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C-Sections: Will You Need One?

Cesarean surgeries have saved the lives of many babies and their mothers, usually as a last resort in difficult birthing situations. In recent years, the number of children delivered by c-section has risen dramatically -- in 2016, about one in three children were delivered through c-section, a rate 500 percent higher than in 1970 -- and the reasons for this increase remain controversial.

A c-section is a major surgical procedure by which doctors open the pregnant woman's abdomen and uterus and deliver the baby through the incision. In nearly all cases the mother is awake but anesthetized from the chest down by epidural or spinal anesthesia.

Concerned about the overuse of c-sections during childbirth, the American Congress of Obstetricians and Gynecologists (ACOG) issued guidelines in 2014 intended to encourage vaginal deliveries whenever possible.

What are some reasons that women need to deliver by c-section?

Most of the time, c-sections are performed when the health of either the mother or the baby is in jeopardy. In some cases, physicians will deliver babies by c-section at the mother's request, but that is a different and very controversial decision. Some of the most common circumstances that result in a cesarean birth include:

  • The mother is pregnant with multiples. When twins or other multiples are ready to be born too early, or are in the uterus in positions considered unsafe for delivery when labor begins -- in breech position, for example -- there is a likelihood of a c-section birth.
  • The mother's labor stalls. According to the American Congress of Obstetricians and Gynecologists, one third of c-section births are performed because labor doesn't progress. For instance, contractions may not be strong enough to open the cervix for the baby to get through.
  • The mother has problems with the placenta. There are two placental problems that may cause a c-section to be performed: placenta previa, when the placenta covers the cervix either partly or fully; or placental abruption, when the placenta separates from the wall of the uterus and the baby can't get oxygen.
  • The mother has already had one c-section delivery. Previous cesarean birth is one of the biggest reasons that women today have c-sections. However, the latest guidelines from the American Congress of Obstetricians and Gynecologists recommend that obstetricians allow a woman to have a vaginal birth even if she has had a prior casarian.
  • The mother has an abnormal pelvis. A previous injury or condition may rule out a vaginal birth.
  • The mother has a severe illness or other condition, such as diabetes, herpes, a heart problem, or ovarian cysts, in which delivery is not safe for the baby.
  • The mother is advised that delivery is necessary, but she is not in labor. Some reasons may include a severe infection or preeclampsia.
  • The baby is in distress. During labor, the umbilical cord can become compressed, preventing blood flow from the placenta. If the fetal monitor tells the birth attendants that the baby is in distress, a c-section may be in order.
  • The baby's head is too large or she enters the birth canal in a breech position. In this situation, the baby's feet and buttocks enter the birth canal first, instead of the head.
  • The baby has a medical condition such as spina bifida, a birth defect that affects the backbone and spinal cord, and needs to be delivered by c-section.

What can I do to lower my risks?

  • Get prenatal care and take care of yourself. Certain health-related issues increase your odds of having a c-section. For example, if you are significantly overweight or if you have diabetes or high blood pressure, your odds of having a c-section delivery go up. Seeing a health care provider regularly during your pregnancy means that he or she will address any potential conditions that can be treated. Getting adequate prenatal care certainly doesn't guarantee that you won't have a c-section, but it's an important measure for your own health and that of your baby.
  • Ask your doctor about his or her c-section rate. Some physicians have higher rates of c-section deliveries than others. When you interview doctors, talk with them about your wish to have a vaginal birth and your philosophy about pregnancy and childbirth to determine if they are compatible. Some physicians are more willing than others to work with patients to help them achieve the kind of birth the patient desires.
  • Consider teaming up with a midwife and/or a doula to assist in your care and delivery. According to researchers from The Cochrane Collaboration, an international organization of 11,000 medical professionals who voluntarily review health care research and product trials, women who had continuous support from a doula or midwife during birth were less likely to require pain medication or have c-section deliveries.

Where can I find information about what to expect from a cesarean birth?

Email the American Congress of Obstetricians and Gynecologists (ACOG) at resources@acog.org and request a free copy of its pamphlet Cesarean Birth. Include your full name and mailing address.

Are there risks to the baby?

C-sections are quite safe for the baby, but new studies suggest there may be long-term health effects, including a higher risk of developing asthma, obesity, and type 1 diabetes as they grow up.

Where can I find information about having a vaginal birth after cesarean?

It used to be that if a woman had had one cesarean section, her doctor almost always recommended the procedure for the next delivery. These days, vaginal birth after cesarean (VBAC) is possible and even recommended. However, because of the risk of uterine rupture in giving birth vaginally, VBAC is be approached with caution.

The best way to avoid this difficult choice is to do all you can to avoid having a c-section in the first place. It's impossible to control everything, but you can reduce your chances by being in shape before and during pregnancy, working closely with your doctor on your birth plan, and having supportive people around you during labor and delivery.

By learning all you can about a c-section, you can ask the right questions when and if your doctor recommends one.

References

C-sections linked to long-term health problems. CBS News, June 11, 2015. http://www.cbsnews.com/news/c-section-cesarean-births-child-health-problems-asthma-obesity-diabetes/

U.S. doctors may be performing too many c-sections, Alex Cukan,UPI Health News, May 8, 2014

Oakland, Tara. ACOG issues new guidelines to curb overuse of c-sections. Robert Woods Johnson Foundation, 2014.

March of Dimes Pregnancy and Newborn Health Education Center. Labor and Delivery: What you need to know about a Cesarean Birth. http://www.marchofdimes.com/pnhec/240_1031.asp

March of Dimes. Multiples: Twins, Triplets and Beyond. http://www.marchofdimes.com/professionals/681_4545.asp

American Congress of Obstetricians and Gynecologists. Cesarean Birth.

Mayo Clinic. Cesarean delivery: When is it the best option? http://www.mayoclinic.com

March of Dimes. Prenatal Care. http://www.marchofdimes.com/pnhec/159_513.asp

Alan Guttmacher Institute. Maternal Mortality Risk Rises with Cesarean Birth, Falls with Prenatal Care. Perspectives on Sexual and Reproductive Health. Volume 36, Number 1, January/February 2004. http://www.agi-usa.org/pubs/journals/3603704b.html

American Pregnancy Association. Trying to Avoid a Cesarean. http://www.americanpregnancy.org/labornbirth/avoidcesarean.html

Hodnett, E.D. et al. Continuous Support for Women During Childbirth. The Cochrane Database of Systematic Reviews. 2003, Issue 3. http://www.cochrane.org/cochrane/revabstr/AB003766.htm

National Institute of Clinical Studies. What is the Cochrane Library? http://www.nicsl.com.au/cochrane/guide_whatiscl.asp

National Center for Health Statistics. Births Method of Delivery. http://www.cdc.gov/nchs/fastats/delivery.htm

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