Helplessness and powerlessness are feelings no one ever wants to experience! Most of us like to have control in our lives which gives us a sense of security. But then do we really have control of anything at all? No, not really... It’s often just an illusion which is time and again rocked by situations around us. This especially happens during a pregnancy. Pregnancy could easily be the most unpredictable lifetime journey for some women.
Labor is the most awaited and yet most dreaded part of it all. Whether it's a natural birth or c-section, every birthing experience is unique for a mother. If mom-to-be has any complications then there could be a c-section waiting. A c-section could be medically necessary, and scheduled at an appropriate time by the obstetrician.
In an elective or medically indicated c-section, there is a risk involved that may cause potential harm to the mother or the baby. It's usually scheduled according to the health condition of the mother and baby. However nowadays, elective c-sections are also being performed by ‘maternal request,’ too. A c-section by maternal request means that medically it is not required, but it's the mother’s choice to opt for surgery.
There could be many reasons for a mother requesting an elective c-section. Common reasons for such requests are her work schedule or maternity leave, or simply the convenience it brings to organize everything meticulously before the baby arrives. If nothing else, waiting for the baby to come is the ultimate surprise, and some people simply don’t like surprises. However, in this article we discuss the scientific rationale that sometimes makes a c-section a safer proposition for both the mother and baby.
15 A Large Baby
A mother shares her story in that out of her 5 babies, who weighed between 9 – 10 lbs. each, two babies suffered from a fractured clavicle due to their big size and they could not pass easily through the birth canal. She too, experienced heavy bleeding due to the big size of the babies.
If the baby’s size is big, the doctor usually leaves the choice to the mother for mode of delivery. There is a risk of birth trauma to the baby, for instance shoulder dyspraxia can occur. So mom's might opt for a forceps' delivery to avoid too much tearing in the perineum.
Another mother of two, shares her story about when she opted for vaginal delivery even after the doctors found out that the baby was big. During labor, the baby got stuck and the doctors had to perform an emergency c-section. In such cases the mother’s bodies get too tired from labor and c-section together, making the recovery slower.
14 Women Of Size
According to obstetricians, many women who have a high BMI who want a natural birth end up with an emergency c-section. The reasons are many - one being that obesity can result in changing the alignment of the pelvis. This may lead to mal-positioning of the baby. There is a high risk of injury to an overweight mother if she chooses a vaginal delivery. For a big woman, natural birth could end with more complications.
In fact, in many hospitals, some obstetricians follow a generic rule of automatic c-section for women with a BMI over 40, and automatic c-section for women with a BMI over 30 plus complications. C-sections in the case of obese women are considered a lot safer than natural birth. If the mother has other health issues such as diabetes or high blood pressure then she should never take the risk of having a natural birth.
High blood pressure may sometimes put the mother and baby at risk during pregnancy and labor. Sometimes, it may also result in pre-term delivery. Some mothers are advised to take bed rest to keep their blood pressure under control so that they can carry the baby to term. If high blood pressure is not identified early it may result in pre-eclampsia, which can be fatal to both mom and baby.
Mismanaged hypertension may result in preterm labor, and may lead to a spike in blood pressure, which isn’t favorable for anyone involved. Natural labor can prove to be dangerous if an epidural is taken. It can cause blood pressure to fall. Therefore, many mothers do not take any chances with the baby so they plan their c-section with the doctor to birth the baby with minimal stress on on themselves or to the baby.
12 Multiple Pregnancies
Statistically, most twin pregnancies end in c-sections even when the mothers plan for a natural birth. There have been numerous cases where the mothers gave birth to the first child vaginally and the second had to come through a c-section. In such a scenario recovery is all the more difficult.
Many doctors believe that c-sections are the best bet in cases of multiples. Some hospitals do standard c-sections in case of twins. In a twin pregnancy, natural birth can be very risky if the position of the second baby is breech. In such a cases, changing the position of the baby is attempted by the doctor after the first twin is born - but this is very painful for mom.
Many moms are also scared by this kind of intervention as the baby may get suffocated with the umbilical cord or get hurt when the doctors try to change the position.
