Reasons for Cesarean Delivery - dummies

By Joanne Stone, Keith Eddleman, Mary Duenwald

Your doctor may perform a cesarean delivery for many reasons, but all are about delivering the infant in the safest, healthiest way possible while also maintaining the mother’s well-being. A cesarean delivery can be either planned ahead of labor (elective), unplanned during labor (when the doctor determines that delivering the baby vaginally isn’t safe), or done as an emergency (if the mother’s or the baby’s health is in immediate jeopardy).

If your practitioner feels that you need a cesarean delivery, she will discuss with you why it is needed. If your cesarean is elective or proposed because your labor isn’t progressing normally, you and your partner have time to ask questions.

In cases in which the baby is in a breech position, you and your practitioner may consider together the pros and cons of having either an elective cesarean delivery or a vaginal breech delivery. Both carry some risks, and often your practitioner asks you which risks are most acceptable to you.

If the decision to perform a cesarean is due to a last-minute emergency, the discussion between you and your doctor may happen quickly, while you’re being wheeled to the operating room.

If things seem hurried or rushed when you’re on your way to the operating room for an emergency cesarean, don’t panic. Doctors and nurses are trained to handle these kinds of emergencies.

Your practitioner may suggest that you have a cesarean delivery for one of many different reasons. This list describes the most common ones.

Reasons for elective, or planned, cesarean delivery:

  • The baby is in an abnormal position (breech or transverse).

  • You have placenta previa.

  • You’ve had extensive prior surgery on the uterus, including previous cesarean deliveries or removal of uterine fibroids.

  • You’re delivering triplets or more.

Reasons for unplanned but nonemergency cesarean delivery:

  • The baby is too large in relation to the woman’s pelvis to be delivered safely through the vagina — a condition known as cephalopelvic disproportion(CPD) — or the position of the baby’s head makes vaginal delivery unlikely.

  • Signs indicate that the baby isn’t tolerating labor.

  • Maternal medical conditions preclude safe vaginal delivery, such as severe cardiac disease.

  • Normal labor comes to a standstill.

Reasons for emergency cesarean delivery:

  • Bleeding is excessive.

  • The baby’s umbilical cord pushes through the cervix when the membranes rupture.

  • Prolonged slowing of the baby’s heart rate.

Other than the fact that the baby and placenta are delivered through an incision in the uterus rather than through the vagina, for the baby, there’s not much difference between cesarean and vaginal delivery. Babies delivered by a cesarean before labor usually don’t have cone-shaped heads, but they may if you’re in labor for a long time before having a cesarean.

As the baby is trying to make its way through the vaginal canal, the head often molds, forming a cone-shape as it is squeezing through. Sometimes, the early formation of swelling or leading to a cone-head shape, occurring way before the pushing stage, may be a sign that the baby is not fitting through.

Women who have labored for a long time only to find they need a cesarean delivery are sometimes, understandably, disappointed. This reaction is natural. If it happens to you, keep in mind that what is ultimately most important is your safety and your baby’s safety.

Having a cesarean delivery doesn’t mean that you are a failure in any way or that you didn’t try hard enough. Roughly 20 to 30 percent of women need a cesarean delivery for a variety of reasons. Practitioners stick to basic guidelines when monitoring progress through labor, and those guidelines are all about giving you and your baby the best chance for a normal, healthy outcome.

All surgical procedures involve risks, and cesarean delivery is no exception. Fortunately, these problems aren’t common. The main risks of cesarean delivery are

  • Excessive bleeding, rarely to the point of needing a blood transfusion

  • Development of an infection in the uterus, bladder, or skin incision

  • Injury to the bladder, bowel, or adjacent organs

  • Development of blood clots in the legs or pelvis after the operation