Medical Indications For Planned And Emergency Cesarean Sections

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. 

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

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. 

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 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. 

Read More: Cesarean Delivery Risk Factor

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.

What Causes The Need For An Emergency Cesarean?

Emergency c-sections are cesareans that were not planned in advance. The mother will have gone into labor naturally, after which something caused the need for a c-section. Despite the alarming word "emergency", not all emergency c-sections happen in life and death situations where seconds matter. 

Failure To Progress

Failure to progress, or a stalled labor, is the number one reason for emergency c-sections in the United States. Research shows that 10 percent of first-time moms in the US had a c-section for this reason. That seems like a lot, but what does failure to progress actually mean?

It may be diagnosed at different points in the labor, depending on various factors such as:

• Is the mother having a first or subsequent baby?
• Does the mother have epidural anesthesia?
• Was the labor augmented with Pitocin?
• Did her bag of waters rupture?

The medical team will weight all these factors to come to a decision on whether to advise a c-section. Natural birth proponents describe the "failure to progress" diagnosis as a mere "failure to wait" — or in other words a tendency to be too intervention-happy. While this is certainly the case for some births, failure to progress can indicate an underlying but still undiagnosed problem with the baby, uterus, or the mother's physiology. 

Fetal Distress

Fetal distress is diagnosed when there are signs and symptoms that the baby is not doing well. Those include heart rate irregularities, or an increased or decreased heart rate, lack of fetal movement, and the presence of meconium in the amniotic fluid. 

If your baby shows any of these signs, your healthcare team will be quick to suggest a cesarean section. Continuing natural labor could worsen the baby's condition, while carrying out a c-section immediately means the baby can received adequate assessment and care very soon. 

Other Reasons For An Emergency C-Section

There are numerous rarer complications that result in the need for a cesarean during labor. Cord prolapse is a complication in which the umbilical cord is expelled from the vagina before the baby.

Read More: Vaginal Birth After C-Section - When Is It Safe?

Placental abruption is a situation in which the placenta starts to detach from the uterine wall before the baby is born. This, too, is a very dangerous and potentially fatal situation that calls for an emergency c-section. 

A uterine rupture is a situation in which the uterus ruptures, either with or without immediate symptoms. This is a known complication in vaginal births after c-sections, but they can happen to women who have never had a cesarean section as well. A uterine rupture leads to internal hemorrhage and places both mother and baby at immediate risk.