Why some women may need a cesarean delivery

All women know of other women, and perhaps themselves, who have delivered a baby by cesarean section or also known as a C-section. There is a good reason why women are familiar with C-sections – they are the second most common surgery performed in the United States with the first most common surgery being cataract removal.  According to National Center for Health Statistics from the Centers for Disease Control and Prevention (CDC), 32% or 1,272,503 babies born in the United States in 2016 were delivered by cesarean.  The number of vaginal deliveries for this same year was 2,703,504.  That’s a lot of babies being born surgically.

A baby born by cesarean is a birth that occurs through an incision in the abdominal wall and uterus rather than the vagina.  Over the past 30 years, there has been a gradual increase in the number of babies delivered by C-section.  Even though C-section deliveries are common and often necessary, at the same time there can be risks to the mother and baby such as infection, hemorrhage, injury to organs, extended hospital stay and recovery time, reaction to medications, and emotional reactions of not being able to have delivered vaginally.  This has led a lot of major medical organizations such as the Society of Maternal Fetal Medicine and the American College of Obstetricians and Gynecologists to question why and what can be done to safely reduce the number of babies born by cesareans.

What are the reasons for Cesarean deliveries?

Reducing the number of C-sections is a worthy goal but what are the reasons why some women may need to deliver her baby by cesarean?  Reasons are numerous as to why a healthcare provider may recommend a cesarean delivery.  Some cesareans are planned in advanced while others are unplanned and are decided upon during labor and delivery when unexpected complications arise.

Here are some of the most common reasons why a woman may require a C-section:

·      Placenta previa – This occurs when the placenta lies low in the uterus and partially or completely is covering the cervix.  One in every 200 pregnant women will have this condition.  If the cervix is completely covered by the placenta, a cesarean will be necessary.  If a marginal placenta previa is diagnosed, a vaginal delivery may be an option.

·      Placental abruption – This is when the placenta separates from the uterine lining that usually occurs in the third trimester.  Only 1% of women will have this occur.

·      Uterine rupture – In approximately 1 in every 1,500 births, the uterus tears during pregnancy or labor which can lead to hemorrhaging in the mother and interferes with the baby’s oxygen supply. 

·      Breech position – Normally, most babies move into delivery position a few weeks prior to birth with the head moving closer to the birth canal.  However, a “breech birth” is when the baby’s buttocks and/or feet are in position to be delivered first – this occurs in approximately 1 out of every 25 full-term births.

·      Cord prolapse – A cord prolapse is when the umbilical cord slips through the cervix, protruding from the vagina before the baby is born.  An emergency cesarean is done since whenever the uterus contracts, it causes pressure on the umbilical cord, diminishing blood flow to the baby.

·      Fetal distress – Lack of adequate amounts of oxygen being delivered to the baby is the most common cause of fetal distress.

·      Failure to progress in labor – If the cervix is not dilated completely or if labor has slowed or stopped or the baby is not in an optimal delivery position, then a C-section will need to be performed.

·      Preeclampsia – This is a condition when a mother has high blood pressure during pregnancy. Having preeclampsia could prevent the placenta from getting the proper amount of blood needed reducing the flow of oxygen to the baby. 

·      Diabetes – If a woman develops gestational diabetes during her pregnancy or she is diabetic at the time of conception, she has a greater chance of delivering a large baby which would increase the chance for having a cesarean.

·      Active genital herpes – If the mother has an active outbreak of genital herpes, a C-section may be scheduled to prevent the baby from being exposed to the virus while passing through the birth canal.

·      Repeat cesarean – Not all women who’ve had one C-section will automatically require another.  Some women may be candidates for a vaginal birth after cesarean or VBAC.  The biggest concern in a VBAC is uterine rupture which happens in 0.2 – 1.5% of VBACs.  A discussion with their healthcare provider will determine what her options may be.