Cesarean Section

During a c-section, the doctor makes a cut in the mother’s abdomen and uterus and removes the baby. So, the baby is delivered through surgery instead of coming out of the vagina. Most women get spinal or epidural anesthesia during a c-section. This allows her to stay awake without feeling pain. But sometimes general anesthesia is needed. With general anesthesia the woman is asleep during the procedure.

A c-section can save the life of a baby or mother. If health problems come up before or during labor and delivery, a c-section can get the baby out very quickly. Most c-sections result in a healthy mother and baby.

Still, a c-section is major surgery. And all surgeries have risks. These include infection, dangerous bleeding, blood transfusions and blood clots. Women who have c-sections stay at the hospital for longer than women who have vaginal births. Plus, recovery from this surgery takes longer and is often more painful than that after a vaginal birth. So, c-sections should only be done when the health or the mother of baby is in danger.

When do Doctors Recommend C-sections?

Doctors recommend c-sections when the health of the baby or mother is in danger. Even so, there are risks of delivering by c-sections. Limited studies show that the benefits of having a c-section may outweigh the risks when:

  • the mother is carrying more than one baby (twins, triplets, etc.)
  • the mother has health problems including HIV infection, herpes infection, and heart disease
  • the mother has dangerously high blood pressure
  • the mother has problems with the shape of her pelvis
  • there are problems with the placenta.
  • there are problems with the umbilical cord
  • there are problems with the position of the baby (e.g. breech presentation)
  • the baby shows signs of distress (e.g. slowed heart rate)
  • the mother has had a previous c-section

Elective C-Sections: Can Women Choose?

A growing number of women are asking their doctors for c-sections when there is no medical reason. Some women want a c-section because they fear the pain of childbirth. Others like the convenience of being able to decide when and how to deliver their baby. Still others fear the risks of vaginal delivery including tearing and sexual problems.

But is it safe and ethical for doctors to allow women to make medical decisions? The answer is unclear. Only more research on both types of deliveries will provide the answer. In the meantime, many obstetricians feel it is their ethical obligation to talk women out of elective c-sections. Others believe that women should be able to choose a c-section if they understand the risks and benefits.

Experts who believe c-sections should only be performed for medical reasons point to the risks. C-sections can be dangerous for the mother and baby. This major surgery increases the risk of infection, bleeding and pain in the mother. C-sections also increase the risk of problems in future pregnancies. Women who have had c-sections have a higher risk of uterine rupture. If the uterus ruptures, the life of the baby and mother is in danger. Babies born by c-section have more breathing problems right after birth and are very rarely cut during the surgery.

Supporters of elective c-sections say that this surgery may protect a woman’s pelvic organs, reduces the risk of bowel and bladder problems, and is as safe for the baby as vaginal delivery. The American College of Obstetricians (ACOG) is not opposed to elective c-sections. ACOG states that “if the physician believes that (cesarean) delivery promotes the overall health and welfare of the woman and her fetus more than vaginal birth, he or she is ethically justified in performing” a c-section.

Can I Try a Vaginal Birth if I’ve had a C-Section (VBAC)?

Some women who have delivered previous babies by c-section would like to have their next baby vaginally. This is called vaginal delivery after c-section or VBAC. Women give many reasons for wanting a VBAC. Some want to avoid the risks and long recovery of surgery. Others want to experience vaginal delivery.

Studies show that VBACs are more risky for the woman and baby than a repeat c-section. The most serious danger of VBACs is the chance that the c-section scar on the uterus will open up during labor and delivery. This is called uterine rupture. While very rare, uterine rupture is very dangerous for the mother and baby. Less than 1 percent of VBACs lead to uterine rupture. Even so, uterine rupture can lead to life-threatening bleeding for the mother and brain damage or even death for the baby.

The biggest and best study on VBACs was published in the New England Journal of Medicine in 2004. The researchers studied more than 30,000 women who had had a c-section and were pregnant again. Some of these women chose to have a VBAC. Others decided on a repeat c-section. The doctors compared the health of the women and babies after both types of delivery.

Almost three-quarters (73%) of women had a successful VBAC. The other 27% of women who tried to deliver vaginally ended up having another c-section. While rare, problems with the woman and baby were more common among VBACs compared with repeat c-sections. Only 0.8 % of women had a uterine rupture. Women who tried VBACs had more blood transfusions and a greater risk of endometriosis than those who had repeat c-sections. Babies born by VBAC had a higher risk of brain damage than those born by repeat c-section.

The percent of VBACs is dropping in the United States for many reasons. Women, doctors and hospitals are worried about the rare, yet possible problems of VBACs. A growing number of doctors and hospitals are banning VBACs. They are afraid of lawsuits that might follow VBACs that go wrong. In 2004 the American College of Obstetricians and Gynecologists recommended that hospitals have a surgical team “immediately available” whenever a woman is having a VBAC. In other words, ACOG suggests that a surgeon, nurses and an anesthesiologist be standing by in case an emergency c-section is needed. Guaranteeing this stand-by team is just too expensive for many hospitals.

Doctors are also discouraging or flat out refusing to perform VBACs. Sometimes this is because their affiliated hospital does not allow them. In other cases, doctors can not get malpractice insurance to cover claims related to VBACs. And some doctors admit they are afraid of getting sued if a VBAC goes wrong.

Choosing to try a VBAC is a difficult decision for many women. If you are interested in a VBAC, talk to your doctor and read up on the subject. Only you and your doctor can decide what is best for you. VBACs and planned c-sections both have their benefits and risks. Learn the pros and cons and be aware of possible problems before you make your decision.

The American College of Obstetricians and Gynecologists (ACOG) recommends that doctors consider VBACS when:

  • a woman has had 1 previous planned c-sections done with a low, horizontal cut or incision (“bikini” incision)
  • a woman has no other uterine scars (aside from the prior c-section) or problems
  • a woman has no known problems with her pelvis
  • a doctor is present during all of labor and delivery and can perform an emergency c-section if needed
  • an anesthesiologist and other members of a surgical team are standing by in case an emergency c-section is needed