Whether the thought of labor is a woman’s envisioned warrior woman moment, or something that scares her to her very core, it’s an eventual reality of pregnancy. My grandmother once told me that she was totally comfortable while she was expectant, that is until the moment it hit her that the baby growing by the minute would need to “get out” somehow.
No matter how hard a person prepares for birth, and how detailed a birth plan may be, this might change: whether these changes are scheduled or not, they may be the reality of how baby arrives.
A caesarean section is when a child (or children in the case of multiples) is delivered through an incision in the abdominal wall and into the womb. Most of the time the mom is awake during the procedure and is able to be with her new baby very soon postoperative.
Most expectant women are able to deliver their children through the birth canal, but there are other times when the safety of baby and/or mom requires a C-Section birth. Over the past several decades the number of births by C-section has increased tremendously: from around one in every 20 births to roughly one third of all births.
There is some talk of women choosing C-section surgery in place of natural birth, however with the added risks involved in this procedure most doctors will only recommend a C-section when it’s medically necessary. No matter what the birth plan is, or what number baby this is, there are many reasons why some women absolutely should opt for a C-section, here are 15 of them.
15Baby Is Breech Or In A Dangerous Position
If a baby is in breech position (feet or bum first, as opposed to head down) near the end of the pregnancy doctors and their patient will need to have a very important discussion surrounding whether or not they should opt for a C-section in place of natural birth.
Only around four percent of babies are actually born in the breech position, with most of these births in the United States being C-Sections. Dutch researchers found there was a ten times greater chance of newborn mortality rates when breech babies were born vaginally instead of via C-Section.
Many doctors, and patients, are not willing to take this risk, I wasn’t and when my twin son was breech at 36 weeks we decided to schedule a C-section. In fact, many modern doctors are trained to see a planned section as the only acceptable method to deliver full term breech babies.
Mothers approaching their due date with a breech baby are encouraged to have a frank discussion with their doctor surrounding the best approach for delivery of their child.
14Mom Has A Heart Condition
Although for many women, even those with a heart condition, the body can handle birth, just as it has handled pregnancy. There are times when a heart condition can be made worse because of the stress of labor and doctors won’t want to take an unnecessary risk. This means the best possible option is a C-section to ensure the safety of both mom and baby.
Robert M. Hayward, M.D conducted some research on heart disease and pregnancy, the results from that study completed in 2014 caused him to say, “We are pleased to find the risk of complications are not as high as expected in women with congenital heart disease. While we don’t know why these women have longer hospital stays, it’s possible their doctors are keeping them admitted for extra observation.”
The study also revealed that women with such conditions were much more likely to give birth via C-section.
13The Baby Has Macrosomia
The fourth most common reason for an induction to labor, and the fifth most common reason for a C-Section (making up a total of nine percent of all C-sections) is a baby who is very large for their gestational age.
This is known as a big baby or macrosomia (meaning big body), with some considering this being a baby born over 8lbs, 13 oz. and “extremely large” babies weighing in over 11 lbs total.
These babies are induced or delivered via C-section because they are at a higher risk for getting their shoulders stuck in the birth canal, it prevents the baby from getting any bigger inside the womb (thus reducing other complications associated with a large baby), and when the risks of vaginal delivery are greater than those associated with a C-section.
Another cause for C-Section delivery is known as Cephalopelvic Disproportion, which is essentially when it is determined that the baby’s head is too large, or the mother’s pelvis is too tiny to allow for the baby to safely pass through the birth canal.
12Mom's Had A C-Section Before
Moms who have had C-sections before will sometimes need to schedule another C-section, particularly if the doctor believes that labor may cause the scar to tear (also known as uterine rupture). While around 90 percent of women who have had caesarean sections for previous births are prime candidates for a vaginal birth after caesarian (AKA VBAC), there are specific criterion that must be met in order to qualify.
Mostly, if the issues that led to the C-Section last time are not present this pregnancy, a mom can usually decide to go with regular labor. Around 60 to 80 percent of moms who attempt a VBAC will be able to deliver their child vaginally.
Other items that make mom a prime candidate for a VBAC include: a low horizontal uterine incision from the previous C-section, a pelvis large enough to allow safe passage for baby, no previous uterine ruptures, and a doctor attending who can perform an emergency C-section if required.
11Mom Has High Blood Pressure
High Blood Pressure during pregnancy is known as preeclampsia. Preeclampsia could prevent blood flow to the placenta, and decrease oxygen for the baby, with delivery recommended as treatment. In cases of severe preeclampsia cesarean section is recommended immediately.
