The Fine Print: Common Impacts of Cesarean Surgery

• Scar sensitivity or numbness. Even after it’s healed on the surface, your scar or surrounding belly area may be numb, extremely sensitive, or some combination of both. You can do sensitization practices to help your brain reconnect with the little nerves that are cut or damaged during surgery. Rebuilding this connection helps us gain full, normal sensation in our bellies.

• A belly that continues to stick out, even months or years after birth. Some people call this a “mom pooch.” It’s actually a condition called diastasis recti where the abdominal muscles separate during pregnancy. It happens to all pregnant bodies. However, the condition is more severe after cesarean birth because of the way the lineal alba is pulled apart during surgery. While there are no health risks associated with this condition, it can undermine our confidence. Special exercises are needed to help re-unify the abdominal muscles and rebuild the core (it’s not as simple as doing crunches…in fact, these can cause more harm if your body isn’t ready).

• A c-section “shelf” of tissue above the scar. Most c-section bodies have “shelving” (sometimes called an “apron”) that occurs above the incision site. The c-section shelf is caused by a combination of factors, depending on recent surgery took place: excess fluids and swelling, higher body mass, and specific surgical techniques that cause fat and fascia to become “stuck” and appear unevenly distributed across the abdomen.

• Raised or hypertrophic scar. Some scars are raised instead of flat. In order to move fluidly and feel better under clothes, these may need different rehabilitation.

• Belly sensitivity above or below scar. Your stomach may be sensitive or sore well above your incision site, even above your belly button. This is because our entire abdomen is affected by the surgery, not just the place behind the incision. It’s common to have strange sensations throughout your abdomen for a few months after surgery.

• Chronic pain in hips, lower back, and pelvis is extremely common for c-section moms. This pain is often caused by scar tissue and adhesions. Scar tissue is cobweb-like material designed to help stabilize damaged areas. It can overgrow and connect to organs and muscles, creating strange pain or undermining functionality.

• Painful sexual intercourse is also very common for c-section moms. Painful sex is caused by scar tissue, adhesions, hypertonic pelvic floor (tight pelvic floor), and carrying emotional trauma in the pelvic floor.

• A c-section “shelf” of tissue above the scar. Many c-section bodies have “shelving” (sometimes called a c-section “apron”) that occurs above the incision site. This is a place where fat and fascia appear “stuck” or “built up” above and/or below the scar. Contrary to popular belief, research published in the January 2026 edition of AJOG suggests surgical technique is the greatest contributor to c-section shelf:“the cesarean apron results primarily from incomplete or absent closure of the Scarpa fascia during cesarean wound repair.” That said, fluid retention and swelling, higher body mass, and scar tissue can exacerbate the issue and there is some evidence (primarily anecdotal, not peer-reviewed, to my knowledge) that proper scar massage, mobilization, and core work can reduce the shelf’s appearance - sometimes significantly. However, because the shelf results from neglecting surgical best practices, unfortunately, scar reconstruction surgery is sometimes the only path for full resolution.

Trigger Warning

The issues listed above are inconvenient and frustrating, but, for the most part, not life-threatening.

Below, I summarize some of the more severe health conditions associated with cesarean birth. Most of these arise in a subsequent pregnancy or birth.

Before you read on, please do pause, breathe, and check in to make sure this is the right time to take in this difficult information.

When you learn about these risks, it’s normal to feel angry.

It’s normal to feel mislead by your care team.

It’s normal to feel like you were deprived of true informed consent.

Sometimes, all of these feelings exist alongside regret. And other times, they exist alongside knowing your cesarean was right for you.

We can feel multiple things simultaneously.

Whatever you are feeling is normal and appropriate.

The very fine print: severe (and less common) impacts of cesarean birth

• Surgical injury and errors involve accidental damage to the mother or baby during cesarean surgery caused by the surgeon or medical staff. There are many different types of injuries, perhaps the most common being damage to mother’s organs or to baby’s clavicle or skull. Some studies indicate that surgical injury happens about 2% of the time, though about one-third or my clients experienced some type of birth injury (which makes sense, since I mostly serve people who identify as having experienced birth trauma). There are some wonderful organizations dedicated to supporting people with birth injuries, whether you are pursuing legal action or not. In some rare cases, birth injuries can also be caused by obstetric violence. Many mothers and children who experience surgical injury and errors are impacted for life.

• Surgical complications are the short and long-term complications experienced as a result of cesarean surgery. I’ve separated these from “surgical injury and error” because they aren’t necessarily caused by medical mistakes but rather, these result from the body’s response to the surgery. These include, but are not limited to, infection at the incision site, bowel obstruction, blood clot, incisional hernia, anesthesia risks, hemorrhage, and others. Surgical complications can have short-or long-term impacts on our bodies and overall health. Like surgical injury and error, mothers who experience surgical complications may be impacted for life.

• Cesarean scar defect is a small pouch, “niche,” or indentation that forms in the wall of the uterus when a c-section fails to heal completely, or when certain “best practice” surgical techniques are not utilized. Research shows that 40-70% of cesarean patients have a scar defect, and a whopping 42.5% of cesarean mothers will develop bothersome symptoms, including painful sex, brown discharge between periods, painful periods, secondary infertility or difficulty getting pregnant, pregnancy loss, and other issues. Research on scar defect is still in it’s infancy and women often suffer without answers because many OBs do not have the education needed to conduct proper screenings and referrals. If you are experiencing any of the symptoms of scar defect, it’s important to continue advocating for yourself and doing your own research until you find a provider who can help.

• Placenta Previa happens during pregnancy when the placenta positions itself over the cervix. Women who deliver via cesarean are 50-60% more likely to develop previa in a later pregnancy than non-cesarean mothers. Previa creates a number of serious risks for baby and mother and requires close monitoring during pregnancy and birth. Read more.

• Placenta accretia happens during pregnancy when the placenta grows into the lining of the uterine wall, and in most extreme cases, embeds itself into the c-section scar. Accretia can be a life-threatening condition and is actually a greater risk to mother and baby’s life than uterine rupture. Evidence Based Birth summarizes the risk: “With the second cesarean, the risk [for placenta accretia] is 0.31%. With the third, it’s 0.57%. With the fourth cesarean, it’s 2.13%. With the fifth, it’s 2.33%. And with the sixth cesarean, the risk of having placenta accreta is 6.74%.” Placenta accretia is one of the most common and dangerous conditions for mother and baby, though many women don’t know this condition exists until they are diagnosed.

• Uterine rupture is an “anatomical separation of the uterine muscle” which can cause risk to mother and baby during pregnancy and labor. While the risk of rupture is higher for cesarean mothers, the overall risk is actually much lower than most of the other complications listed above. And one of the misunderstandings about rupture is that it’s a major fatality risk during VBAC. In fact, the absolute risk is extremely low. According to Evidence Based Birth, “The risk of uterine rupture for people who are having a trial of labor after cesarean [VBAC] is about 0.47%. The risk of uterine rupture for people who are having an elective repeat cesarean is about 0.026%.” Additionally, there are different types of rupture, with a small minority of overall ruptures actually resulting in severe consequences or fatalities for mother and baby. Uterine rupture is one of the risks that doctors focus heavily on when trying to persuade us against VBAC, but placenta accretia is actually a much larger risk and can happen however you plan to give birth.

These things do happen to people who birthed via cesarean. Though they are statistically unlikely, they are a real piece of the picture.

Looking at risk statistics can be really scary. It’s helpful when we compare these to the risks of other scary (and unlikely) things to put them in perspective.