11 A Breech Baby
When a breech baby is delivered vaginally, there is a high risk of fetal mortality, which is 1.6 in every 1000 babies. In the US, the number of c-section deliveries in cases of a breech baby is 87%. Alison G. Cahill, MD at St. Louis School of Medicine at Washington University, says that vaginal deliveries of breech babies hasn’t been taught to an entire generation of OB/GYNs, so they haven't been trained on how to deal with them.
In case of a breech baby, when the baby descends into the birth canal, there is often added pressure on the umbilical cord. It gets squeezed and can deprive the baby of oxygen for a long time. The main danger of a breech baby in a natural delivery is that the head may get trapped in the cervix when it isn't completely dilated yet. Therefore, most doctors strongly recommend a c-section and, usually, mothers also do not want to take any risk.
10 Placental Problems
A low lying placenta can make the last trimester very difficult for some women. Many women experience bleeding due to a low lying placenta. Women who experience a lot of bleeding usually give birth preterm and have to rush for an emergency c-section. If a low lying placenta is diagnosed in a pregnancy and the placenta position is too low, then there is threat to the life of the baby.
In some cases, the placenta is diagnosed as low much later in the pregnancy which may result in further complications. There have been cases where lack of an expert professional during the ultrasound resulted in missing the mild previa and resulted in emergency c-sections before the due date. In case of bleeding, doctors try to keep the baby in the womb until the lungs are fully developed by giving steroids to the mother. In certain cases the low lying placenta also begins to fail slowly. It is very critical to monitor the baby closely in such cases.
9 Mom-To-Be's Age
Statistically, more than 40% of first time moms over 40 go through elective c-sections due to their age. The most common reason is that after 45, the mother is more likely to suffer from other health issues, and recovery time from a natural birth may take longer. Many older women face long labor, which can be extremely tiring, but more than that, it leads to other complications. They mostly receive oxytocin to speed up the labor as they do not have enough strength to deliver the baby.
Also, women in their late 40s accept the offer of planned c-sections made by the obstetrician as some of them worked hard and spent lots of money to conceive. So, they do not want to take any chances with the delivery. Although, women after 45 also find it difficult to recover after a c-section, so some of them just want to feel secure about the baby.
8 History Of Traumatic Vaginal Birth
Natural birth may not be easy for some women. Long labor, excruciating pain and failed epidural could be a few reasons that may make the whole experience extremely unpleasant. A mother who has gone through a traumatic birth experience is likely to choose c-section over natural birth the next time around.
Another reason could be the unsupportive and unsympathetic hospital staff that did not listen to the mother, or coerced her into something that she wasn’t ready for. The feeling of helplessness and no control over her own body may make the mother not want to go through it again. Any serious injury to the mother or the baby during labor can scar the memory forever.
For some women, it may be a very long time to come out of such an experience. If the mother did not heal from the previous experience of natural birth, then elective c-section is a much better idea. It is extremely important for the mother to overcome the past trauma.
7 History Of Miscarriage Or Stillbirth
There have been cases where moms elected for a c-section after experiencing a previous stillbirth. Stillbirth is extremely devastating and leaves the mother's heartbroken. Sometimes the reasons for a stillbirth are unknown as the pregnancy could have been healthy. The mother and medical staff might not have seen any signs of fetal distress during labor. In a subsequent pregnancy, the fear of losing the baby again looms throughout the period of 9 months.
The mother feels anxious in case the baby doesn’t move for some time. It makes all the sense to try and save the baby when someone has already lost one. In such cases, moms may refuse labor induction and choose caesarean. Even the care provider may support the mother’s decision wholeheartedly. Nothing can be more important than the baby coming out alive. Therefore, even in a healthy pregnancy, it makes sense for the mother to choose a c-section for the baby’s sake.
6 Vertical Incision From Previous C-section
Some mothers who had a previous emergency or unavoidable c-section try for a VBAC to experience natural birth subsequently. However, VBAC (Vaginal Birth After C-section) is usually not recommended by obstetricians when the last c-section incision was vertical or T/J-shaped. The reason behind the need for a c-section with a previous vertical scar is that the risk of uterine rupture is as high as 30% in cases of previous vertical incisions.
