Understanding C-Sections

We don't tend to think of childbirth as dangerous, but it's never been risk free. "Just a relatively short time ago, women and babies died in labor due to infection or prolonged, dysfunctional labor," says Angela King, MD, an ob-gyn in Fort Collins, Colorado. "Thankfully, medicine has improved to where that very rarely happens in the U.S." The option of a c-section is part of that improvement.

If problems arise during labor, your doctor might decide that an emergency c-section (one that's unplanned) would be safer than a vaginal birth. For instance, the baby's oxygen supply might be in jeopardy due to pressure on the umbilical cord. Maybe the fetal monitor signals trouble with the baby's heart rate. Or perhaps the baby just isn't budging, which puts the mother at risk for infection.

When facing a difficult delivery, doctors have traditionally resorted to extracting the baby with forceps or a vacuum. But many younger physicians don't have the same experience with these techniques as previous generations of ob's have, so they consider them to be riskier than surgery.

For another range of reasons, scheduled c-sections are on the rise as well. An ultrasound might show that the baby is breech (bottom first), and efforts to turn her in the womb aren't working. Prior health issues (such as hypertension or diabetes) can also lead to pregnancy complications that require a c-section. And if a woman has had a previous uterine operation, she may opt for surgery to avoid the risk of rupturing her uterus during a vaginal birth.

An increase in multiple births has also inched up the c-section rate, especially for women expecting triplets. "With 40 percent of twins, labor is not a problem, as long as their heads are down," says John P. Elliott, MD, director of maternal fetal medicine at Banner Good Samaritan Medical Center, in Phoenix. When Courtney Hall, of Fort Worth, went into preterm labor at 33 weeks, she welcomed the option of delivering her twins by c-section. "I was glad that it happened that way," she says. "I trusted that it would be okay because doctors perform so many c-sections."

Finally, as c-sections become more common, there's a small but growing trend to choose this form of childbirth. Some women want to avoid the possibility of prolonged labor pain or vaginal tearing. Others like the convenience of scheduling the birth. "I call them designer deliveries," says Dr. Elliott. "A woman will say, 'I'd like to deliver my baby next Tuesday. My mother is flying in.'" So she'll opt either to induce labor (which raises the odds of emergency c-section) or to schedule an elective c-section (one performed without a medical reason). The surgery is generally done at or shortly after 39 weeks' gestation, which is the earliest time sanctioned by the American College of Obstetricians and Gynecologists.

Elective c-sections also give doctors a measure of control. Obstetrics, in general, is unpredictable, and can require that an ob is on call for 24 to 48 hours at the hospital, says Kenneth Johnson, a doctor of osteopathic medicine who practices obstetrics in Fort Lauderdale. A scheduled 25-minute c-section, on the other hand, is more predictable.