Reasons for a C-Section: Medical and Elective

One of the first major decisions you’ll make as a mom-to-be is how to deliver your baby.

While a vaginal delivery is considered safest, doctors today are performing cesarean deliveries more often.

A cesarean delivery — also called a C-section — is a common but complicated procedure that poses health risks for mom and baby.

What’s a planned C-section? 

Although cesarean deliveries are common and generally safe, they have more risks than delivering a baby vaginally. For this reason, vaginal births are recommended. But it’s possible to schedule a cesarean delivery in advance for medical reasons.

For example, if your baby is breech and doesn't change position as your due date approaches, your doctor may schedule a cesarean delivery. Additionally, cesarean deliveries are usually scheduled for the medical reasons listed below.

It’s also possible to schedule a cesarean delivery for nonmedical reasons, but this isn’t recommended. A cesarean delivery is major surgery and there's a greater risk for complications, including:

  • blood loss
  • organ damage
  • allergic reaction to anesthesia
  • infections
  • blood clots

Should you schedule an elective C-section?

A scheduled surgery for nonmedical reasons is called an elective cesarean delivery, and your doctor may allow this option. Some women prefer to deliver by surgery because it gives them more control in deciding when their baby is born. It can also reduce some anxiety of waiting for labor to start.

But just because you’re given the option of an elective cesarean delivery doesn’t mean it comes without risks. There are pros to a scheduled cesarean delivery, but there are also cons. Some health insurance plans also will not cover elective cesarean deliveries.

thumbs up Pros of an elective C-section
  • Lower risk of incontinence and sexual dysfunction after the birth of the baby.
  • Lower risk of the baby being deprived of oxygen during delivery.
  • Lower risk of the baby experiencing trauma while passing through the birth canal.
thumbs down Cons of an elective C-section
  • You’re more likely to need a repeat cesarean delivery with future pregnancies.
  • There’s a higher risk of complications with cesarean deliveries.
  • You'll have a longer hospital stay (up to five days) and a longer recovery period.

What are the medical reasons for a C-section?

A cesarean delivery might be scheduled by your doctor in advance of your due date. Or it may become necessary during labor because of an emergency.

Below are some of the most common medical reasons for a cesarean.

Prolonged labor

Prolonged labor — also called “failure to progress” or “stalled labor”— is the reason for nearly one-third of cesareans, according to the Centers for Disease Control and Prevention. It happens when a new mom is in labor for 20 hours or more. Or 14 hours or more for moms who’ve given birth before.

Babies that are too large for the birth canal, slow cervical thinning, and carrying multiples can all prolong labor. In these cases, doctors consider a cesarean to avoid complications.

Abnormal positioning

In order to have a successful vaginal birth, babies should be positioned headfirst near the birth canal.

But babies sometimes flip the script. They can position their feet or butt toward the canal, known as a breech birth, or position their shoulder or side first, known as a transverse birth.

A cesarean may be the safest way to deliver in these cases, especially for women carrying multiple babies.  

Fetal distress

Your doctor may choose to deliver via emergency cesarean if your baby is not getting enough oxygen.

Birth defects

To reduce delivery complications, doctors will choose to deliver babies diagnosed with certain birth defects, like excess fluid in the brain or congenital heart diseases, through a cesarean to reduce delivery complications.

Repeat cesarean

About 90 percent of women who’ve had a cesarean can deliver vaginally for their next birth, according to the American Pregnancy Association. This is known as vaginal birth after cesarean (VBAC).

Moms-to-be should talk with their physician to decide whether a VBAC or repeat cesarean is the best and safest option.

Chronic health condition

Women may deliver via cesarean if they live with certain chronic health conditions like heart disease, high blood pressure, or gestational diabetes. Vaginal delivery with one of these conditions may be dangerous for mom.

Doctors will also suggest a cesarean if the mom-to-be has HIV, genital herpes, or any other infection that could be transferred to the baby through vaginal delivery.

Cord prolapse

When the umbilical cord slips through the cervix before the baby is born, it’s called a cord prolapse. This can lessen blood flow to the baby, putting the baby’s health at risk.

While rare, a cord prolapse is a serious condition that requires an emergency cesarean delivery.

Cephalopelvic disproportion (CPD)

A CPD is when a mom-to-be’s pelvis is too small to deliver the baby vaginally, or if the baby’s head is too large for the birth canal. In either case, the baby can’t pass through the vagina safely.

Placenta issues

Doctors will perform a cesarean when the low-lying placenta partially or completely covers the cervix (placenta previa). A cesarean is also necessary when the placenta separates from the uterine lining, causing the baby to lose oxygen (placenta abruption).

According to the American Pregnancy Association, placenta previa happens to 1 in every 200 pregnant women. About 1 percent of pregnant women experience placental abruption.

Carrying multiples

Carrying multiples can pose different risks during pregnancy. It can cause prolonged labor, which can put mom in distress. One or more babies may also be in an abnormal position. Either way, a cesarean is often the safest route for delivery.

Takeaway

Since pregnancy and birth can be unpredictable at times, moms-to-be should be prepared in case a cesarean delivery is necessary. Giving birth is a beautiful and miraculous thing, and it’s best to be as prepared for the unexpected as possible.

You asked, we answered

  • Why are so many more women today scheduling elective C-sections? Is this a dangerous trend?
  • The trend in elective cesarean deliveries is growing. One study showed that 8 percent of mothers requested an elective cesarean delivery. While popular, this trend can have serious complications, including the risk of blood loss, infection, blood clots, and adverse reactions to anesthesia. It’s important to remember that a cesarean delivery is a major abdominal surgery, and typically has a longer recovery than a vaginal delivery. If you’re thinking about scheduling an elective cesarean delivery, you should talk to your doctor more about the risks and benefits. 

    - Katie Mena, MD