Caesarean delivery: When is it the best option?

If you're generally healthy and you've had a trouble-free pregnancy, chances are you'll give birth vaginally. But in some circumstances, Caesarean birth — delivery of a baby by means of an incision in the abdomen and then uterus — is safer for the baby or mother.

Although Caesarean deliveries are sometimes planned because of pregnancy complications or previous Caesarean births, most first-time Caesareans occur unexpectedly. Events can move quickly if you're in labor when the doctor decides you need a Caesarean. Because you may not have time to grasp your situation and find out about the procedure, it's best to familiarize yourself with it now. That way, should the need arise, you'll be prepared.

Why you might need a Caesarean

A Caesarean may be necessary if:

• Labor does not progress normally. About a third of all Caesareans are done because labor progresses too slowly or stops altogether. This can happen if your contractions are too weak to dilate your cervix completely or if your baby's head is too big to pass through your pelvis.
• The baby's heartbeat suggests a reduced oxygen supply. Certain patterns of fetal heart rate during labor may indicate a problem with the baby's oxygen supply. Because the heart rate patterns that raise concern don't necessarily mean the baby is in trouble, the doctor may consider other variables in deciding whether to do a Caesarean. If the baby is overdue or delivery seems unlikely within a reasonable time, for instance, a Caesarean may clearly be the safest route.
• Your baby is in an abnormal position. Vaginal delivery can be difficult and risky if your baby is in a breech position, in which the buttocks or feet enter the birth canal before the head. Similarly, a baby lying horizontally across your uterus (transverse lie) cannot pass through the birth canal and will need to be delivered by Caesarean.
• Your baby's head is in the wrong position. When your baby enters your pelvis, he or she should be head-down and facedown. If the chin is up or the head turned, the fit can be very tight. Even though your cervix might be fully dilated, your baby simply may be unable to fit through your pelvis.
• You have a serious health problem. If you have diabetes, heart disease, lung disease or high blood pressure, your doctor may induce labor early. But because induced labor may have an adverse effect on the fetal heart rate or fail to dilate the cervix, it's more likely to end in a Caesarean. Unless these problems develop, however, vaginal delivery is preferable.
• You have a primary (first episode) herpes simplex infection in the genital tract. Unless you have a Caesarean delivery, the infection can be passed to the baby during birth, giving rise to serious disease.
• You're carrying twins, triplets or other multiples. In twin and other pregnancies with multiple babies, at least one baby will usually be in an abnormal position in the uterus. In this situation, Caesarean birth is often safer than vaginal birth, especially for the baby born second.
• You have a problem with your placenta. The placenta may detach from the inner wall of your uterus before labor begins. This condition, known as placental abruption, can cause life-threatening complications for you and your baby. In another possible placental problem — placenta previa — the placenta lies low in your uterus and partially or completely covers the cervix. If delivery were attempted, the placenta would be born first, cutting off the baby's access to oxygen.
• Your baby's umbilical cord is in an unsafe position. A loop of umbilical cord may slip out through your cervix before your baby is born. This displacement, known as umbilical cord prolapse, can endanger your baby. Sometimes, the cord is positioned between the baby's head and your pelvic bones, where it may be compressed, depriving the baby of oxygen.
• Your baby is very large. Your baby's size may be a problem if you have an abnormally small pelvis or an unusually large baby, due to gestational diabetes, for example. If your baby weighs 9 pounds, 14 ounces or more, Caesarean birth is more likely. In general, however, mothers with large babies attempt vaginal delivery instead of electing to have a Caesarean delivery. If it becomes apparent that the baby is too big to deliver vaginally, the doctor can still perform a Caesarean.
• You've had a previous Caesarean birth. If you've had a Caesarean birth before, you may need to have one again. But this isn't always the case.
• Your baby has a health problem. Your doctor may recommend Caesarean delivery if prenatal tests indicate that your baby has a developmental problem such as spina bifida (failure of the vertebrae to fuse, sometimes leaving part of the spinal cord completely exposed) or hydrocephalus (enlargement of the fluid-filled cavities in the brain). In these situations, a Caesarean birth might not be necessary to prevent damage to a baby, but being born in a controlled situation with a team of pediatric care providers on hand may benefit the baby greatly.

How to understand your situation

You and your doctor should have a thorough discussion about the possibility of Caesarean delivery well before your due date. This conversation, along with other talks with your doctor throughout your pregnancy, helps lay a foundation of trust between you and your labor-and-delivery team. That trust will help you through whatever happens when the all-important day arrives.

If your due date is still some time away when you learn that you may need a Caesarean, take the opportunity to ask your doctor every question that comes to mind. Don't hesitate to voice your worries and uncertainties, or to review — repeatedly if necessary — the circumstances that make a Caesarean the best option for you.

Emergency Caesarean deliveries are often hurried, for good reason: They're performed when your doctor determines that continued labor is no longer in your or your baby's best interest. In this situation, time may not permit you to ask all your questions. With general knowledge about Caesarean birth and solid trust in your doctor and nurses, however, you'll have less trouble taking events as they come. The end result — a healthy baby — is what you all desire most.

Related

Vaginal birth after C-section (VBAC) guide
Caesarean birth and the road to recovery