A vertical incision could have been made by the surgeon in case of preterm birth or extreme emergency cases. In some cases, a low vertical incision is made if the baby is in an awkward position. In certain cases, if the mother is overweight or the baby is large then the doctor may go for a vertical incision. Uterine rupture may be rare, but it is highly fatal as there is literally a very small time window to save the life of the mother and the baby.
5 History Of Uterine Rupture
Women who had suffered uterine rupture or dehiscence in a previous delivery need to undergo a c-section before the onset of labor in the subsequent pregnancies. In these cases, the pregnancy is monitored according to a specific protocol. Usually, the risk of recurrence of a rupture is between 4.8 to 19%. This recurrence is more common in women who had a classical or upper vertical scar.
Therefore, in previous cases of uterine rupture, the c-section is scheduled at 37 or 38 weeks by most doctors. However, some doctors may ask for admission in the hospital one week before the time labor started in the previous delivery. It must be noted that even after a uterine rupture women can have a successful pregnancy and can deliver the baby via c-section without any complications. All of this is possible with an expert doctor monitoring the progress of the pregnancy carefully during the last trimester.
4 Previous Uterine Surgeries
There are women who had other surgeries done on their abdomen or uterus before pregnancy. There could be many reasons for such a surgery. The most common one is to remove uterine fibroids. Even after the removal, there are also chances that fibroids may reappear after some time. A c-section is performed in such cases to avoid any risk of tearing apart the uterus.
In many cases, fibroids are very deep into the uterus which may require deeper cuts. This may leave the uterus at a higher risk of rupturing in subsequent pregnancies. The shorter the gap between the myomectomy and pregnancy, the higher the chances of a c-section. Also, if there was more than one abdominal surgery performed in the past, then the doctors may push for a c-section.
3 Two Or More Previous C-sections
The American Congress of Obstetricians and Gynecologists have changed their stance on VBAC, which now states that a VBAC can be safe for a mother who has a history of one or two previous c-sections. However, in case a mother has a history of more than two c-sections, the doctors urge her to go for a c-section again. The decision to go for a c-section is usually supported by other risk factors, which may lead to complications.
Other risk factors apart from more than two c-sections are a large baby, a vertical or T-shaped scar, the baby being overdue, the baby being breech, or other maternal health issues. In case the mother never went into labor in the previous deliveries, she is more likely to be recommended for a c-section. In case of a condition such as polyhydramnios, the doctor may also suggest a c-section to prevent any serious complications with the placenta.
2 Possible Infections
Around 20 to 25% of healthy women have Group B Strep bacteria present in their vagina, which may lead to a urinary tract infections in some women. If there is any such presence of dangerous bacteria in the vagina then the baby is at risk of catching the infection while passing through the birth canal. The infection could have been transmitted sexually by the partner. The most common form of STI is chlamydia and gonorrhoea.
It could also be a case of herpes outbreak or yeast infection. There are chances that the baby may go blind after catching such an infection. Some babies may have respiratory problems as well. In case the baby catches gonorrhoea, it may result in joint or blood infection, which can be life threatening. Some of the infections are extremely dangerous and pose a serious risk to the baby, and the doctors will not let the mother go for vaginal birth.
1 Abnormal Shape Of Pelvis
Some women are told by their doctors after an internal examination that they have a flat or platypelloid pelvic bone, which may force some women to have a c-section. Along with this there are additional reasons for an elective c-section as it could lead to complications that may increase the risk for mother and baby. In case the baby is large, then there are chances of labor being stalled.
Usually in such cases, if the mother opts to try a vaginal delivery, then there are chances of serious injuries to the mother. The baby may be pushed towards the rectum due to the shape of the pelvis and the perineum could have 3rd or 4th degree tears. It could also result in fracturing or dislocating the tailbone during labor. The shape of the pelvis, along with the position of the baby can make matters worse for the mother during a vaginal delivery.