Options: C-Section

What situations can lead to cesarean section?

• Non-urgent health problems: If your doctor or midwife suggests a c-section, chances are you have plenty of time to ask questions and find the information you need to make the decision that is right for you. Even if you are in labor, most situations are not urgent. However, it is important to learn as much as you can before labor so that you are fully prepared in case you do have to make the decision quickly. The most common non-urgent reasons why a cesarean is proposed are discussed below.
• Urgent health problems: Much less commonly, situations may arise that pose an urgent threat to the health or life of the mother or baby. For example, if the mother is bleeding heavily (hemorrhage) or the baby isn't getting enough oxygen, a cesarean is needed. Such urgent situations can occur in pregnancy or while giving birth. This Pregnancy Topic doesn't cover the small proportion of situations when just about everyone would agree that a cesarean section is necessary.
• Non-medical situations: In some cases, your caregiver may propose, or you may be considering, a cesarean section for reasons that have nothing to do with your health or your baby's health in the present pregnancy. In this case, it is important to make an informed decision with full understanding of the risks and benefits involved.

What can affect whether I have a cesarean section or a vaginal birth?

• your choice of caregiver and birth setting
• your access to supportive care during labor, and
• the medical interventions you experience while giving birth.

Why is the c-section rate so high?

• under-use of care that can enhance the natural progress of labor and birth, for example less emphasis on:
  • providing continuous labor support (by a trained or experienced companion)
  • encouraging women to be upright and moving during labor (not on their backs, a position that can slow down labor)
  • ensuring that women are well-rested and well-nourished while giving birth
• side effects of widely used medical interventions: the likelihood of c-section goes up, for example, when:
  • caregivers try to cause labor to start (labor induction)
  • caregivers use continuous electronic fetal monitoring (EFM) to check the baby's heart beats
• the willingness of some caregivers to move to cesarean section before trying measures that may avoid the surgery, for example by:
  • failing to attempt to turn babies in a breech position (buttocks- or feet-first) to a head-first position in late pregnancy with hands-on-belly movements (external version)
  • failing to allow more time for a vaginal birth to occur due to pressures in understaffed hospitals and on busy caregivers
• pressures on caregivers today to practice "defensive medicine," for example:
  • caregivers may feel that performing a cesarean section reduces their risk of being sued or of losing a lawsuit should complications occur
• failure to offer women with a previous cesarean section a choice between VBAC (vaginal birth after cesarean) and repeat c-section:
  • more and more hospitals and caregivers are adopting a 'no-VBAC' policy, and a woman who wants a VBAC may be unable to have one due to these restrictions
• loss of skills or unwillingness to offer vaginal birth to women in some situations, for example:
  • a woman who makes an informed choice to have a vaginal birth with a baby in breech position may have trouble finding a caregiver who is experienced and willing to attend such a birth
  • a woman who is expecting twins may have trouble finding a caregiver who is experienced and willing to attend the vaginal birth of twins
• the perception that a cesarean section, and especially a planned (elective) c-section, is "safe":
  • although cesareans are safer now than before, the surgery still carries a broad range of short- and longer-term risks for mothers and babies
  • although planned cesareans offer some advantages in comparison with unplanned cesareans, the fact remains that surgery - planned or unplanned - poses a series of risks in comparison with vaginal birth.

How does my right to "informed consent" or "informed refusal" relate to these matters?

How can I learn more about my specific situation?

• What is the benefit of a c-section for me or my baby?
• What problems might happen if I continue with my plan for a vaginal birth?
• How likely are those problems if I plan for a vaginal birth?
• Could they still happen if I have a c-section?
• What are the possible harms of a c-section?
• How likely are these possible harms?

What are some non-medical (elective) reasons for cesarean section?

What are some situations where some caregivers may recommend a cesarean section?

How does planned cesarean compare with unplanned cesarean?

How does planned cesarean compare with vaginal birth?

