These days, doctors get plenty of flak for the rising rates of unnecessary caesarian sections in the Western World. Indeed, in the United States about a third of babies are born through C-section, a rate that most experts deem is excessive.
Do note that “experts” in this case, perhaps surprisingly, includes obstetricians, the very persons who prescribe C-sections themselves. But this is because we seldom do get the full story of what happens in the delivery room and the operating theater.
It’s important to remember that while we’re primed to see childbirth as a normal experience that we have to go through, a rite of passage even into motherhood, doctors may have a slightly different perspective. While the complications of pregnancy are rare in places where there is good quality of life and access to health care, doctors do see a larger proportion of it than we do.
And so, they’re pretty much primed to expect the worst in many cases. Even though they do try to remain calm, it can worry them since they are actually genuinely concerned that both you and your baby get through childbirth healthy and alive. But the thing is that no labor is the same. In some women, the experience can resemble things that your doctor is worried about even when it actually ends up being a minor cause for concern.
To get you into the mind of your doctor, here are a few things that they’re considering when they opt for a caesarian section or just a regular vaginal delivery.
10 Multiple Births
It is possible to give birth to twins vaginally. Some old records show, after all, that women have given birth to up to eight babies without the need for caesarian section. But as a general rule, the more babies there are the greater the risks in childbirth and the greater the chance you’ll need to go through the knife.
One of the main considerations is how the babies are positioned inside your uterus. If both babies are head-down in there, your doctor is more likely to give you the clear for a normal vaginal delivery. However, even during the delivery, risks for complications can be higher, especially considering that you will have to be in labor longer and that the second twin’s cord may prolapse after the first one is born.
Because of this, even if you’ve decided to give birth normally, your doctor will still want to have all equipment necessary for a caesarian section ready just in case something goes wrong.
9 Cephalopelvic Disproportion
Cephalopelvic disproportion simply means that your pelvis is too small to allow your baby’s head, the largest part of his body, to pass through. While true cephalopelvic disproportion is pretty rare and is probably diagnosed early on in the pregnancy, women with relatively small pelvises may experience longer labor times. This may cause the baby to take too long to get out, especially in first time moms. Fortunately, most women who have been diagnosed with cephalopelvic disproportion during their first pregnancies are able to deliver normally the next time around, indicating that this may not be the case.
To understand why doctors will choose a C-section even given this scenario, it’s important to remember that the longer it takes for your baby to descend through your birth canal, the risks do stack up. Even if the risk isn’t too significant and may not necessarily apply to you, it may worry your doctor into just going for the C-section just in case.
8 Fetal Distress
Throughout labor, you and your baby will be monitored closely by the medical team. After all, the best way to ensure that nothing goes wrong is to catch the signs of complications early on. In some cases, your baby’s supply of oxygen could be compromised. This may be due to problems with his umbilical cord or the placenta, but a longer labor could also factor in.
When the baby’s heart rate goes extremely up or down, your doctor may begin to worry. Mere minutes of oxygen deprivation, after all, could mean brain damage or even death. The thing is that sometimes your baby’s heart rate could normally change for a short time during the labor process. For your doctor, it can be a tough decision whether to wait and see if it subsides or to put you under the knife to minimize risks, especially since they know what is at stake.
7 Placental Problems
The placenta is an extremely important organ through pregnancy as it is a vital link between you and your baby. It delivers much-needed oxygen and nutrients that your baby just can’t get for himself in your womb. Early separation of the placenta cuts your baby off from your blood supply too early, causing oxygen deprivation especially if he’s still in a position where he can’t breathe yet.
There are two main problems with the placenta that may complicate your childbirth. The first is placenta previa. This is when the placenta implants too low in your uterus, blocking your baby’s normal exit route. If undiagnosed early on, this may result in the placenta presenting first during labor. The second condition is placental abruption, which means that the placenta separates too early internally. In both these cases a caesarian section will be necessary to save your baby’s life, as well as yours.
6 Baby’s Position
In most pregnancies, babies assume the left occiput anterior position, or when the baby’s back is toward your tummy with his head lodged at the smallest angle towards your birth canal. Babies who assume this position are ideal candidates for a normal vaginal delivery. However, if the baby presents in any other position, the chances for a caesarian section can rise. This can be a slight increase in risk, as with babies in the occiput posterior position, when the baby’s back is pressed up against your spine. Positions that significantly increase your risk of going under the knife is the breech position, when the baby presents feet-first rather than head-first, or a transverse lie, when the baby is lying sideways.
