Most women don’t plan on having a C-section. With the rising awareness of the benefits of vaginal deliveries and the popularity of documentaries like The Business of Being Born, which expose how doctors and hospitals sometimes fail moms when it comes to birth, most moms-to-be hope to offer their child a calm, vaginal delivery into the world.
While it’s great to be educated, have a birth plan, and work with a doctor to help it be realized, there are situations where C-sections are absolutely necessary. It’s also true that there are situations created by unnecessary medical interventions that cause mom to have an unwanted C-section.
What’s important is that mom and her baby are safe and that mom knows what situations require a C-section for the benefit of her and her child.
The C-section rate in the United States is over 30%, a percentage that is much higher than many health professionals believe it needs to be. Many people don’t understand why or how this has happened, but most people agree that there is a time and a place for a C-section, and many moms and babies wouldn’t survive without this surgical option. In fact, in countries where C-sections aren’t possible, many women die from obstructed labor and other conditions that can be prevented by a C-section.
While rising C-section rates should give mom pause, she also needs to go into labor understanding that sometimes a surgical birth is the best option she can offer her child. Certain circumstances trigger C-sections, and when these occur, mom has to adjust her expectations and get through a surgery.
15 Failed Induction
Inducing labor is a common practice, and it happens for a variety of reasons. Some are related to the health and wellness of mom and the baby and can’t be avoided.
However, inductions are also scheduled for the convenience of mom or the doctor, and some women ask to be induced because they are nearing their due date and are just over being pregnant.
The problem is that an Australian study found that inductions increase the chances of C-section by a whopping 67%! For moms hoping to avoid a surgical birth, being induced can be a big step in the wrong direction.
When the body is ready to labor, it can usually do it on its own, but when it’s not ready, induction won’t particularly force labor to start. Even if an induction helps start labor, many women putter out when their bodies refuse to follow through with something they weren't ready for.
There are times inductions are necessary, and mom will have to give it a try or agree to an immediate C-section. However, if it’s possible to avoid an unnecessary induction, mom would be wise to if she doesn’t want to end up in an operating room.
14 Position Of The Child
Mom hopes her little bundle of joy will be in the proper position for birth because it makes her life much easier. The best way for a baby to present for vaginal delivery is head down.
Babies, however, do not always choose to cooperate and have been known to stay in positions not conducive to vaginal deliveries. A baby who is breech has their feet or bottom presenting first, meaning the lower half of the body is where the head should be. A child who is transverse is actually lying sideways across mom’s stomach.
While it’s possible for babies to change positions throughout pregnancy, it becomes more difficult towards the end when there is less space. If a child is in a transverse position when the due date arrives, a C-section is the only option. The same is true if a baby is breech when it’s time to deliver, though there are a few doctors who will let mom attempt a vaginal delivery. However, many OBs don’t allow this now due to the risk of injury to the baby and mom.
13 Obstructed Labor
Sometimes labor goes as far as it can, and then it stops. The baby travels as far as he or she can down the birth canal, but they can’t make it out for a variety of reasons including the narrowness of mom’s pelvis or the large size of the baby’s head.
A baby may also maneuver into a position that causes him to be stuck. Whatever the reason, if obstructed labor is not dealt with, it can lead to death for mom and her baby.
The phase before obstructed labor is called prolonged labor, and if mom goes into a state of prolonged labor, medical staff will watch her closely.
If mom reaches the 20 hour point and is still in labor, she is considered in a stage of prolonged labor, and this is cause for concern because the prolonged labors often lead to obstructed labors.
In a case of obstructed labor, mom will be grateful for a C-section because it is the best solution in a bad situation. Obstructed labor isn’t as much of a problem in countries that have access to C-sections, but it’s a leading cause of death for moms and babies in countries where C-sections aren’t available.
12 Mom Has Preeclampsia
Preeclampsia is a serious condition that causes high blood pressure and a host of other complications for a pregnant mom. When blood vessels constrict in certain organs in the body, mom will start to have symptoms that may include headaches, vision problems, or vomiting.
Preeclampsia may be a trigger for C-sections because moms with preeclampsia often deliver early. If mom’s blood pressure won’t come down and there are going to be further complications for her and her child, doctors may choose delivering a baby preterm over risking the pregnancy going any further.
When mom delivers preterm, she often needs a C-section because starting labor is difficult when the due date isn’t even near. While some doctors will let a mom try to be induced if she is closer to the due date, others will not because labor is hard on the baby, and a baby who is going to be born early may not be able to deal with the stress of a conventional delivery.
Labor is also hard on mom, so if she has already been compromised by preeclampsia, she may not be able to deal with the strains of labor. In those cases, C-sections are required.
