For thousands of years every baby entered the world the same way: through the mother’s vagina. Today, more than one out of every five babies are born via an incision made through the abdomen and uterine wall. This method of birth is called a Cesarean section, or ‘C-section’.
Although C-sections and vaginal births are very different, they have the same goal: the safe delivery of a healthy baby (or babies) to a healthy mother.
What happens during a C-Section?
The exact process of having a C-section varies depending on circumstances and location. If a mother is already at the hospital in labor when the decision is made to perform a C-section, the process is very quick. In some hospitals a baby can be delivered within 15 minutes of the decision to operate.
In most cases the doctor makes a horizontal incision at the pubic hair line. This is called a transverse incision. A transverse incision results in less visible scarring and a quicker recovery time than a vertical (midline) incision.
However, the doctor might make a vertical incision if:
- an emergency requires the quickest time from incision to delivery.
- the incision needs to be longer than possible with a transverse incision.
- the mother has a condition associated with an increased risk of bleeding.
Women who have had a vertical incision almost always have a C-section with subsequent pregnancies. This is because the uterus has a higher risk of rupturing during labor.
Although the whole operation can take less than half an hour, a C-section is major surgery. The mother stays in a recovery area for a couple of hours and in the hospital for at least 2-3 days. She is usually given IV medication for pain the first day, and then oral pain medication afterwards.
What are the reasons for having C-Sections?
C-sections are performed for many reasons. Examples are:
Unforeseen life-threatening emergency. The baby must be delivered as quickly as possible. Life-threatening emergencies include:
- Placental abruption: The placenta pulls away from the uterus before the baby is delivered and causes heavy bleeding.
- Uterine rupture: The uterus ruptures along the scar from a previous C-section, causing heavy bleeding.
- Prolapsed umbilical cord: The umbilical cord, which supplies the baby with oxygen, exits the uterus before the baby. As the baby enters the birth canal its body presses on the cord, cutting off its oxygen supply.
- Fetal distress
- Maternal distress: An example would be the mother showing signs of having a stroke or heart attack.
Signs that if labor is allowed to progress, the health or safety of mother or baby will be at risk. The baby should be delivered in the next 30-60 minutes. These signs include:
- The cervix is not dilated enough to allow the baby’s head to pass through despite medical intervention.
- Contractions remain ineffective or weak even after medication is given to make them stronger.
The mother has a condition which can be more safely managed if she does not go into labor at all. These C-sections are planned and scheduled in advance. Medically indicated reasons for a planned C-section include:
- The placenta is lying across the cervix, a condition called “placenta previa”. As the cervix dilates during labor, blood vessels connecting the placenta to the uterus can rupture and cause a hemorrhage.
- The baby is too large to safely deliver vaginally. This is most likely to happen if:
– The mother is significantly overweight.
– The mother has diabetes, particularly if blood sugar has been high during pregnancy.
– The mother has a small pelvis.
– The mother previously delivered a large baby.
- The baby’s head is not in position to be delivered first. The baby might be presenting its buttocks or feet first, or might even be sideways.
- The mother has a medical condition that prevents her from pushing.
- The mother has an active infection that can be transmitted from mom to baby during a vaginal delivery, such as herpes or HIV.
- The mother is delivering multiple babies. Around half of all twins are delivered by C-section. Virtually all triplets or higher multiples are delivered by C-section.
- The mother has a large fibroid, or a fibroid blocking the cervix.
- The mother had a previous C-section.
There is an expression “once a Caesarean, always a Caesarean” but that is no longer true for everyone. However, some women prefer not to try a vaginal birth after Caesarian (VBAC). Whether to try a VBAC depends on factors such as:
- The location of the previous uterine incision.
- The number of previous C-sections.
- Any risk factors for having a vaginal delivery.
C-sections are sometimes done for non-medical reasons, either planned or after labor has begun. Some non-medical reasons include:
- Timing – the doctor would like to go home.
- No financial incentive for the doctor to wait out a long labor. (This is a more complicated issue than it might seem).
- Parents can plan for childcare or time off from work.
- The mother wants to know that her own obstetrician will deliver the baby.
- There are fewer unknowns. The date, length of delivery, and assurance of anesthesia are predictable.
What are the risks or complications of a C-Section?
A C-section involves greater risks than a vaginal delivery of:
- Injury to the bowel, uterus, or urinary tract.
- Wound Infection.
- Allergy or bad reaction to medication or anesthesia.
- Blood clots in legs or lungs.
- Higher risk of complications in subsequent pregnancies.
– Risk of uterine rupture where the incision was made (small risk)
– Higher risk that placenta attaches abnormally to the uterus
In addition, the recovery period is longer and considered more difficult for a C-section than for a vaginal delivery.
What are the risks to a baby of a cesarean birth?
- Scientists are discovering that exposure to bacteria in the mother’s vagina is beneficial to their babies. Babies born via C-section don’t get this exposure.
- Short-term respiratory difficulty is more common than in babies born vaginally. This is usually temporary.
Are C-Sections increasing?
The World Health Organization (WHO) estimates that by the year 2030, 29% of all births will be C-sections. However, scientists estimate that globally, it is medically reasonable for 10-20% of all births to be C-sections.
The reasons for the increase in C-sections vary by region and country, but include:
- Lack of regulation of financial incentives favoring C-sections.
- Greater cultural acceptance of C-sections.
- Convenience for both the mother and the health care provider.
- Physician concern that a malpractice lawsuit is more likely if something goes wrong during a vaginal delivery than during a C-section.
- Training. The more C-sections young obstetricians perform, the less comfortable they are with handling complicated vaginal births.
- Misinformation. Mothers often mistakenly believe that a C-section is easier than a vaginal birth, and equally safe overall.
- Medicalization. More births in hospitals rather than at home or at birthing facilities, and with physicians rather than with midwives promotes the idea that birth is an event requiring medical intervention.
- Previous C-sections. Once a woman has had one C-section, she is more likely to have subsequent C-sections.
- Reliance on continuous fetal heart rate monitors (FHRM). It takes skill, experience, patience, and judgment to interpret FHRM tracings and to know when they indicate – or don’t indicate – the need for a C-section.
For at least one out of every ten women, a C-section will be the safest way to deliver a baby. Remember that the course of labor and delivery is unpredictable, and things can go wrong. But whether a delivery is vaginal or Caesarian, the goal is for a doctor or midwife to finally hand a new mother her long-awaited bundle of joy.
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