Do I Need A Cesarean Section?
A cesarean delivery should be performed when it is safer for the mother or the baby than a vaginal delivery. That can sometimes be determined before labor and a cesarean section will be scheduled. In this case, it is important to be very sure how far along the pregnancy is, so as not to deliver a baby prematurely.
Reasons for a Cesarean Section
Listed below are some of the more common reasons that a cesarean section needs to be performed:
- Previous surgery on the uterus, such as removal of fibroids from deep in the muscle wall of the upper part of the uterus or cesarean section with a high (classical) incision.
- Infectious conditions, such as HIV, large vaginal warts or acute herpes outbreak at the onset of labor; these could otherwise transmit to the baby once he enters the birth canal. Vaginal warts treatments are available to provide fast relief.
- Medical conditions that make labor too great a risk for the mother, such as extremely high blood pressure or severe diabetes.
- The baby is too big for the size of the mother’s pelvis ("cephalopelvic disproportion"). Sometimes this is so obvious that a cesarean delivery is scheduled from the outset; sometimes the decision is made to do a "trial of labor" and see what happens, only resorting to cesarean delivery when the baby appears to be stuck ("failure to progress in labor").
- Having more than one baby - risks are greatly elevated, especially for the second or third baby, as the placenta may detach from the wall of the uterus before all the babies are out.
- The exit is blocked; if a large tumor is located in the lower part of the uterus, it may block passage of the baby through the birth canal. The placenta can cover the cervix and block the exit. This is called placenta previa.
- Malpresentation, such as a breech presentation. Even though many babies can be delivered in the breech position (bottom first), the risk of complications is greatly increased because the head and shoulders are the largest parts of the newborn. Once they’ve stretched the birth canal, the rest follows automatically. When the smaller bottom end comes out first, the head may get trapped and the umbilical cord can be compressed between the baby’s skull and the mother’s pelvic bones. The baby then does not get any oxygen because the placental blood is cut off and the head isn’t yet in the air. The American College of Obstetricians and Gynecologists now recommends that an attempt should be made to turn breech babies in late pregnancy and only deliver them by cesarean section if turning them fails.
- If the mother wants a c-section, she can opt to have one. She may choose this because she had one before and feels as she already has a scar, she doesn’t want to subject her pelvis and vagina to the trauma of labor. The mother may just decide that labor is not for her, in which case she’ll have problems getting her insurance company to pay. Even with a previous cesarean, women and their doctors have been pressured by insurance companies to do a "trial of labor".
Reasons for Cesarean Section During Labor
Sometimes the need for a cesarean section becomes apparent only during labor on a more or less emergency basis.
- Fetal distress. During labor, the baby’s heart rate, including how it responds to contractions, is followed either with a monitor or by auscultation. A non-reassuring fetal heart rate pattern can be a sign that the baby is not receiving enough oxygen. This can occur because the cord is tightly wrapped around the baby’s neck or shoulder, the placenta is separating from the uterine wall or the baby is at risk for a host of other reasons.
- Placental problems. This usually involves the placenta beginning to separate from the uterine wall (placenta abruption). Signs of this are excessive bleeding and fetal distress.
- Labor problems or "failure to progress." About 30% of cesarean deliveries are performed for this reason. The most common reason the baby stops advancing down the birth canal is that the baby does not fit ("cephalo-pelvic disproportion"). If labor is allowed to continue indefinitely, something will eventually give — either the baby will develop fetal distress or the uterus will rupture.
- Rarely, the laboring woman will develop medical problems, such as seizures, that make it unsafe for her to continue with labor.
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