A cesarean section, or a C-section, is defined as the delivery of a baby via a surgical incision in the abdomen and uterus of a mother. In 2011, an estimated 33% of American women delivered their babies via a C-section. In fact, c-sections have become one of the most popular forms of surgery women undergo every year.
When many pregnant women think about their birth plan, delivering on an operating table is probably one of the last things that come to mind. For many women, this type of delivery will be a reality.
Some cesarean section deliveries are planned in advance, and some are unplanned and done in an emergency situation. Whether it is planned or not, a C-section should only be done if it is deemed medically necessary. The goal of the surgery, which is one of the most commonly performed procedures in the world, is to safely deliver a baby when a vaginal delivery is not an option.
While the majority of C-sections result in a healthy mom and baby, there is a possibility that it can put both babies and women in danger – if they are done when they aren’t medically necessary.
With that said, physicians focus on the need for the surgery on a case by case basis. In other words, after performing a thorough assessment, a doctor will determine whether or not a C-section is deemed medically necessary.
What reasons warrant a cesarean section necessary? Actually, there are many more reasons than most women realize, and here’s a look at 15 of the most common reasons…
15 Placenta Previa
The placenta is a vital organ during pregnancy. In fact, this organ only exists in pregnant women (how cool!) It provides the developing baby with the oxygen and nutrients it needs and removes waste products from his or her blood.
The placenta attaches to the wall of the uterus and connects to the baby via the umbilical cord. In the majority of pregnancies, the placenta attaches high up in the uterus, but in some pregnancies, it attaches lower, covering part or all of the cervical opening. This condition is referred to as placenta previa.
Placenta previa can correct itself, especially if it occurs early in pregnancy. As the baby grows and the uterus expands, the placenta naturally moves up and away from the cervical opening. If, approaching the due date, the placenta still covers the cervix, a C-section will be necessary. Because the placenta blocks the cervix, the baby cannot pass through the birth canal.
Preeclampsia, a condition that used to be called toxemia, is a condition that causes high blood pressure in women who have never had an issue with high blood pressure before.
Additionally, women with preeclampsia have high levels of protein in their urine and may experience swelling in their hands, legs and feet. It occurs in about 5% of pregnancies, generally developing sometime after the 20th week, though it can develop earlier in pregnancy.
If left undiagnosed and untreated, preeclampsia can turn into eclampsia, a very serious condition that can be life threatening to the baby and the mother. The trademark sign of eclampsia is seizures.
Preeclampsia develops when the placenta fails to function properly; however, nobody knows why this occurs. The condition is not treatable. In cases where the condition progresses and the mother and baby are thought to be in danger, a C-section will be ordered to deliver the baby.
13 Fetal Distress
Typically, fetal distress is the term that is used when the fetus is not getting enough oxygen during pregnancy or during labor. It is usually detected when the fetus shows an abnormal heart rate through a fetal heart rate monitor. Other signs of distress include a decrease in fetal movement and low amniotic fluid levels.
There are a number of factors that can lead to fetal distress, including:
- An illness the mother is experiencing
- Compression of the umbilical cord (this often happens when fluid levels are low)
- A fetal infection
- Placenta abruption
- When the mother is in a position that puts pressure on major blood vessels, thus limiting the supply of oxygen the baby receives
In cases when a decreased oxygen supply is caused by compression of the umbilical cord or when pressure is being put on the major blood vessels, doctors will recommend the mother lay on her left side to alleviate the compression or pressure. If this does not work, or if the distress is not the result of these two reasons, an emergency C-section will be necessary.
12 Improper Positioning Of The Fetus
In order to successfully pass through the birth canal, the baby must pass through the mother’s pelvic bones to reach the vaginal opening. In order to make the passage through the birth canal easy and successful, the baby should be in a head down position with the front of its body facing toward the back of the mother.
This position is referred to as the occiput anterior position, and it is the ideal position for a vaginal birth.
Not all babies turn into the occiput anterior position, however. Other positions that the fetus may be in include:
- Breech – the bottom is facing down instead of the head
- Occiput posterior – the head is down, but the front of the baby is facing toward the front of the mother, not the back
- Transverse – the baby is in a sideways position
When a baby is in one of these positions, efforts can be made to turn him. However, if the efforts fail, a C-section may be necessary, particularly in a breech or a transverse position.
