birth plan to communicate your needs and wishes for staff support with breastfeeding.
  5. You will be in pain after the initial anesthetic wears off. Ask about the safest pain medication available for breastfeeding.
  6. Ask for your partner, friend, or doula to stay with you in the room to help you lift your baby, change positions in bed, change the baby’s diapers, and help you get out of bed.


Deciding if VBAC is Right for You: A Parent’s Guide

California Maternal Quality Care Collaborative, White Paper: Cesarean Deliveries

Childbirth Connection, Cesarean Section

Childbirth Connection, Pathway to a Healthy Birth

Northern New England Perinatal Quality Improvement Network, Risk Consequences of a Near Term Birth,  a video

Coalition for Improving Maternity Services, Breastfeeding Is Priceless

Association for Women’s Health, Obstetrics and Neonatal Nurses, What Parents of Late-Preterm (Near-Term) Infants Need to Know


Updated April 18, 2016.


18 Responses to “How Does a Cesarean Affect the Baby?”

  1. Henriette Akins-Hinkle August 19, 2017 at 6:44 am #

    I was 43 when my daughter was born Via C-section because she breech. Not Butt side down, but she lay across my womb. I actually went into labor the same day I was scheduled to go in for the doctor to attempt to turn her into the correct position. Her birth wt. was 7lbs 6oz.
    she was breast-fed for 9mos and was always healthy. She is very intelligent, has always aced any and all school subjects, and now she tested into one of the best high schools in our area, which she will be attending in the fall.
    My son was born when I was 45. I was given the option of another C-section because of the first one. I chose c-section over a vbac because I had no problems previously. When he was born he did’nt just cry, he was screaming! So much so that I asked my husband to go to where the nurses had him to check on him. His birth wt was 8lbs 8oz. He has a severe peanut allergy, and he has been diagnosed with ADHD. He is as intelligent as his sister and does well in school, but he has his challenges. I have often wondered if my age at his birth combined with the c-section could have contributed to his ADHD and his food allergies.

  2. Reger December 8, 2016 at 10:47 am #

    I had an elective CS at 37+6. Fully conscious,a wonderful experience.
    Baby had skin to skin contact with my husband immediately after birth. The only complicatIon was that I metabolized the anesthetic very fast, so they had to briefly knock me out to finish sewing me up.
    When I woke up, I was given the baby and started nursing. Three nights in hospital, then home.
    Absolutely no bonding problems, nursing issues, and healed perfectly. Daughter is extremely healthy (despite strong history of asthma in the family), rarely ill, and seriously smart.

    Stop frightening women. They don’t need to be made to feel guilty for decisions they made, or over events they could not control.

    • Nicette December 9, 2016 at 10:23 am #

      I’m glad that you had a cesarean birth which was satisfying for you. However, it isn’t a positive experience for all mothers and complications do occur which mothers are not informed about. I don’t believe there is anything guilt-inducing in the article and the references listed at the end reflect that those complications do occur. I believe mothers should be aware of them so they can decide on their own how they want to give birth, if they have the choice. Women’s choices should be respected, it is preferable that choices are made based on accurate information.

  3. Nafisa September 19, 2016 at 12:46 pm #

    I am expecting my 4th baby to deliver, 41 weeks already. But still there is no sign of contraction. The baby is already about 4 kg. Should i go through c-section? We cannot decide.

    • Nicette September 19, 2016 at 6:33 pm #

      Hello, Nafisa

      I am not a medical professional and don’t know your health history. However, you should look at both options, the benefits and risks and together with your careprovider make the best decision for you. If you and your baby are in good health, you can ask your careprovider to keep a close eye on the baby and wait until labor starts on its own. Thank you for writing to Nicette

  4. Ryan September 4, 2016 at 5:42 am #

    Hi there! When I was born I was an emergency C-section. I was two weeks early! I’m probably not wording all this right, but when I always try to talk to my mum about this she always tells me to stop! And I just would like to know more! Is there something she’s not tell me? Please write back!

    A personal response was sent to Ryan.

  5. Kaytoyia August 7, 2016 at 8:28 pm #

    My sister just gave birth to a 7 lbs and 14 oz baby boy. She had to go through a c-section because her blood pressure was too high and his heart rate started to decline. She was 38 weeks pregnant and was in labor for over 24 hours. She was induced. He was delivered about one week before his due date. They had to put him in a monitoring room to keep an eye on his vitals, especially his breathing because his lungs were the one thing that were underdeveloped. Now they are saying that his breathing rate has dropped and now they are transporting him to another hospital. We are all terrified that we may loose my sisters newborn son.