11 Carrying Multiples
When mom is carrying more than one baby, she needs to mentally prepare for a C-section. While it’s true that twins are sometimes delivered vaginally, not all of them can be, and a woman carrying triplets or quadruplets will almost definitely be scheduled for a C-section.
The reason C-sections are preferred when mom is carrying more than one child is largely due to the unpredictability of a vaginal delivery. With twins, the first baby needs to be head down, but even after that one emerges, the second baby can always flip into a breech or transverse position.
When this happens, mom sometimes has to undergo a C-section after having already delivered vaginally.
Certain conditions, like twin-to-twin transfusion syndrome (TTTS) and twin anemia polycythemia sequence (TAPS) can also get worse during a vaginal delivery. If doctors know beforehand that mom is dealing with either of these conditions during her pregnancy, they will likely schedule a C-section.
Moms of multiples are also more likely to suffer from issues like gestational diabetes and preeclampsia, so that makes it even more likely they will have a C-section. The risk of preterm labor, a real concern for moms carrying multiples, also increases the chances of a surgical delivery.
10 Mom Is Past Her Due Date
It’s logical to think that the longer mom carries a baby in her body, the less likely she will be to end up with a C-section. If mom gives a baby plenty of time to come into the world when he or she is ready, he should come on his own, right? Not always, unfortunately.
Some women will fly right past the 40 week due date with no signs that their bodies know they are supposed to go into labor. While this is common for many reasons, and going past 40 weeks is much more common when mom has a midwife, carrying past 40 weeks does have its risks, and because of those risks mom may end up with a C-section.
Why? Because when a pregnancy goes past the due date, it can cause problems with the pregnancy. The placenta may be compromised or amniotic fluid may have fallen to a lower than desired level.
Doctors will run a non-stress test on the baby to see how he or she is doing, and if the situation in the womb is causing the baby stress, the doctor may opt to skip the strain of labor and deliver the child by C-section.
9 Prior C-Section
Unfortunately, once mom has undergone a C-section, she is at a higher risk of having another one. In fact, many doctors will tell a mom that once she has a C-section she must always have them with all future pregnancies.
While this is not true due to vaginal birth after caesarean (VBAC), which is when mom delivers vaginally after already delivery a previous child by C-section, many doctors will no longer perform VBACs.
They don’t want to deal with the risks and the time involved, though VBACs can actually carry less risks in many areas for mom and baby.
If a woman wants a VBAC, she should seek out a doctor who is willing to work with her. Not every woman is a good candidate for VBAC, but many are and don’t even have the chance to try due to doctor or hospital policies.
Mom speaking up about her desire to try vaginal birth after a C-section can make all the difference. If she doesn’t, there’s a good chance the OB will use a prior C-section as a reason for the next one without every giving mom further options.
8 Birth Defects
There are times when sonograms reveal a problem with the baby. These problems can range from Down syndrome to congenital heart defects and a million other issues in between. These are called birth defects, and they add a whole different level of complication to making sure the baby arrives safely.
While it’s not always necessary for a child with birth defects to be delivered by C-section, most of the time doctors prefer it. For one, it puts less strain on the child, and depending on what problem they have, they may not be able to handle the stress of labor.
C-sections also give doctors a bit more control in these situations.
Instead of having to worry every time the heart rate monitor shows the slightest change during labor because contractions may be having a particularly adverse effect on a baby with special needs, doctors can simply lift the child from the womb and assess the baby’s health without putting the child through labor.
7 Prolapsed Cord
Prolapsed cords are a very rare occurrence, but if this occurs, mom will absolutely be taken in for an emergency C-section to save her child. This is one of those times when we should all be thankful C-sections exist.
Prolapsed cords occur when the umbilical cord that supplies blood to the baby comes out of the cervix before the baby is born. The cord will be visible because it will fall out of mom’s vagina, and this situation is not good.
As contractions continue, the cord will be compressed and slow or stop blood flow to the baby. The cord can also develop a kink that cuts off support to the child, and in prolapsed cord situations, minutes matter.
Moms who have C-sections due to prolapsed cords will not have the conventional set up. There will be no time for normal C-section prep, so mom will be knocked completely out so doctors can start working on her immediately.
This situation is scary but rare, and C-sections come through to save the day in many instances.
6 Certain Diseases And Infections
No one really wants to talk about herpes, especially when they’re pregnant. However, it’s necessary for mom to discuss past genital herpes outbreaks with her OB, and she also needs to be aware that if she has an outbreak of genital herpes when she goes into labor, it’s likely she will have a C-section.