11 Labor Isn’t Progressing
As labor progresses, the cervical opening becomes larger, eventually dilating to 10 cm. Once the cervix is fully dilated, a vaginal delivery will commence. Unfortunately, labor does not always progress the way that it is supposed to.
When labor slows or stops, the cervix is not completely dilated, or the baby has not moved far enough down the birth canal to be delivered vaginally, labor is not progressing properly.
If labor starts and stops, or the cervix isn’t completely dilated, doctors will use different techniques to progress the labor. A foley catheter can be used to induce contractions, for example, or medications can be administered to progress contractions and open the cervix.
When these efforts fail to progress the labor, or the baby is not far enough down the birth canal, a C-section will be deemed medically necessary to deliver the baby safely.
10 The Umbilical Cord Prolapses
Cord prolapse occurs in only about one out of every 300 births, but when it does, an emergency C-section is necessary.
A cord prolapse happens when the umbilical cord slips through the cervix and moves into the birth canal before the baby does. When it happens, the mother may actually be able to feel it or see it, or it may be detected when the baby shows signs of distress.
A cord can prolapse happen to anyone, but there are certain situations that can increase the risk. For example, if the baby is in the breech position or if the baby is premature, the umbilical cord is more likely to prolapse. Other situations when a cord prolapse may occur include:
- The delivery of the second twin
- The water breaks before the baby’s head has started to move into the birth canal
When a cord prolapse occurs, the oxygen supply to the baby can be compromised, which is why a C-section will be deemed necessary.
9 A Repeat Cesarean
Mothers who have delivered a previous baby via a Cesarean section will likely deliver any future babies via a C-section.
Though a VBAC (vaginal birth after a Cesarean) is possible, there are certain risks involve, the biggest of which is a uterine rupture.
A uterine rupture occurs when there is a tear in the wall of the uterus, and in mothers who have had a previous C-section, the rupture can occur through the site of the previous incision. If a complete rupture occurs, the tear will pass through all of the layers of the uterine wall. If this happens, the consequences can be severe, including extreme blood loss or the need for a hysterectomy.
In order to be considered a candidate for a VBAC, a woman must meet certain criteria. Pregnant mothers who have had a previous C-section and wish to attempt a vaginal birth with any future children should consult with their doctors.
8 A Multiple Pregnancy
Though it is possible to safely delivery multiple babies via a vaginal birth, many mothers who are pregnant with one or more babies will deliver their babies in a planned C-section.
In most multiple pregnancies, a C-section will be planned and completed prior to the mother going into labor. Why? – Because, as you might guess, there is limited space in the mother’s womb, and the more babies there are, the less room there is. As a result, the mother and the babies may not be able to make it safely to the anticipated due date.
Less space in the room increases the risk for fetal distress, which can be detrimental to the babies. Additionally, there is a chance that the cord of the second baby could prolapse after delivering the first baby.
If a mother is expecting two or more babies, a C-section will likely be scheduled a few week in advance of her due date.
7 A Pre-Existing Health Condition
Mothers who have a pre-existing health condition may need to deliver their babies via a planned C-section.
Labor and a vaginal delivery can actually aggravate certain pre-existing health conditions, putting the mother and the baby at risk of serious danger. The stress of labor and delivery can aggravate the heart of a mother who has heart disease, for example.
Mothers who have been diagnosed with hepatitis C or HIV may also have to deliver via a C-section, especially if the condition is not under control, because there is a risk that the virus could be transmitted to the baby during delivery. Likewise, a mother who has active herpes will have to deliver via a C-section, again, because it could impact the health of the baby.
Mothers who have pre-existing health conditions will discuss delivery options with their healthcare providers, and a C-section may be the safest delivery option for both mother and baby.
6 A Narrow Pelvis
In order for a baby to successfully and safely pass through the birth canal, there needs to be enough room in the pelvis. For women who have a narrow pelvis, this may not be possible.
When there isn’t enough space for the baby to pass through the pelvis, the results can be dire for both the baby and the mother. For the mother, it could lead to broken bones and internal bleeding; for the baby, it could lead to broken bones or issues with the umbilical cord.
In some cases, the baby may not be able to complete his journey through the birth canal, which could necessitate an emergency C-section once delivery has commenced.
