The WHO states that the rate of caesarean section should be 10-15%. In high income countries such as Australia, Britain and America, one third of all mothers give birth by caesarean. Each year c-sections are important and can save lives. It is performed when the baby is at risk. All operations carry some risks. A c-section involves major surgery in your tummy and pelvic area. Complication and readmission in the hospital sometimes happen. It is however rare. It is planned and you are fit and healthy. Sometimes c-section is needed to save the life of mother or baby. Then there is no option. In some cases, your doctor offers you choice between induced labour and c-section. Sometimes in induced labour you have to do interventions like vacuum or forceps. That also carries risks too. So you and your doctor need to weigh these risks against the risks and benefits of c-section. Birth by c-section poses several challenges for a baby as compared to babies born vaginally. Babies born by c-section are at risk for health complications. 1) Babies are more likely to have difficulty in breathing on their own, may have other respiratory complications as well. With c-section, mother and baby are likely to have skin to skin contact. Skin to skin contact has several adaptive benefits for the new born. Medications that sedate the mother can affect the new born’s ability to latch on and breastfeed. Drugs used for anaesthesia, including epidurals, cross the placental barrier and make it more difficult to initiate breast feeding. Suctioning of new born’s mouth oesophagus and airways can also make it more difficult for breast feeding. 2) Foetal lacerations- There is a rare chance of baby getting knick during incision. 3) Elective c-section has greater risk for babies born pre-maturely. Estimated due dates are based on USG and the woman’s menstrual cycle can be wrong. Babies born between 34th and 36th week of pregnancy is considered late pre-term. Being born a week early can increase the risk of complications for the baby despite being of similar size and weight to full term babies. 4) Respiratory problems- Babies who are born by c-section before 39 weeks are more likely to suffer from respiratory distress than babies born vaginally. The last few weeks in the uterus are vital for the development of lung surfactant. Being born before term significantly affects the level of surfactant that helps babies to breathe. Respiratory distress syndrome is a serious medical condition that requires treatment in the NICU. 5) Mother-infant attachment is likely to be delayed. Holding, touching and caring the baby enhances the attachment between the mother and baby after birth. Minimizing the separation of babies from mother reduces the stress in healthy new born and mother. So encourage skin to skin contact between mother and baby as soon as possible for at least one hour. 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 him warm, reduces the newborn’s crying, stress and energy use. Skin to skin contact also helps in metabolic adaptation and stabilizes the blood glucose level. Nature prepares the mother and baby to need each other from moment of birth. Oxytocin, the hormone that causes a women’s uterus to contract also causes the temperature of her breasts to rise and helps her feel calm and responsive and enhances the motherly feeling. High level of adrenaline which is normal in babies at birth, make the baby alert and prepare him to look for his mother and find his way to her breast. In c-section delivery, babies are more likely to be taken to nursery for observation. They have to spend more time in nursery than his mother’s lap. The baby is also devoid of mother’s milk during this period. 6) Breast feeding- Use of medications during c-section have negative impact on breast feeding, so does the separation of mother and baby after birth. It affects the new born’s ability to suckle in an organized manner. Separation interferes with the bonding and establishment of breast feeding. Drugs including epidural anaesthesia cross the placental barrier which makes it more difficult to initiate the breast feeding. Suctioning of new born’s mouth; oesophagus and airways can also make breast feeding difficult. After the operation, holding and feeding the baby is difficult for the mother due to pain, fever and infection. If hospitals provide support, guidance and support and education from the lactation specialist, mothers are likely to initiate and continue breast feeding. 7) Persistent pulmonary hypertension- Pulmonary hypertension is 4 times higher for babies born by elective c –section than for babies born vaginally. Babies who are born prematurely also have increased of persistent pulmonary hypertension. When the babies are born, the blood vessels in the lungs relax to allow blood flow through them in the first moments after birth. This allows the blood to exchange carbon-dio-oxide for oxygen. If this does not happen and blood vessels do not relax, it increases the new born’s blood pressure. Babies with persistent pulmonary hypertension and have low blood oxygen and can suffer from brain and organ damage. 8) Wet lung- While the new born is in uterus, their lungs are filled with fluid during labour. The contractions press and squeeze the baby which helps to expel the fluid. Babies born by c-section are likely to develop transient tachypnea commonly known as wet lung where the fluid has not been expelled. It is characterized by fast and laboured bleeding during the first and few days of life. Babies with this condition require oxygen, they also need IV fluids. Babies also may need antibiotics in case of infection. Immediate health After birth, babies are assessed at 1 and 5 minutes and given a score on the APGAR test. The score provides information about new born’s health and well being. Low APGAR score can be due to anaesthetic or foetal distress before birth. Babies born by c-section generally score lower on the APGAR test scale then those born vaginally. Long-term health Research shows that babies born by c-section are not exposed to important and beneficial bacteria as they would acquire during vaginal birth. Level of harmful bacteria is quite high in babies born by c-section. Babies born by c-section also have higher incidence of Type I Diabetes, obesity and asthma than those born vaginally.