I'm not here to tell you that you shouldn't have a cesarean section, or that if you had one by choice, you did something wrong, or that if you had one that wasn't by choice, that you were in some way wronged. I'm not here to tell you that there is never a need for a c-section, or that all c-sections are bad, or that I wish c-sections never had to happen.
Indeed, thank G-d we have the medical knowledge to perform a c-section when necessary, because a necessary c-section is a routine, reasonably safe alternative to vaginal birth that can save the lives of both mother and child.
I do, however, believe that c-section is an overused procedure. A c-section is a sometimes-necessary abdominal surgery which requires the doctor to cut through layers of skin, fat, and muscle, rearrange internal organs, cut through the huge muscle that is the uterus, pull the baby out, and then close it all back up. It isn't a simple procedure like the removal of an ingrown toenail or unwanted mole. Major abdominal surgery carries risks to both mother and baby. The most common risk to the mother is post-surgical infection. Other risks for the mother include severe blood loss, reaction to anesthesia, and blood clots. Risks to the baby include lung or breathing problems and birth injury (such as being cut by the scalpel). Risks to the baby of a planned (scheduled) cesarean, as opposed to one that occurs during labor, also include premature delivery, which can carry many complications of its own. It should be noted that a planned cesarean does appear carry fewer risks to the mother than an emergency c-section.
There are also long-term risks of c-section, or multiple c-sections. These include increased risk of future placenta previa (where the placenta is blocking the cervix), future placenta accreta (where the placenta is too deeply attached in the uterine wall), uterine rupture, and risk of future emergency hysterectomy during birth. These risks increase exponentially with each additional c-section.
What Is A Cesarean Section?
A cesarean section is a surgery used to deliver a baby. Rather than a typical birth, during which the baby is pushed through the cervix and vaginal canal in order to leave the mother's body, in a cesarean section, a surgeon cuts through the mother's abdominal wall and into the uterus and removes the baby through this incision, then repairs the incision with sutures.
Here is an excellent photo essay with explanations showing a typical cesarean delivery. (Slightly graphic, although photos are small. If blood or depictions of surgeries disturb you, I don't recommend clicking.)
Basically, the surgeon cuts through the abdomen with a scalpel, makes an incision in the uterine wall, retracts (pulls back) the sides of the incision, suctions out the amniotic fluid, disengages the baby from the pelvis (if necessary), and delivers the baby head-first through the incision. When the head is out, the fluids are suctioned from the baby's mouth and nose to clear the lungs and airway, then the rest of the body is pulled free of the incision, the umbilical cord is cut, the baby is (usually) shown to the mother, then taken to the warmer to be cleaned and examined. The placenta is removed and examined to ensure it is intact. Then the uterus is sutured and the abdominal incision is closed up. The entire procedure typically takes about 45 to 60 minutes, with the first 5 to 10 minutes being delivery of the baby.
Depending on the practices of your particular doctor and hospital, it may be possible to hold your newborn on your chest during the second phase of the surgery, and even breastfeed him or her if desired. This would have to be discussed with the doctor prior to surgery.
When Is A C-Section Necessary?
**This is not a comprehensive list, just a sampling of instances when cesarean section is indicated.**
There are instances when a c-section is medically necessary. In such cases, it is determined that a vaginal delivery carries too much risk to mother and/or baby, and a c-section is a safer way to deliver the baby.
- Placenta previa. This is when the placenta is blocking the cervix. Attempting to deliver vaginally under such a circumstance would cause severe maternal blood loss, often leading to maternal death.
- Prolapsed cord. This is when the umbilical cord precedes the baby through the birth canal.
- Fetal or maternal danger which requires immediate delivery of the baby when induction of labor fails or would be too dangerous. An example of this would be preeclampsia or eclampsia, which is a dangerous rise in maternal blood pressure that can cause seizures or stroke. Eclampsia is often fatal to the mother. If maternal blood pressure fails to come into a safe range within a reasonable amount of time, delivery of the baby immediately is indicated, as delivery of the baby is the only "cure" for preeclampsia/eclampsia. Medical induction may be attempted, but if it fails, cesarean delivery is necessary to protect both mother and baby.
- True fetal distress during labor.
- Abrupted placenta. This is when the placenta detatches from the uterine wall before delivery of the fetus.
- Maternal preference. Some women just don't want to go through labor, so they request to schedule a c-section. This enables them (and their doctors) to know exactly when and how the baby will be born.
- Previous c-section. Many doctors and hospitals do not allow VBAC, so a woman giving birth through a particular care provider may not be offered the option of VBAC. In such a case, she will be advised to schedule a c-section. Alternatively, a woman may feel that the risks of VBAC are not ones she is willing to face and so elects a c-section. Or, perhaps the difficult or traumatic labor which resulted in the previous c-section makes her unwilling to attempt labor again, and planned c-section seems to be a more palatable option for her. Finally, depending on the reason for her previous c-section, she and her doctor may feel that any future labor would also result in c-section, so rather than take the risk of needing an emergency c-section, or of going through labor only to result in a second c-section anyway, she elects a planned c-section. In addition, if a woman has had three or more previous cesarean births, VBAC is considered too risky. Also, VBAC is not considered safe if the previous c-section incision is not the "low transverse" or "bikini" incision.
- Breech presentation. Breech presentation is when the baby is not head down at the end of the pregnancy or when the mother goes into labor. The preferred way to deliver a baby vaginally is head-first. Some babies do not turn around near the end of the pregnancy and present feet-first or buttocks-first at or near the onset of labor. Most OB/GYNs in the United States prefer not to attempt a vaginal delivery of a breech baby, and so they will recommend a scheduled c-section in order to ensure safe delivery of the baby. There are variations of breech presentation that would make vaginal delivery impossible or very dangerous to mother and/or baby, in which case, of course, a c-section is indicated.
- Prolonged labor. Some women may labor for many hours or days. Sometimes this is because labor is not progressing as it should, the cervix is not dilating properly, or despite hours of pushing, the baby does not come down into and through the cervix even after full dilation. These cases are usually labeled "failure to progress," and the doctor or midwife may suggest a c-section to deliver the baby and relieve the mother. It is difficult to know from case-to-case whether a c-section was necessary, because it depends on the reason that labor is not progressing. However, often the mother, doctor, midwife, or other birth attendant can make changes that may help move labor along. I won't get into a long list here, but "failure to progress" is a vague term, and in order to determine whether c-section was medically necessary, one needs to know the reason for the stalled or prolonged labor.
- Twins. It is possible to deliver twins vaginally, although most OB/GYNs and hospitals prefer to deliver twins via c-section. There are additional risks during vaginal delivery of twins that simply do not exist in the delivery of a single baby, so these risks need to be discussed with your doctor.
- Large baby. Sometimes it is estimated that a baby is simply very large and the mother will have a very difficult time delivering him or her vaginally. This is not to say that a vaginal birth is definitely impossible with a large baby (plenty of women have delivered 10+-pound babies vaginally). However, if it looks like your baby is headed into the 10-pound or more range, your doctor may bring up the possibility or probability of scheduling a c-section.