Prenatals are extra important late in your pregnancy because this allows your doctor to determine your baby’s position early on. After 36 weeks, she may also be able to externally maneuver your baby into a position more ideal for vaginal birth, lowering your risk for a C-section.
5 Your Health Condition
If you’re dealing with health conditions along with your pregnancy, such as hypertension or diabetes, you may be at increased risk for a C-section. It’s not that a normal birth is not possible, of course. If your condition has been stabilized, whether through medication or other intervention, you may still be a candidate for normal birth. However, if your condition is untreated, does not respond to treatment or requires medications that can make normal childbirth risky, your doctor may highly recommend getting a C-section instead.
If you’re dealing with this, it’s best to talk to your doctor early on, determine your preferences and have a backup plan in case something doesn’t go as planned. Regular prenatals become even more important as your condition toward the end of your pregnancy could be a major factor in determining whether you need a C-section or not. After all, things can change as you come closer to your due date.
4 Previous C-Section
If you’ve had a C-section before, it’s still possible to have a normal vaginal delivery. In fact many mothers do opt for, and safely get through, this route. However, in this case, there is still a slightly higher risk that the old caesarian wound could open up due to the pressure of childbirth. Note that this doesn’t happen in a vast majority of cases, but your risks do increase if you have a bigger baby have another medical condition. One other thing that can increase risks is if you’ve had more than one C-section in the past. In this case, there is more than one bit of scar tissue to worry about.
Because of this, your doctor will also want C-section equipment on standby during your delivery just in case it will be needed. This means that even if you seem likely to have a normal delivery at first, you might have to prepare yourself physically and emotionally for a possible C-section as well.
3 Baby’s Risk
Certain factors can reduce your baby’s risk of surviving childbirth, or even the last few weeks of your pregnancy. This includes an umbilical cord which is abnormally short or long, which can either coil around your baby or snap abruptly when the baby moves. Another factor that could contribute to this is the lack of amniotic fluid in your uterus. If your doctor is able to detect any of these conditions by ultrasound during one of your late-term prenatals, she may recommend a scheduled caesarian section. This is because conditions such as this increase the risk that your baby’s umbilical cord will become compressed or separate, causing fetal distress before or on your due date. This is not necessarily going to happen, but the risks are high enough that your doctor will be very worried. She does, after all, want both you and the baby to survive, even if it takes a C-section to ensure it.
2 Labor Slows or Stops
If, for some reason, your labor slows down or stops your doctor may deem it a failure to progress. This is especially if you’ve been in active labor for more than 20 hours. There are many causes this, including cephalopelvic disproportion, delayed opening of the cervix, weak pushing and even just plain labor exhaustion.
Now, for some women it may be worth waiting to see if the labor picks up. In some cases, the labor will slow down for a while but resume after a few minutes without harming either mom or the baby. However, the longer the labor, the risk of you losing too much blood or your baby going in distress does increase significantly. For this reason, your doctor might suggest a C-section to veer away from the possible complications just to stay on the safe side. It is, after all, tough when the delivery is at a crossroads between a normal one and a potential complication.
1 Liability Risk
This may seem out of place in a list of primarily medical complications. But it does help tie it all together. One interesting article in Harvard Magazine found that the doctor’s overall environment does factor into her decision to put you under the knife or not. That is, hospitals or even states with policies that encourage normal vaginal deliveries produce doctors that are more likely to opt for this. This encourages an environment in which the doctor, like most midwives, will be willing to wait for a few extra minutes for the labor to get back into progress before deciding a C-section in necessary.
In hospitals or states, however, where there are rigid limitations placed on doctor’s liabilities, doctors are not likely to wait it out no matter how small the risk of a complication. Doctors, after all, have far more control during C-sections and this allows them to manage the risks better, even if there are numerous disadvantages to C-sections on the mother’s side.
In the end, it’s best to talk to your doctor about your preferences. Keep in mind that no matter how calm your doctor may seem, she is genuinely concerned about you and your baby’s health. Making her more aware of what you want for yourself will help her factor your wishes in with every decision on the delivery table.