A planned cesarean still involves the risks associated with major surgery. And both planned and unplanned cesareans result in a uterine scar and internal scarring and adhesions. This means women with planned and unplanned cesareans face similar risks in future pregnancies and for problems related to scarring and adhesions at any time

What is the relationship between care during birth and pelvic floor problems? 

More and more research finds that some practices used at the time of pushing increase the likelihood of pelvic floor injury. Many women experience one or more of these during vaginal birth. You can lower your risk by choosing a caregiver and birth setting with low rates of intervention. These practices include:

• cutting an episiotomy
• using vacuum extraction or forceps to help bring the baby out
• having women give birth while lying on their backs
• using caregiver-directed pushing, which is often more forceful than having the woman and her own reflexes guide pushing
• pressing on the woman's abdomen to help move the baby out

Preventing Pelvic Floor Dysfunction is a full Pregnancy Topic on this important issue.

What is it like to have a c-section?

A c-section might happen during labor or before labor starts (scheduled c-section). Unless there is a special situation, the woman will be awake during the surgery. Before the surgery starts, there are many preparations:

• An intravenous (IV) line will be put in the woman’s arm or hand. The IV will be used to deliver fluids as well as medicines to prevent infection and bleeding problems.
• An anesthesiologist will give an injection into her back to deliver spinal or epidural anesthesia, which numbs her belly and legs.
• She will be positioned under the operating light on a firm, narrow bed that is slightly tilted to prevent her from lying flat on her back. Straps that are similar to seat belts will secure her on the bed.
• A catheter will be inserted into her urethra to remove urine. The catheter will stay in place for about one day, and will be removed when the woman can walk on her own to the bathroom.
• Oxygen will be given through a tube that fits into or over the nose.
• Her belly and thighs will be shaved and cleaned with a special soap to reduce infection
• Her belly, legs, and chest will be covered with sterile cloths and a curtain will be raised between her head and her lower body.
• Machines will check her blood pressure and oxygen levels.
• Before the surgery starts, staff will count all of the tools (clamps, scissors, etc.) and other supplies and may introduce themselves and double check the woman’s name and the reason for the surgery. These are safety checks to help prevent errors in the operating room.
  

During the surgery, the woman will have a support person (usually her partner or other family member) next to her on the same side of the curtain. The anesthesiologist will also be on that side of the curtain. After making sure the belly is numb, a doctor and a surgical assistant will begin the surgery. The woman may feel tugging and pulling sensations, especially right before the birth of the baby, but should feel absolutely nothing sharp. (If there is pain or a sharp sensation, the surgery should be stopped immediately so more anesthesia can be given.) It usually takes about 15 minutes from when the surgery begins to when the baby is born. Just before the baby is born, the curtain may be lowered to allow the woman and her support person to watch the baby come out. A nurse will dry and place the baby on a warming table to do a quick check on the baby’s breathing, color, and heart rate.

Once the baby is stable, the baby may be wrapped and brought to the woman to cuddle cheek-to-cheek. Some hospitals will place the baby skin-to-skin on the woman’s chest because early skin-to-skin contact after birth is healthy for babies and women. After the baby is born, the doctors will deliver the placenta, give medications to control bleeding, and stitch the uterus and other muscle and tissue layers. The skin may be closed with stitches or staples. Stitches will dissolve on their own after a couple of weeks. Staples are removed with a special tool either just before the woman goes home from the hospital or at an office visit about 1 week after the birth.

After the surgery is done, the woman is moved to a recovery room for an hour or so to be closely checked for bleeding and other problems. The baby is usually in the recovery room with the mother. This is a good time to have the baby skin-to-skin and begin breastfeeding. After the recovery room, the woman will be moved to a regular postpartum room in the hospital. The spinal anesthesia wears off around this time, and pain medications are then given by IV. The woman cannot eat or drink at first, but will soon be able to have clear liquids like juice or popsicles, then regular food. At this point the IV will be removed and the woman will take pain medication by mouth. Most women stay in the hospital about 3-4 days after a c-section.