According to the Preeclampsia Foundation, this condition is a complication in around five to eight percent of all pregnancies. Preeclampsia is a hypertensive disorder that usually develops in the second half of pregnancy. According to the foundation, “Most women who develop preeclampsia will deliver a healthy baby and fully recover."
When left untreated preeclampsia can cause the following complications: low birth weight, placenta separating from the uterus, preterm delivery, stroke, kidney failure, rupture of the liver, seizures, and even maternal or fetal death.
Mild preeclampsia often is treated with bed rest, fetal monitoring and a hospital stay. In more severe cases, mom is often given a steroid shot to help baby’s lungs develop, and then baby is delivered in the next few days. Mothers with preeclampsia at around 28 weeks have around a 50 percent chance of delivering their child via C-Section. Most of the time preeclampsia resolves itself within 24 hours post-delivery.
10Mom Has Placenta Previa
When the placenta is lying unusually low in the womb, and is partially or entirely covering the cervical area, this is known as placenta previa. Approximately one in every 200 pregnancies will be diagnosed with this during their third trimester.
Treatment for placenta previa includes bed rest (also called pelvic rest), where mom will be told to take it easy and stay clear of things that might cause bleeding, including vigorous exercise, intercourse, or any strenuous activity. Those diagnosed will undergo regular monitoring of the condition. Often this diagnosis leads to the requirement of birth by C-section since the placenta is blocking baby’s way out.
Placenta previa can cause bleeding and other complications that sometimes require delivering the baby early, mostly because the placenta is what supplies the nutrients to baby through the umbilical cord.
For those who have been diagnosed in the second trimester, don’t panic, often the placenta will migrate away from the cervix and this may not be an ongoing problem, as will be determined in your third trimester ultrasound.
9Placental Abruption Is Present
Placental abruption occurs, usually in the third trimester (often in the final few weeks prior to birth), when the placenta separates from the inner wall of the uterine lining. Around one percent of pregnant women experience this, with mom experiencing bleeding from the spot of the separation along with some pain in the uterus, back pain, abdominal pain, and rapid uterine contractions.
Placental abruption can happen both partially and completely. This can interfere with baby receiving the required amount of oxygen and may lead to an emergency C-section. When left untreated it can be extremely dangerous for both the mother and baby. The cause of placental abruption is mostly unknown, but can occur following a trauma to the abdomen (i.e. a car accident).
Sometimes a brief hospital stay and monitoring can help elongate baby’s stay in the womb, other times (usually after 34 weeks) baby will be delivered by immediate C-Section, particularly if mom or baby’s health is at risk.
8Mom Has A Uterine Rupture
Although very rare, uterine tearing during pregnancy or labor often leads to immediate, emergency C-section. Uterine rupture can both impact the oxygen supply for baby and cause mom to hemorrhage. One in every 1,500 births will have uterine rupture, with it being a more common complication for mothers who have had previous C-Sections.
These ruptures usually happen during early labor with the first sign often being an abnormality in the baby’s heart rate. The rupture usually happens because the scar from a previous C-section has burst because of the stress caused by contractions. This can also happen to women who have received previous uterine surgeries for fibroids.
Anyone who has had a previous uterine rupture would be automatically scheduled for a C-section in future deliveries to avoid unnecessary risks for mom or baby.
7Mom Has Gestational Diabetes
Any news of complications can be an expecting mom’s worst nightmare. A diagnosis of gestational diabetes can get a lot of expectant mom’s spinning; thankfully most women who develop diabetes during pregnancy recover well and birth healthy babies. Nearly 10 percent of pregnant women develop this condition, so it’s actually quite common, despite being worrisome.
Most of the time the diabetes goes away after delivery, although women who develop gestational diabetes have a higher chance of getting type two diabetes later in life. Women with gestational diabetes have higher odds of needing a C-section and of developing preeclampsia (another reason to need a C-section).
Moms diagnosed with diabetes should talk to their healthcare practitioner about their options, particularly surrounding risks related to a C-section and whether or not this is the recommended course of action.
6There Is Cord Prolapse
The umbilical cord is a fairly flexible structure, similar to a tube, that connects the baby to mom throughout pregnancy. This is what brings the baby its nutrients, and also removes waste. Occurring in one in every 300 births, cord prolapse is when the umbilical cord moves through the cervix, ahead of the baby.
