When You Should Have a C-Section… And When You Shouldn’t

With approximately 1.3 million babies in the United States delivered via caesarian section, C-sections are the second most commonly performed surgery in the country, behind only cataract removal procedures. In total, nearly one out of every three U.S. births involves a C-section. And while many of these procedures are medically necessary, it’s an operation that should not be taken lightly. In fact, it’s fair to say that a 33 percent C-section rate is unnecessarily high.

It’s important to remember that a C-section is major surgery, during which a surgeon makes an incision that cuts through the abdominal wall and uterine wall, creating an opening through which the baby is delivered. Vaginal delivery, on the other hand, is much safer, especially for the mother, unless there’s a medical reason for the C-section. There’s a lower risk of infection after a vaginal birth, as well as less pain and a quicker recovery. In fact, most women can walk soon after giving birth vaginally, with six weeks to a full recovery. With a C-section, recovery can take up to eight weeks.

Why Have a C-Section?

The most common reason for a C-section is “failure to progress,” which means that no matter what we do to move your delivery along, it’s stalled. Another common reason is known as “non-reassuring fetal heart tracing,” which means we’re concerned that something may be wrong with the baby based on readings from a monitor of the baby’s heart rate.

Other medical reasons why a woman needs a C-section include:

• Breech presentation, which means the baby would deliver feet or butt first
• Cord presentation or cord prolapse, during which the umbilical cord comes out before the baby
• Placenta previa, a condition where the placenta is in a low position and would come out in front of the baby
• Placental abruption, during which the placenta separates from the mother
• Three or more prior C-sections or a classical C-section
• Having suffered a ruptured uterus

Vaginal Birth After C-Sections

While having a prior C-section means it’s important to be careful during subsequent vaginal deliveries, it doesn’t mean you can never have a vaginal birth. However, some doctors won’t perform a vaginal birth after C-section, or VBAC, so it’s important to discuss your options with your OB-GYN as early as possible. Should you decide to have a VBAC, the safest place to do so is a hospital in case there’s a medical emergency. So, you shouldn’t have a VBAC at home or in a birthing center.

Still, a prior C-section does increase your risk for an abnormal placenta, especially if your placenta is in a low position. If that’s the case, and you’ve had a prior C-section, consult a high-risk doctor to be safe.

One of the best things you can do to decrease your chances of needing a C-section is to avoid being admitted too early, unless you’re experiencing medical issues with the pregnancy. If this is your  first baby, be prepared that labor can sometimes take a few days, so you shouldn’t be admitted to the hospital if you are at three centimeters or less. Prior to reaching five or six centimeters, you are in  latent labor, which can take several hours. People often have an expectation that labor is a fast process, possibly because it’s depicted that way on TV. It’s not, so have patience.

The Birthing Experience at Winnie Palmer Hospital

At Orlando Health Winnie Palmer Hospital for Women & Babies, our labor and delivery nurses are trained to use frequent position changes, following a labor menu. Our anesthesia department can provide you with IV medications, walking epidurals and full epidurals, depending on your preference. And our pediatricians, obstetricians and anesthesiologists are in the hospital 24 hours a day should an emergency arise.

We also are currently working with the Florida Perinatal Quality Collaborative toward the goal of decreasing our C-section rates for first-time moms. We participate in their PROVIDE initiative to promote vaginal birth in first-time mothers who are full-term and carrying only one baby. The objective of PROVIDE is to minimize the number of C-sections performed at under six centimeters for failure to progress.

As always, it’s important to have open communication with your OB-GYN and discuss your wishes and preferences. Your doctor will make sure you understand what’s going on with your pregnancy and your baby so you can make collaborative, informed decisions.