A Look Back – Common Cesarean Reasons

I decided to go back and look at some of my old posts and see if my views have changed since then with all I have learned.

So, my first – Common 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 blue, my commentary will be in green, and my new thoughts will be in yellow).

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. I definitely still think this is a necessary cesarean if you truly have Placenta Previa and not just a low lying placenta. There truly is a difference

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. Now, I have learned that there are different kinds of placental abruption. There is partial and there is complete. If it is just a partial separation, you do not need a cesarean if the bleeding stops and the baby is doing okay. A complete is a true medical emergency requiring immediate cesarean.

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. This is a big deal still in my mind. It does need to be caught right away and both the mother and baby can be saved. If you have any symptoms of rupture, call your ob or midwife right away and let them know.

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. In Canada, they no longer will do a cesarean strictly for a breech baby. Which I think is incredible!! Even in some hospitals now in the US they are slowly changing the law from cesarean to vaginal delivery of breech babies. I do not think there is a reason for a cesarean with a breech baby. It is just a variation of normal, not something that is completely abnormal and something to be feared.

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. This mainly happens when your water breaks and there is too much room between the baby’s head and the cervix so the cord can pass between them. Which is why you should not have your water artificially broken. Even if you baby is engaged, there still might be room between the head and the cervix for this to happen. Be aware of any feeling in your vaginal that doesn’t feel right and let your provider know, especially if your water has broken.

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. If there is TRUE fetal distress, changing positions and other things might not change a thing. The best thing to do first is to see if position change will help the heart rate at all first. If not, then a cesarean might truly be necessary if you are not far enough along to speed the delivery for a vaginal delivery. But, do not let them tell you that it is imperative you have a cesarean if they haven’t tried other things first if you baby is not in immediate danger.

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. This is not a reason at all. Labor speeds up and slows down and plateaus and then speeds up again. Your body needs time to rest and gain strength for the next leg of the race. If your labor “stalls”, change positions, walk around, be ACTIVE. Don’t just let them tell you your body can’t labor and give birth. It does know how, better than anyone could possibly know.

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? I still think this is COMPLETELY unnecessary. Every woman should be told she can have a VBAC instead of she can try for a VBAC. Trying implies failure. Can implies that your body knows what to do. There are risks, as there is with labor in general, but the risks are far greater with a repeat cesarean than with a VBAC. Know the facts. Don’t go by one person saying it is unsafe.

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. Most times this goes hand in hand with Failure to Progress. Obviously your baby was too big so you couldn’t dilate. This is SOOOO not the case. Sure, there are babies that cannot be born vaginally, but that is definitely not 30% of the women and babies in this country. Learn your rights to say no, and stay active in your labor. Movement does wonders to position a baby and dilate your cervix.

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? If you do have an outbreak, it is necessary to have a cesarean section. If you do not have an active outbreak, you can have a vaginal delivery safely.

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! If you have uncontrolled diabetes, you could possibly have an 18 pound baby which will definitely require a cesarean. Diet can go a VERY long way in controlling your diabetes. If you have it, talk to your provider about how to control this so your baby will not have problems after birth and will also not grow to be incredibly large. This DOES NOT require an automatic cesarean section.

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. You do need to be under close observation, and if it is controlled and doesn’t get worse, you can have a vaginal delivery. Just make sure to talk to your provider about what it all entails.

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. I do believe sometimes this is the lesser of two evils. A vaginal delivery can complicate a birth defect more than help it. Especially since the baby has to rotate and shift to get out that isn’t needed in a cesarean section. I would talk to your provider about this and your baby’s particular birth defect.

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. I still do not believe that a cesarean for multiples is necessary. As long as they are in a favorable position (pretty much anything but transverse) a vaginal delivery is a great possibility. Make sure to have a provider that is very supportive, and that will help you be able to get into positions that are favorable for delivering multiples. And also make sure to have someone that trusts in the process and knows that twins do not require more interventions than normal.


One Response

  1. Great post! I agree with your assessment. I don't know if you read the "Baby Faith Hope" blog, but her baby had anencephaly, and she had to fight for a c/s which would allow her baby a chance for her short life (the baby most likely would not have survived a vaginal birth, although anything's possible). The docs didn't want to allow a c/s (weird, huh?) because the baby was not going to live a long life anyway, but the mama ended up having a cesarean and her baby lived for 3 months. A good example of when a cesarean is a good thing! That would fall under your birth defects category.Most cesareans I hear about are for FTP/CPD. I think I've only heard of one true case of CPD among my acquaintances, and that was a homebirth transport in which the midwife said "This is really CPD, and we need to go in." It's definitely not as common as is reported!Thanks for a great entry.

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