Commons Cesarean Reasons

Since the cesarean percentage is going up every year, and it is considered a major surgery, you have to wonder why.

So, I reasearched the common reason for having a cesarean. (The practice will be in green, my commentary will be in red).

Placenta Previa: This occurs when the placenta lies low in the uterus and partially or completely covers the cervix. 1 in every 200 pregnant women will experience placenta previa during their third trimester. The treatment involves bed rest and frequent monitoring. If a complete or partial placenta previa has been diagnosed, a cesarean is usually necessary. If a marginal placenta previa has been diagnosed, a vaginal delivery may be an option. This is a pretty scary thing. It involves bleeding while you are pregnant, and some people believe they are miscarrying. Once it is diagnosed, they can help you rectify it, but most times it is delivered by cesarean. It is definitely safer to have it by cesarean than to try to push a baby over a placenta, especially when it can come off during the process.

Placental Abruption: This is the separation of the placenta from the uterine lining that usually occurs in the third trimester. Approximately 1% of all pregnant women will experience placental abruption. The mother will experience bleeding from the site of the separation and pain in the uterus. This separation can interfere with oxygen getting to the baby and depending on the severity, an emergency cesarean may be performed. This is if the placenta comes off before the baby comes out. It is dangerous to the baby and cesareans are what keeps these babies alive.

Uterine rupture: In approximately 1 in every 1,500 births the uterus tears during pregnancy or labor. This can lead to hemorrhaging in the mother and interfere with the babies oxygen supply. This is a reason for immediate cesarean. This is a HUGE problem. If it isn’t caught and repaired right away, it can lead to a hysterectomy and death.

Breech Position: When dealing with a breech baby, a cesarean delivery is often the only option, although a vaginal delivery can be done under certain circumstances. However, if the baby is in distress or has cord prolapse (which is more common in breech babies) a cesarean is necessary. A cesarean may also be done if the baby is premature. Tons of breech babies are born vaginally every year. They just stopped teaching how to do it in medical school, since it is “safer” for breech babies to be born by cesarean. If you use the right positions during labor to make you more ‘stretchy’ you can get a breech baby out without a tear. I know that here in Utah, the only hospital that still does breech deliveries is at the University of Utah.

Cord prolapse: This situation does not occur often but when it does an emergency cesarean is done. A cord prolapse is when the umbilical cord slips through the cervix and protrudes from the vagina before the baby is born. When the uterus contracts it causes pressure on the umbilical cord which diminishes the blood flow to the baby. This is also a huge issue. The baby has to be out right away so that it can keep its oxygen level. If it is cut off for too, long it does lead to death or mental retardation.

Fetal distress: The most common cause of fetal distress is lack of oxygen to the baby. If fetal monitoring detects a problem with the amount of oxygen that your baby is receiving, then an emergency cesarean may be performed. When this is correctly diagnosed, a cesarean is the best option. Most doctors say this is what is happening in your labor more often than not to get you to deliver faster, or to take you in for a cesarean section. There are numerous tests they can do to make sure the baby is ok before they jump the gun because your baby’s heart rate slows down a bit during a contraction.

Failure to progress in labor: This can occur when the cervix has not dilated completely, labor has slowed down or stopped, or the baby is not in an optimal delivery position. This can be diagnosed correctly once the women is in the second phase (beyond 5 centimeters dilation), since the first phase of labor (0-4 centimeters dilation) is almost always slow. Once you reach active labor, more than 4 cms, they say you should open 1 cm every hour. Some women open faster, some much slower. Every labor is different. Unless there is a medical emergency to get your baby out, saying everyone dilates 1 cm an hour and then telling them they have to go in for a cesarean because they’re body can’t handle labor is just wrong. Women lose faith in themselves and it ends up as a bad birth experience.

Repeat cesarean: You may be surprised to find out that 90% of women who have had a cesarean are candidates for a vaginal birth after cesarean for their next birth (VBAC). The biggest risk involved in a VBAC is uterine rupture, which happens in 0.2-1.5% of VBACs. However, there is a criteria you must meet in order to have a VBAC. Consult with your health care provider about your current situation and your options. OB/GYNs and Midwives need to stress this more. A cesarean is a major surgery. The first isn’t as big of a deal as subsequent ones. Any number of things can go wrong in 2nd and 3rd cesareans. Most times a bowel is nicked and if it isn’t caught, infections set in and worse things happen. If you can have a VBAC, why would you want to have another surgery?

Cephalopelvic Disproportion (CPD): A true diagnosis of CPD occurs when a baby’s head is too large or a mother pelvis is too small to allow the baby to pass through. If this is truly the case, that’s fine. Most times this is misdiagnosed. When they take your pelvic measurements, they can’t really tell how big you are. It is all an estimation. Most women’s body’s won’t make a baby bigger than they can push out. If you have had rickets or something else that has ruined your pelvic bones or something, then it can happen. But if you body made a baby too big for you to push out regularly, the human race wouldn’t exist.

Active genital herpes: If the mother has an active outbreak of genital herpes (diagnosed by a positive culture or actual lesions), a cesarean may be scheduled to prevent the baby from being exposed to the virus while passing through the birth canal. A cesarean is necessary in this case. If you have an outbreak, would you want your baby to get it? It can be prevented, but would you take the chance?

Diabetes: If you develop gestational diabetes during your pregnancy or are diabetic, you may have a large baby or other complications. This increases your chance of having a cesarean. Large babies are very common in genstational diabetes. Some babies do get stuck and cesareans are performed. But this goes back to the baby won’t be bigger than you can push out. Your body knows what it’s doing!

Preeclampsia: Preeclampsia is a condition of high blood pressure during pregnancy. This condition could prevent the placenta from getting the proper amount of blood needed and decrease oxygen flow to the baby. Delivery is sometimes recommended as a treatment for this condition. Only with severe preeclampsia is a cesarean needed. This is a very severe condition. It isn’t as severe as eclampsia, but it still needs to be addressed. You are monitored closely if you are diagnosed, and most women with preeclampsia deliver vaginally. But there are those rare cases where a cesarean is mandatory to save the baby and mother.

Birth defects: If a baby has been diagnosed with a birth defect, a cesarean may be done to help reduce any further complications during delivery. I don’t agree with this one. Sometimes during deliver things happen. Things go wrong, just like with everything else. I don’t see how doing a cesarean is going to stop a baby from being Down Syndrome.

Multiple births: Twins may be delivered vaginally depending on their positions, estimated weights and gestational age. Multiples of three or more are less likely to be delivered vaginally. I don’t agree with cesareans for multiples. If they are transverse or breech or something, then it is a little better, but if both babies are down, or one is down and the other is breech, a woman does not need to deliver on an operating table with an IV “just in case”. And now in Utah, you can’t have multiples at home, no matter if you are the perfect candidate. They are now classified as “high risk”. And I know they are normally early, and home births can’t occur before week 38 and after week 42, so why did they have to ban it for multiples anyway? It is just another way that they tell you about your pregnancy and the “problems” that “could” arise.


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