Dr. Grayson introduces himself and recalls the typical reasons a woman would have a cesarean section.
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Dr. Robert Grayson: Hi, I am Dr. Robert Grayson. I am an obstetrician here in the East Valley practicing at primarily out of Banner Desert Hospital. I am also one of the Directors of the in-house OB program. So, we are here for emergencies should they occur for pregnant women in labor. What Are The Typical Reasons A Woman Would Undergo A Cesarean Section? Dr. Robert Grayson: Well, there are probably too many reasons for having cesarean section to talk about one setting, but you can probably put them into two general categories. The first category would be causes that are related primarily to the mother, and those would include things like sheer size disparities where the baby is too big to pass through the normal size of the maternal pelvis. The second thing that you would think about, as far as the maternal cause, would be things like prior cesarean section and that’s probably a big evolving one in this day and age in medicine. Once someone has a cesarean section, there’s a growing tendency to have a repeat cesarean section. It’s not mandated that women have a second cesarean section, but there are certain criteria that have to be met in the labor environment for a woman to accept those risks and pursue a trial of labor after cesarean and those include being at a tertiary facility where there is 24-hour availability of obstetricians, anesthesiologists and nursery teams, so that if a consequence or catastrophe occurs, prompt intervention can take place. The other general category for causes for cesarean section would be ones that primarily involve the baby, and the most obvious one is just intolerance of the labor process. So, a baby that just doesn’t do well when it comes time to have contractions, and that can be something that happens very subtly at the early part of the labor and something that you could even reverse and have time to think about and have an alternative plan for delivery, or it could be something that happens catastrophically all at once without any warning. And we see that commonly with cord compression, the umbilical cord being compressed during a contraction that just doesn’t go away, a cord prolapse where the cord gets down in front of the baby’s head and as the baby descends on in the cord, it cuts off its own circulation, or things like placental separation like placental abruption where the placenta kind of comes off the uterine wall all at once, and that can cause very emergent catastrophic cause for cesarean section. Another common fetal cause would be something related to the presentation of the baby. So, most babies like to come down and enter the world head first, but they are not always so cooperative and sometimes they will come down breach or with an arm or a leg or a cord and that’s not conducive to a vaginal delivery. It’s also much more common as we see more and more multiple gestations. So, twins, triplets, things like that. So, that would probably be the second most common cause of fetal causes for cesarean section.