This means that the baby can lean against the cord during delivery, lessening the blood flow to the baby. When a doctor discovers a prolapsed cord, it’s often because baby’s heart rate is lessening, they will often move the baby away from the cord to increase blood flow and in some cases will rely on an emergency C-section.
The reason for the emergency C-section is that the longer the delay the greater the chances of brain damage or death for the baby. Breech babies and the second baby in the birth of twins are at a greater risk of suffering from cord prolapse.
5Labor Slows Or Stops
Stalled labor is when a woman in active labor has her labor slow down or even stops. For the woman attempting to give birth, this can feel discouraging. Sometimes this will lead to the administration of the drug Pitocin or birth via C-section. Some women find that it’s helpful to rest, walk, change labor position, stimulate their nipples, or even take a shower to speed things along again.
Other times, there is no choice but to proceed with a C-section. Sometimes stalled labor is believed to be a result of an epidural (which can slow labor). It can also be a sign that mom’s pelvis is too small for baby to pass through. First time moms also usually labor for a longer time than veteran moms, making stalled labor more likely for newbies.
Labor that does not result in the cervix dilating over a 20 hour period of time is generally considered a failure to progress. When a baby is stalled at the pushing stage doctors will often opt for forceps, a vacuum extractor, or an episiotomy to help birth baby.
4Mom's Having More Than One Baby
Parents of multiples, you’ve defied all sorts of odds, and bringing twins, triplets, or more into this world is definitely special. Along with this honor is also an increased likelihood of delivering your multiples (or at least some of your multiples) via C-section.
Birth by C-Section will be the most likely option for you if Twin A is not head down, the twins share an amniotic sac, or if mom is carrying triplets or more. There is more debate among healthcare professionals as to what to do if twin A is head down and twin B is breech.
Some moms who successfully birth twin A via the birth canal, may still require a C-section for twin B, depending on whether or not twin B’s head is down and a variety of other factors surrounding the health of twin B and mom. Nearly one quarter of mothers of twins end up having both vaginal birth and a C-section when one baby is head down and the other is breech.
3Baby Is In Distress
When the baby is in distress it's cause for an emergency C-section. Signs of distress include a very slow or fast fetal heart rate, with the most probable cause of this distress being not enough oxygen being delivered to the baby. When fetal monitoring determines there is a problem with the amount of oxygen baby is receiving, this is when an emergency C-section will be performed.
A baby being considered in distress, either during labor or in the third trimester, happens somewhere between one in every 25 births to one in every 100. Distress can be caused by a variety of factors including: placental abruption, umbilical cord compression, fetal infection, maternal infection or illness, or when the mother is positioned in such a way that there is significant pressure on major blood vessels that deprive the fetus of oxygen.
During labor, some moms are given oxygen or additional fluids through an IV to help better oxygenate mom’s blood, but when this doesn’t work the only option is speedy birth, usually via C-section.
2Mom May Have A Disease
There are several STI’s that can make doctors opt for caesarian delivery. If mom has an active outbreak of genital herpes, this is diagnosed through a positive culture finding or the presence of visible lesions, they may decide that a C-section is the best possible way to ensure baby is not exposed to the virus as they would be when passing through the birth canal.
When HIV positive moms are pregnant there are many factors surrounding her health which must be considered when creating a birth plan. If an HIV positive mother has a high, or unknown, viral load (meaning her body is not fighting HIV very well at that time) a C-section is the preferred method of delivery, generally scheduled at 38 weeks.
All mothers with HIV should be taking HIV medications that can both protect the baby from contracting HIV, as well as the mother's own health.
1The Baby Has Certain Health Conditions
When a baby is diagnosed with particular health conditions or birth defects from inside the womb, this can cause problems in their overall health, sometimes making a C-section a better birthing option. This would include birth defects such as spina bifida, fetal abdominal wall defects, or even some medical problems with the mother.
One of the most important decisions a healthcare practitioner needs to make when scheduling a C-section is determining whether or not the baby is ready to be delivered.
Advantages of a planned C-section include: knowledge of when baby will be born, minimizing some complications, avoiding post term pregnancy, ensuring the mother’s doctor will be present for delivery, providing a more controlled and relaxed environment for delivery, and minimizing damage or injury to pelvis muscles, and surrounding tissues.
No matter what the reason may be for considering a C-section delivery, whether it’s a split second emergency decision from a team of professionals, or a carefully calculated decision made weeks before birth, it’s best to have these conversations with your family and health care professional ahead of time, before there is an issue, ensuring you make an informed decision.
Sources: Web MD, American Pregnancy, BabyCenter, Fit Pregnancy, Parents
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