For mothers who have a narrow pelvis, their doctors will consult with them prior to the due date to determine the best and safest route for delivery. Oftentimes, the answer is a C-section.
5 Cephalopelvic Disproportion (CPD)
Cephalopelvic disproportion happens when a part of the baby’s body, usually the head, is too large to fit through the pelvis of the mother. True cases of CPD are rare, meaning that they are not diagnosed before labor. However, in many cases, a labor that does not progress is often diagnosed as CPD. In either case, a Cesarean section will be necessary to safely delivery the baby.
There are certain factors that can contribute to cephalopelvic disproportion, including:
- Pregnancy that continues after the due date
- The mother has had previous pregnancies
A CPD diagnosis may also be made if the fetus is in an abnormal position, the mother has an abnormally shaped pelvis, or her pelvis is too small.
A diagnosis of CPD is usually made when labor commences but it does not progress sufficiently. While medical therapies, such as the administration of labor inducing drugs, may be used to help a mother successfully deliver vaginally, but if these treatments don’t work, a C-section will be necessary.
4 Placenta Abruption
Placenta abruption occurs when the placenta either partially or completely separates from the uterine wall before the baby is born. This condition is serious and can have devastating results for both mother and baby.
The placenta provides the baby with oxygen and vital nutrients. It also removes waste from the baby’s bloodstream. When the placenta separates from the uterine wall, it cannot perform these functions, which could seriously impact the health of the baby. For the mother, a placenta abruption could cause severe bleeding – which can also be dangerous for the baby.
Placenta abruption also increases the likelihood that the baby will have growth problems while in the womb, could result in premature birth, or could result in a stillborn birth.
Placental abruption is not very common, only occurring in approximately one in every 150 pregnancies. Most often, it occurs during the third trimester, but it can happen any time after 20 weeks gestation.
3 A Diagnosis Of Spina Bifida
Spina bifida is a birth defect. It occurs when the backbone of the baby fails to fully close as it is developing during the first month of pregnancy, which leaves part of the spinal cord exposed. A neural-tube defect, spina bifida can result in nerve damage, and in the most severe cases, it can cause paralysis.
The exact cause of spina bifida is unknown, however, experts think that it is likely the result of a combination of genetic and environmental factors. It can be hereditary. If one or both parents already have a child with spina bifida, there is a greater chance that a future child will have it.
Certain medications can also cause it, such as anti seizure medications. Other factors that can contribute to the development of spina bifida include uncontrolled diabetes, obesity and low levels of folic acid.
Because a vaginal birth can lead to further damage, babies who are diagnosed with spina bifida are usually delivered via a C-section.
2 Placental Insufficiency
As previously mentioned, the placenta is an organ that only grows in the womb of a pregnant mother. Its serves an invaluable purpose, providing oxygen to the baby, as well as vital nutrients. The placenta also eliminates waste from the baby’s blood stream.
Because the placenta is so vital, if it is found to be insufficient, the baby can suffer devastating results. Babies who are unable to receive adequate oxygen and nutrients from the placenta, and whose waste cannot be removed from the bloodstream, will not be able to thrive in the womb.
As such, low birth weight, premature birth and/or birth defects can occur. Additionally, an insufficient placenta can cause complications for the mother.
Causes of placental insufficiency can include:
- A blood clotting disorder in the mother
- Chronic high blood pressure
- The use of drugs, especially cocaine, heroin and methamphetamine
- Blood thinners and other medications
When the placenta is deemed insufficient, the baby will need to be delivered as quickly as possible, and a C-section is the quickest option.
1 Uncontrolled Pre Existing Diabetes
If a mother has preexisting diabetes (she had it before she was pregnant,) she may need to deliver her baby via a C-section.
Diabetes, a condition in which the pancreas does not release insulin, can cause a number of problems during pregnancy, especially if it is not controlled. These problems can include:
- The development of preeclampsia
- The development of birth defects
- A very large baby, which may not be able to successfully pass through the birth canal
Because of the issues that preexisting diabetes can cause, it is extremely important for mothers who have this condition to keep it controlled during pregnancy. If any of the aforementioned problems develop during pregnancy as a result of uncontrolled pre existing diabetes, there is a good chance that doctors will determine that a vaginal birth will be unsafe for the mother and the baby. Thus, a C-section will be necessary.