  6. Diane May 4, 2016 at 12:30 am #

    I had csection in January (had wanted a home birth ) with polyhydraminos and footling breech baby. Baby was 37+4 and she needed resuscitating as she needed help with breathing. It was heartbreaking. But she recovered after a few minutes.

    Luckily the NHS are 100% supportive of breastfeeding and baby was under lamps in recovery waiting for me. We breastfed within minutes of being together, she wouldn’t leave my arms for days and we are still going strong with baby still reluctant to leave my arms except to play with daddy xxx

    • Nicette May 4, 2016 at 11:26 am #

      Thank you for writing in, Diane. In the U.K. the National Health Service develops guidelines that all providers must follow. It sounds like you received good care and I’m glad you were able to successfully breastfeed.

  7. Anita November 27, 2015 at 5:35 pm #

    My son was 9lbs2oz. It was better for me to schedule a c-section, then to start with a vaginal birth and ultimately have a c-section.
    He was exactly 38 weeks.
    He couldn’t be healthier. 98% height 97% weight.
    We instantly bonded when the Dr.’s delivered him they cleaned him up and placed him in my arms. I started breast feeding. All was well.
    He is 11 now everytime we have a check up he gets a clean bill of health.
    Some minor issues are nose bleeds but that is it. Asthma runs in the family, and he can complain of breathing problems when running. So not sure if it is a result of the c-section
    or hereditary.
    I think the worst part is the muscle that was cut, never be the same. But it was well worth it.

  8. Daronna April 7, 2015 at 10:09 pm #

    I had a emergency section at 33 weeks with my second child a few days ago but not with my first child. Right now he’s in NICU because his (lungs) aren’t fully developed, his temperature was too low and he wasunder weight at first. Now he’s doing a lot better and should be home within two weeks. His breathing is great, he’s eating from a bottle instead of a tube. All he needs to do is gain weight then he’s out free 🙂 Can’t wait until my little one is home with me.

  9. PTeasa March 18, 2015 at 2:40 am #

    I had my daughter at 29 weeks via c-section due to placental abruption and pre eclampsia. She was 3lbs 3ozs. I had my son at 30 weeks via c-section due to blood clots and placenta previa. He was 3lbs 1oz. And, I am having my next daughter via c-section in 4 days. My first two had no breathing problems or anything had no issues with speech, breathing, eating, or walking. They are now 4 years old and 18months.

    • PTeasa March 18, 2015 at 2:41 am #

      With my first two I was automatically put to sleep and with this one, since she’s my last, and I’ve had a semi normal pregnancy. I got to stay awake.

  10. ocaya moses January 27, 2015 at 11:11 am #

    my boy was born through caesarian section six years ago.he has failed to talk well. i would like to know whether c/s is the cause. and how could it be corrected?.

    • Nicette January 27, 2015 at 12:04 pm #


      Thank you for writing. I’m sorry I can’t answer your question since I have not seen any research associating cesareans with delayed speech. You may want to consult with a speech therapist. They specialize in helping people improve their speech.


  11. April June 14, 2013 at 11:21 pm #

    My son was born via a planned C-section at 38 wks due to a previuos classical C-section (the cut on my uterus was up & down as opposed to side to side). He spent 2 days in the NICU due to low oxygen levels (low 80’s). While he has basically been very physically healthy we are now dealing with a severe speech delay. He is 27 months old but is at a 7 month olds level for speech. We were never warned by anyone in the medical field that he may have a speech delay, autism and other learning disabilities. The ramifications of all this are finally starting to sink in for me and I am getting a little pissed off. Especially since I brought up my concerns at his 12 month checkup and his 18 month checkup and was told to wait. I cant wait to see his doctor again and ask her some questions about how things were handled.

    • Britney Robinson March 27, 2016 at 6:56 pm #

      The risk was higher for you, so you most likely had to have a c-section again. I don’t think you would have been able to vaginally have a baby. The side effects in your case don’t outweigh the risk of something worse happening.

  12. Katie March 2, 2013 at 9:34 pm #

    I had a breech 2nd time around, there was no question that a repeat C/S would be the best thing for my son and I. he spent 3 days in NICU, otherwise a very healthy child.

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