Reasons For a C-Section

When a Cesarean Section Birth Is Needed

C-Section Incision, C-Section Bruises, After C-Section, After Cesarean Section, C-Section Image
After C-Section Surgery. © Getty Images-Peter Dazeley

There are many reasons that a cesarean section delivery may be done rather than a vaginal delivery. For some, an issue may be known well in advance and the c-section may be scheduled days or weeks ahead. For others, a complication may arise during labor that makes a cesarean delivery necessary. An emergent c-section occurs when the fetus or the mother are in distress and face the risk of serious harm if the procedure is not performed immediately.

The cesarean procedure is performed to prevent or minimize harm to the fetus, the mother, or both. Despite what you may have seen on television, a c-section delivery is not done on a whim (such as to make sure the baby shares a birthday with a relative or a holiday). While the cesarean procedure is considered very safe it does have risks, including the risks associated with anesthesia, so the decision to perform surgery is not taken lightly.

Risks Associated With Cesarean Section

Concerns About the Fetus

  • Abnormal Heart Rate: The heart rate of the fetus can decrease with contractions during labor, a phenomenon known as deceleration. If this decrease becomes too severe, a cesarean may be necessary.
  • Abnormal Position: A breech position (when the feet or buttocks present through the birth canal first) or a transverse position (when the baby is positioned sideways) may make a c-section necessary.
  • Developmental Problems: If the fetus is known to have a significant problem, such as a major heart defect, a surgical birth may be necessary to limit stress and speed the delivery.
  • Multiples: Pregnancy with two or more fetuses may be an indication that a cesarean is needed.
  • Baby Isn't Getting Enough Oxygen: If there are concerns that the baby is not getting enough oxygen, which can happen for a variety of reasons, an emergent cesarean section may be performed.
  • Baby's Head Circumference: If the head of the fetus is too large to pass through the birth canal, a c-section will typically be performed.

Concerns About the Labor Process

  • Labor is Taking Too Long: Long labors can be exhausting for both mother and fetus and, in some cases, leads to a surgical delivery.
  • Labor is Not Progressing: If labor fails to progress, or stalls for a significant period of time, a c-section may be performed.
  • Fetus Size: A very large baby may not fit through the birth canal and may need to be delivered abdominally.
  • Umbilical Cord: If the umbilical cord presents through the birth canal prior to the fetus, oxygen delivery can be significantly decreased, making a c-section likely. In some positions, contractions can also compress the umbilical cord, which may also lead to a cesarean.

Concerns About the Mother

  • Placenta Previa: If the placenta attaches to the wall of the uterus in such a way that it partially or completely blocks the cervix, the birth canal is effectively closed off and a cesarean section will likely be necessary.
  • Placenta Abruptio: Separation of the placenta from the uterine wall causes bleeding and can decrease or stop the flow of blood to the fetus.
  • Mother is Not Tolerating Labor: If the mother is not tolerating the birthing process due to exhaustion, illness or another factor, a cesarean delivery may be necessary.
  • Active Herpes: A herpes infection can be passed to the newborn infant as it passes through the birth canal in a vaginal delivery.
  • Uterine Fibroids: The presence of fibroids greatly increases the changes that the delivery will be handled surgically. Fibroids increase the chances of experiencing placental abruption, abnormal fetal positions and premature labor.
  • HIV: The HIV virus, which causes AIDS, can be passed to a fetus during its passage through the birth canal. The risk of the baby's contracting HIV is often lower if the delivery is surgical. But for a woman on anti-retroviral medications with a viral load that is HIV RNA < 1000 copies/mL, performing a cesarean will not lower the risk of transmission to the baby, so vaginal delivery is usually offered.
  • Previous C-section: A VBAC, or vaginal birth after cesarean, is often successful but in some cases a cesarean delivery may be recommended. The likelihood of a successful vaginal birth after having a cesarean varies between individuals and should be discussed with your physician.
  • Previous Uterine Surgery: A previous surgery on the uterus can increase the risk of uterine rupture during labor, a cesarean delivery may be planned to prevent this serious complication.
  • Preeclampsia/Eclampsia: Preeclampsia is a condition where a pregnant woman develops very high blood pressure. The condition can progress to eclampsia, where the blood pressure is so high that it results in seizures. A c-section may be performed to prevent injury to the mother.
  • Severe Illness: If the laboring mother is ill, a cesarean may be performed to limit the risk to the mother or relieve symptoms. Eclampsia, a very serious condition where the mother's blood pressure is high and causing seizures, would be one situation where a surgical delivery is advised. Other types of illness or injury, such as trauma after a car accident or an asthma attack during delivery, may be a strong indication for a cesarean section.
  • Hemorrhage: Significant or uncontrolled bleeding during labor often leads to a cesarean delivery, allowing physicians to safely deliver the child and to work to control the bleeding.
  • Low Blood Pressure: Some medications given during labor, bleeding or even pain can cause blood pressure to fall. A decrease in blood pressure can cause a decrease in blood flow to the fetus, which may lead to a c-section.

Sources:

C-section. Medline Plus. Accessed June, 2013. http://www.nlm.nih.gov/medlineplus/ency/article/002911.htm>

Pregnancy in women with uterine leiomyomas. Up To Date. Accessed June, 2013. http://www.uptodate.com/contents/pregnancy-in-women-with-uterine-leiomyomas-fibroids

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