written by Graham Hutchings, British gynaecologist who works in Delta hospital, Brussels. See www.gyneco-bruxelles.com for more about Graham and his practice.
Reasons for C-section
Although there are some absolute reasons for performing a C-section, often the decision is based on a combination of individual factors that are unique to your situation. It is important that you are involved in the decision and feel comfortable with your choice.
- Conditions of the mother – The woman may have medical conditions that worsen as pregnancy progresses or a condition that will not allow the woman to tolerate labour and vaginal delivery. In addition, there may be problems with the uterus or other pelvic organs, which would prevent a successful vaginal birth (such as a previous caesarean section).
- Conditions of the fetus – The baby may have medical conditions that result in its inability to tolerate the stresses of labor. The baby may also be coming down through the birth canal in an unusual position so that a vaginal birth is not possible.
- Obstructed labour – It is not uncommon that the baby cannot be delivered vaginally because it ‘will not fit’ through the birth canal. This may be due to the baby’s size or the shape / size of the mother’s pelvis. However it is most common that obstructed labour occurs due poor positioning of the baby (a ‘back-to-back’ position). Obstructed labour is difficult or impossible to predict and the most reliable test for the pelvis is labour itself.
- Conditions of the placenta – In some cases, the placenta may be in the way of a vaginal delivery (placenta praevia) or may separate prematurely (placental abruption) which would require cesarean delivery.
For a healthy woman with an uncomplicated first pregnancy her risk of a C-section is around 15%.
Risks of C-section
Although C-section is a very safe procedure when carried out in the developed world, it carries a higher risk than vaginal delivery. There is an increased risk of bleeding, infection, deep vein thrombosis and anaesthetic risks.
In addition, a C-section in one pregnancy leads to specific complications for subsequent pregnancies such as uterine scar rupture or the placenta ‘sticking’ abnormally to the inside of the uterus (placenta accreta).
Fortunately these serious complications are rare but they are increasing in frequency with the increasing C-section rate.
For this reason, doctors try where possible to achieve a vaginal birth.