Doctors choose C-sections over vaginal deliveries in these situations to protect the baby. When the child passes through the birth canal, they are exposed to the active herpes outbreak, and they can contract the disease this way. While it’s not guaranteed that they will, most moms and doctors don’t want to run the risk of it happening.
If mom has herpes but does not have an active outbreak at the time of delivery, it’s likely she will be just fine to deliver vaginally. This is just one of those situations where it’s impossible to know what path mom is going to have to take until the birth date arrives.
5 Placenta Problems
The placenta is necessary for a healthy pregnancy and a safe baby, so when there are problems, it can affect everything about mom’s experience. There are two main issues that occur with the placenta that lead to C-sections, though one is more common than the other.
Placenta previa happens when the position of the placenta is not ideal. If the placenta is low in the uterus, it can cover the cervix. This is a problem and can lead to a C-section, though it depends on how much of the cervix is covered. This situation is fairly common, with one in every 200 women experiencing placenta previa.
Placenta abruption is a bit more rare, but it’s serious. Placenta abruption occurs when the placenta separates from the uterine lining while mom is still pregnant. This is not supposed to take place until the baby has been delivered, and if it happens before, oxygen may not be able to get to the baby. Placenta abruptions can lead to emergency C-sections.
4 Uterine Rupture
This one is on the list because it is cause for an immediate C-section, but it is so extremely rare that most women will never deal with it. Uterine rupture is exactly what the name sounds like. In 1 out of every 1500 women, the uterus tears or ruptures.
This can happen during pregnancy or while mom is in labor, but since the uterus is where the baby lives, it is an emergency situation that requires immediate assistance.
Uterine rupture can lead to death for both mom and her baby in a matter of minutes. The baby will have issues with oxygen supply, and mom may hemorrhage after the rupture occurs, so mom will likely be knocked out so her child can be taken from her body quickly.
Yes, this is one of the scariest birthing situations out there, but it is very, very rare. Though the risk of uterine rupture is higher in women who are attempting a VBAC, even then the number of occurrences is low.
Don’t stress about this one. Just know that a mom who had a C-section due to uterine rupture had absolutely no other choice to save her life and the life of her child.
3 Fetal Distress
Labor isn’t just stressful for mom. It is a major event for the baby in the womb, and for some children it can be too much. Plus, there are events that can occur during labor that cause fetal distress and require the baby to be immediately evacuated by C-section.
Babies’ heart rates will fluctuate during labor due to contractions and position changes, but if there is a concern about the heart rate not stabilizing soon enough, a doctor may recommend a C-section as opposed to take any chances.
There may also be times when signs appear that the baby is not getting enough oxygen, an obvious problem that can lead to death. In these cases, an emergency C-section will be performed so baby can come out and breathe in the real world instead of risking it in the womb.
No one knows when fetal distress is going to strike, but when it does, being able to obtain a C-section is a blessing.
2 Cephalopelvic Disproportion
Cephalopelvic disproportion (CPD) is a condition that involves the baby’s head being so large that it can’t fit through the birth canal or mom’s hips being too narrow to allow the baby to pass. Either way, this condition leads to a C-section so mom will not suffer the consequences of obstructed labor.
The problem with CPD diagnosis is it has to be made from outside the womb, and it is often diagnosed incorrectly. When mom goes into prolonged labor or isn’t progressing as expected, doctors may say CPD is the cause and push for a C-section.
In many cases, once the baby arrives mom finds that wasn’t the case.
Since measurements taken by sonograms are not 100% accurate, doctors have to estimate, and this sometime lands mom in an operating room when she shouldn’t be.
True CPD is rare with only one in 250 women dealing with it. However, women with especially narrow hips may have this issue, and pregnancies that go past the due date or pregnancies where the woman has diabetes are at a higher risk for CPD.
1 Gestational Diabetes
Moms who find out they have gestational diabetes and treat it properly may have a perfectly easy vaginal delivery with zero complications. Since almost all pregnant women are tested for gestational diabetes, it’s common for doctors to find it and put mom on a diet that will help her manage it during pregnancy.
Once mom has the baby, gestational diabetes usually goes away on its own.
For moms who don’t know they have diabetes or who don’t treat it, the complications during pregnancy and delivery increase. Because gestational diabetes can cause mom to have a larger baby, she is more likely to require a C-section since her child may be too big to make it through the birth canal.
Premature labor is also more likely for moms with gestational diabetes, and as previously discussed, the earlier a child is born the less likely it is that they will be able to handle the stress of labor.
Mom needs to follow all instructions for dealing with gestational diabetes if she has it. Exercising and eating a reasonable diet may help her avoid a C-section and the longer recovery that comes with it.