Why might I need a c-section?

Q: Why might I need a c-section?

A: Having a c-section means your baby will be lifted out directly from your belly, rather than pushed out from your vagina. A c-section is surgery, and you’ll have two incisions – one in your abdomen and one in your uterus – while you’re under anesthesia.

Some women end up having c-sections after labor has already started, while other women are scheduled for the procedure in advance. In both cases, your doctor has decided that a c-section is necessary to deliver a healthy baby and avoid complications during labor and delivery.

Once labor has begun the ideal outcome is always a vaginal delivery. However, there are times when it becomes clear that this could be risky for mom or baby’s health – and c-section becomes medically necessary. The main reasons this happens are:

• Your labor’s stalling, or your baby’s head is too big to fit through your pelvis (this is called cephalopelvic disproportion): These are the two most common reasons for needing a c-section, and account for about 30 percent of all cesareans.

• Your baby’s distressed: A c-section often becomes necessary if there are issues with the baby’s heart rate or if the baby’s oxygen supply has been disrupted by a prolapsed cord (a condition in which the cord slips down through the cervix ahead of the baby and becomes compressed) or if your placenta starts to separate from the wall of your uterus (a condition called placental abruption).

If your doctor’s scheduled you for a c-section in advance, it’s because of known factors or complications that would make a vaginal delivery too difficult. These can include:

• You've had a cesarean before: While some women who've had cesareans previously can safely undergo a vaginal birth the next time around, nearly 80 percent of scheduled cesareans are repeats. And once you've delivered one baby by c-section, you'll always be offered the option to do so again.

• Your baby's in the breech position: If your baby is feet first (instead of head first) and your doctor can't turn him around, a c-section is usually the safest way for you to deliver.

• You have placenta previa or placental abruption: If your placenta is lying at the bottom of your uterus (instead of at the side or top), it can block your baby's exit from your womb or cause heavy bleeding during delivery. If your placenta has started to separate from the wall of your uterus (a condition called placental abruption), this can cause heavy bleeding and complications for your baby, so c-sections are necessary in both cases.

• You're pregnant with twins or multiples. Though a vaginal birth is possible with twins, most are delivered by c-section, where both babies can be more closely monitored. Triplets or larger groups of multiples are always born via c-section.

Some women may think about scheduling a c-section in advance for other reasons -- like wanting to have an exact plan for when their baby will be born, or because they're worried about the pain of having a vaginal birth, but some experts advise against having the procedure strictly for convenience's sake. For one thing, a c-section is major abdominal surgery, and there's always the risk of complications with anesthesia or post-procedure infections. There's also a long and painful recovery period, which can make you pretty uncomfortable and have a harder time breastfeeding in the first few weeks after your baby's born.—Stacey Stapleton


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