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Cesarean sections are the most common procedure carried out during labor and birth. Many have criticized the c-section rate in the United States as being far too high, but the rate actually varies greatly from hospital to hospital. Some hospitals have a c-section rate as low as seven percent, while others perform cesareans for a whopping 70 percent of births.
Across the board, the c-section rate in the US stands at around 32 percent. Unnecessary cesareans come with risks to both mothers and babies, but the consequences of not performing a c-section when it was indeed needed can be devastating. Cesareans save lives every day. In what circumstances might you need one?
Medical Reasons For A Scheduled Cesarean
Cesarean sections can be divided into two categories: scheduled cesareans and emergency cesareans. A scheduled c-section is any c-section that was decided upon in advance. Elective (maternal-request) cesareans are probably the most famous in the scheduled c-section category, but most planned cesareans are actually carried out for medical reasons.
In some cases, there is no doubt that the c-section is a true medical necessity. In others, there are both benefits and risks.
Pregnancy after a prior c-section is the prime example of a situation in which both vaginal birth and c-section carry risks. The patient and her medical team have to decide which mode of delivery is preferable in that case. You may have the possibility to make this choice individually, but your hospital's policy may also get a deciding "vote".
Placenta previa is a pregnancy complication in which the placenta covers the cervix partially or completely. Vasa previa is a related complication where fetal vessels are dangerously close to the cervical opening. In all these cases, it is impossible for the fetus to pass through the cervix and birth canal without harm.
Placenta previa and vasa previa both necessitate a planned c-section. To ensure that the placenta does not start to detach and hemorrhage, cesarean sections should be scheduled before a woman has the chance to go into labor by herself.
A Breech Or Transverse Baby
Babies will try out different positions throughout pregnancy, but should settle into a head-down (vertex) position by the time they approach term. The baby's head is its biggest body part. It presses down on the cervix and widens the birth canal as it goes through, making it easy for the rest of the baby's body to be born.
Breech babies are different. They can present either feet-first (footling breech) or bottom-first (frank breech). Though vaginal breech deliveries were very common in previous generations and the only option before c-sections became common practice, breech births do not come without risk.
Head entrapment, in which the baby's head gets stuck after the rest of its body is born, is one of the biggest dangers. Cord prolapse, in which the umbilical cord emerges before the baby, is another risk. This deprives the baby of oxygen and can be fatal.
Vaginal breech deliveries are still a frequent choice in some countries, and a few US-based healthcare providers will also attend such births. Despite that, evidence suggests that a c-section is the safest option for breech babies. Since it does come with some risks for the mother, you'll want to discuss your options with your OBGYN.
A transverse baby presents sideways, and can't be born vaginally. If your baby is transverse, a cesarean is definitely your only option.
More Reasons You Might Have A Planned C-Section
Twins Or Higher Multiples
Research shows that most US twin births are carried out by c-section these days — in 2008 (the most recent year for which data is available) it was 75 percent. That's up from 53 percent in 1995. The increase was not linked to a higher percentage of high-risk twin births either. The c-section rate was over half even in cases where both babies were head-down and there were no other health complications.
The conclusion? Unless other complications are present, personal preference can play a huge role in whether you have a vaginal birth or a c-section. The risk goes up with triplets and higher-order multiples, and it is highly unlikely that these pregnancies will end with a vaginal birth.
A Previous C-Section
A previous c-section is one of the most common reasons mothers have planned cesarean sections, but "once a c-section, always a c-section" isn't necessarily true anymore. Some women who have given birth by cesarean before are perfectly good candidates for a "vaginal birth after c-section" or VBAC for short, while others are not.
Those who have had only one prior c-section, had a low horizontal incision with double suturing, and had the cesarean for reasons unlikely to repeat in the next pregnancy are ideal candidates for VBAC.
Those who had awkward incisions (like a T-shaped incision), more than one c-section behind them, or complications in the current pregnancy are going to be better off with a repeat cesarean.
Any woman who has previously given birth by c-section will be offered — and often encouraged — to have a cesarean again in the US. Ask about the risks and benefits of a repeat c-section as well as a trial of labor in your specific situation if you would prefer to try for a vaginal birth. Looking for a hospital and individual OBGYN that support VBAC in general is going to increase your chances of ending up with a vaginal birth.
Other Medical Problems
Pregnant women who have medical conditions that aren't related to the pregnancy itself may also require a planned c-section. This can be because natural labor and birth would put an unacceptable strain on the woman's health, as with heat disease for example. A c-section might also be advisable if the woman has an infection that could be passed on through vaginal birth. Cesareans are sometimes carried out when the mother is HIV positive, and are always recommended when a woman has a primary outbreak of genital herpes, to name examples.
A cesarean may also be the best option if a woman's pelvis is deemed too small, if she is carrying a large baby, or if the baby has a birth defect that could be complicated by vaginal birth. In some cases, women request a cesarean section for no particular medical reason. This may or may not be covered by your insurance policy.